1. Understanding the opioid epidemic
Brown bag lunch series
Framingham public library
March 1, 2019
Kelly Joseph, MS
Over the past decade, opioid misuse has risen to an epidemic level in the United States. Opioid overdose is now the leading cause of death for those under 50, surpassing motor vehicle accidents and firearms.  Massachusetts has been hit particularly hard, and no community has been immune to the devastating consequences of this public health crisis.   This foundational workshop will provide an overview of the opioid epidemic.  Attendees will gain an understanding of the disease of addiction, how opioids work, the local impact, and learn about the important role that individuals have in helping to reduce the risk of substance misuse in their community.

2. Learning objectives Describe the disease of addiction
Explain how opioids work
Recognize the impact of the epidemic
Identify your role in reducing opioid misuse in your community

3. BEFORE WE BEGIN…

4. WHAT IS ADDICTION?

5. ADDICTION IS A BRAIN DISEASE LIKE OTHER DISEASES, ADDICTION
Characterized by:
Compulsive Behavior
Continued abuse of drugs despite negative consequences
Changes in the brain’s structure and function
LIKE OTHER DISEASES, ADDICTION
Changes a person’s biology
If untreated, can last a lifetime
Is preventable
Is treatable

6. The last part of the brain to develop is the prefrontal cortex – controls judgement and decision making
This, in part, explains why teens and young adults may exercise poor judgment and risk taking behaviors
DELAY USE = lower risk of developing
a substance use disorder later in life

7. Substance use disorder
Using more and more to get desired effect
Continued use despite it causing issues with work/family
Giving up activities/responsibilities due to substance use
Inability to cut down/stop
Dangerous use
Cravings and urges to use
Withdrawal symptoms
(Mild, Moderate, Severe)

9. QUESTIONS?

10. Respiratory Depressants:
What are opioids?
Painkillers:
Drugs that act on the nervous system to relieve pain. Attach/ activate opioid receptors in the brain, spinal cord, and digestive tract to block pain and boost pleasure
Respiratory Depressants:
Slow down the nervous system and make it difficult to breathe

11. Types of opioids - Morphine - Codeine - Methadone - Fentanyl
NATURAL: derived from the opium poppy plant
- Morphine
- Codeine
SEMI SYNTHETIC: created in labs from natural opiate
- Heroin
- Oxycodone
- Hydrocodone
SYNTHETIC: Completely man-made
- Methadone
- Fentanyl

12. Hydrocodone (Vicodin) Hydromorphone Methadone Morphine
Commonly Used Opioids
Codeine
Fentanyl
Heroin
Hydrocodone (Vicodin)
Hydromorphone
Methadone
Morphine
Oxycodone (OxyContin)
Percocet

13. opioid receptors
opioid

14. CANNOT BE WOKEN / NO RESPONSE TO STIMULI LIMP OR HEAVY LIMBS
SLOW OR ABSENT BREATHING
CANNOT BE WOKEN / NO RESPONSE TO STIMULI
LIMP OR HEAVY LIMBS
COLD CLAMMY SKIN / BLUE LIPS OR FINGERNAILS
LOUD GURGLING OR SNORING SOUNDS
PINPOINT PUPILS
Opioid overdoses is essentially a respiratory emergency , so the first sign that you’re going to observe is dangerously slow breathing, or someone who isn’t breathing at all
Pinpoint pupils is unique to narcotic opioid use

15. Opioid Reversal – Naloxone (Narca

16. Opioid Reversal – Naloxone
Medication that reverse the effects of an OPIOID overdose
SAFE – no potential for abuse or overdose
LEGAL to carry in Massachusetts
Can work in 1-3 mins
Lasts for mins
Naloxone

17. RESTORES BREATHING

18. QUESTIONS?

19. Stark Statistics
From 2000 to 2016, fatal opioid overdoses in Massachusetts increased __%
Economic costs associated with substance use have been estimated to be as high as $___ billion annually
In 2012, doctors in the U.S. wrote ___ million prescriptions for opioid painkillers
More than __million Americans currently meet the criteria for an opioid use disorder
In Massachusetts Fentanyl was present in __% of deaths in 2017
__% of heroin users reported using prescription opioids prior to heroin 
__% of MA residents know someone who is addicted to opioids
453
700
259 2 81 80 56

22. What Can I Do…?

23. What you can do AT HOME MANAGE MEDICATIONS PREVENTION
Understand your risk by learning about any family history of SUD
Ask prescribers about their policies regarding prescribing opioids and any non-opioid alternatives they recommend for effectively managing pain
Ask PCP’s about whether they are trained to treat people with addiction
Store medications in a spot where they cannot be accessed by children, teenagers, or family members with histories of SUD
Dispose of opioids & other medications that you are not using (Framingham Police Department)
Teach your children that they should only take medication that has been prescribed to them
Monitor medications that your teen may be using to relieve headaches, pain or soreness from sports, or minor colds

24. What you can do IN YOUR COMMUNITY
DONATE
BECOME TRAINED TO USE NARCAN
LEAD BY EXAMPLE
Consider raising money or collecting gifts for local treatment organizations and sober homes. Reminding those who are struggling that there are folks who are rooting for them can send a powerful message to them that they are valued and give them the boost they need to continue working at their recovery
Model non-stigmatizing language
Intervene and help correct people when you hear or see insensitive language being used
The Framingham Health Department offers free, anonymous training on how to recognize an opioid overdose and administer narcan

26. Language matters Person with a substance use disorder
Person with an alcohol use disorder
Person in recovery
Negative / Positive
Abstinent
Substance use disorder
Addict, Junkie, Druggie, Crackhead
Alcoholic, Drunk
Ex-addict
Clean / Dirty (for drug test results)
Clean (to describe a person)
Drug habit

27. QUESTIONS?

28. want to learn more... Dreamland – Sam Quinones
The Big Fix – Tracey Helton Mitchell
Pain Killer – Barry Meier
Dopesick – Beth Macy
Drug Dealer, MD – Anna Lembke

29. References Massachusetts Department of Public Health CDC SAMHSA NIDA
ASAM
NIH
JRI Rise
The Harm Reduction Coalition
Shatterproof
National Vital Statistics

30. Thank you! Kelly Joseph, MS Program Coordinator City of Framinghamw: