Metropolitan Drug Enforcement Unit
Prescription Drugs / Heroin
2015
 Trends
are constantly changing in the area of drug
abuse…especially with our youth.
 Popularity of drugs change with time.
 Mainstay drugs are getting more potent.
High
Grade Marijuana
Cocaine/Crack Cocaine
Prescription Drugs
Heroin
Club Drugs
Methamphetamine
Ketamine
Alcohol
Where there is one, you will find the other
60
50
40
30
20
10
0
2010
2011
2012
Traffic Deaths
2013
Opiate Deaths
2014
 Ranks
as the second highest threat in our region.
 More
Americans abuse prescription drugs than the
number of Cocaine, hallucinogen, Heroin, and inhalant
abusers combined.
 The
increase in abuse of prescriptions has occurred the
most among younger age groups.
 There
are many reasons kids are abusing prescription
drugs:
• Think the drugs are safe since the are medicine.
• Don’t think the drugs are addictive.
According to a DEA – Milwaukee District Office, 2012
Diverted Pharmaceuticals:
• Oxycodone
Oxycontin most prevalent
• Hydrocodone
• Hydromophone
• Methadone
Each day, 46 people die from an overdose of
prescription painkillers* in the US.
Health care providers wrote 259 million
prescriptions for painkillers in 2012, enough
for every American adult to have a bottle of
pills.
http://www.cdc.gov/vitalsigns/opioid-prescribing/.
More overdose related deaths from prescription
drugs than any illegal street drug.
Health care providers in different parts of the country don't agree on
when to use prescription painkillers and how much to prescribe.
Some of the increased demand for prescription painkillers is from
people who use them non-medically (using drugs without a
prescription or just for the high they cause), sell them, or get them
from multiple prescribers at the same time.
Many states report problems with for-profit, high-volume pain clinics
(so-called "pill mills") that prescribe large quantities of painkillers to
people who don't need them medically.
http://www.cdc.gov/vitalsigns/opioid-prescribing/
Mom and Dad, Grandma, Grandpa, Aunts,
Uncles, friends, friends of friends
are the number #1 dealer to kids!
Theft from medicine cabinet:
49% of teens obtained prescription drugs
from a friend.
20% of parents have given their teen an
un-prescribed drug.
Most people don’t keep track of the number
of pills they have.
STOP Rx ABUSE – Ignorance is NO excuse, by Dr. Raj Arangarasan, National Institute on Drug Abuse, 2013
Prescription
opioid pain medications such as
OxyContin and Vicodin can have effects similar to
heroin.
The
No. 1 sign that someone will use heroin is that he
or she abused prescription painkillers like Vicodin and
Oxycodone.
OxyContin
abusers switch to
Heroin due to the cheaper cost
for the same high.
Pills
can run $1.00 per milligram
so a single pill can cost as much
as $80.00.
A
dose of Heroin is $20.00.
 MONITOR
- Restrict access to prescription drug medicine
cabinets. Lock up the prescription!
 DISPOSE
– Properly dispose (drug collection) expired
medications.
 ENGAGE
- Talk to your kids about the dangers of drug abuse.
 50%
less likely to abuse prescription drugs when teens learn
the risks of drugs from their parents.
STOP Rx ABUSE – Ignorance is NO excuse, by Dr. Raj Arangarasan, National Institute on Drug Abuse, 2013
Brookfield
Menomonee Falls
Mukwonago
Muskego
Oconomowoc
Pewaukee
Waukesha
New Berlin
Delafield
T/Brookfield
V/Hartland
Total
2014
1,303
949
559
351
937
738
1,140
716
125
36
220
7,074 (3.2 Tons)
2013
1,224
1,149
558
663
792
669
1,060
0
0
0
0
6,115
Heroin:
• Most Common Drug
Death
• Record Number of
Overdoses
• The average age at first use
among recent initiates
aged 12 to 49.
• 22.1 years old is the
average age.
Heroin
can be injected, inhaled by snorting or
sniffing, or smoked.
All
three routes of administration deliver the drug to
the brain very rapidly, which contributes to its health
risks and to its high risk for addiction.
Drug-seeking,
no matter the consequences.
 Heroin
users are using a “recreational
mentality”.
 You
can start by smoking or snorting.
Twenty or 30 years ago, Heroin was 6 to
10 percent pure, so if people wanted to
get high, the only choice they had was to
inject it. These days, Heroin is 50 to 60
percent pure, so most users start by
snorting it, then gradually progress to
smoking and injecting it.
 Ultimately
you meet “bad people” or just
“die” without intervention.
 Danger
with Heroin use is
lack of control.
• Heroin can range from
7% to 80% purity.
• This lack of control of
purity can result in “hot
shots” of Heroin.
• Overdose from the “hot
shot” dose because the
purity is too high.
Periods
of extreme euphoria followed by
extreme depression.
Sedated
appearance.
Unkempt
appearance.
Dramatic
weight loss.
Metropolitan Drug Enforcement Unit
262-548-7148
Treatment
It really does work
How Did We Get Here ?
2010: 7 million using psychotherapeutic drugs
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Pain killers – 5.1 million
Stimulants - 1.1 million
Tranquilizers – 2.2 million
Sedatives - 0.4 million
over 80% all detox admission are for IV drug use
Why?
 Misperceptions about their safety. Medications are prescribed by doctors,
many assume its safe to take under any circumstances.
 Increasing environmental availability. Between 1991 and 2010,
prescriptions for stimulants increased from 5 million to nearly 45 million
and for opioid analgesics from about 75.5 million to 209.5 million.
 Varied motives for their use. Underlying reasons include: to get high; to
counter anxiety, pain, or sleep problems; or to enhance cognition. Whatever
the motivation, prescription drug abuse comes with serious risks.
Why?
 Addiction is a medically recognized Brain Disease
 Not a moral failing
 Not related to your relationship with God
 Strong genetic component
Why?
 Many become addicted due to real pain issues and get cut off by
prescribing MD, then turn to street drugs.
 Opiates deplete the body’s supply of endorphins - our natural pain
management system.
 Use to block the pain, then use to avoid withdrawal, and then use
just to feel normal.
 Most users quickly switch to heroin because of the lower price.
Response
 Many local and leading company have made changes
CVS Pharmacy are banning some MD’s.
Milwaukee County E.R.’s agreement
 Treatment providers can go through T19 reviewer and request a
pharmacy history or a “Lock-in”
 Suboxone prescribers must first go through specialized training
and have limits the first few years
Symptoms
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Unexplained financial problems
Scabs, bruises
Relationship / work / school problems
Poor Hygiene
Unclean household
Complaints of constipation, muscle aches
Sedation
Symptoms

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Shallow Breathing, pale / clammy skin
Impaired cognitive function, confusion
Anxiety
Euphoria
Mood swings
Detox
Cold Turkey
- rarely successful on own
2 Medically Monitored,
medicates for W/D symptoms
3 Medically Supervised
-Suboxone
- Short term use in detox
- longer term use, Outpatient
4 Methadone
- requires strong motivation & support
1
Medications for Drug Addiction
 Buprenorphine (Suboxone / Zubsolv)
 Methadone
 Naltrexone / Vivitrol
Suboxone
 Approved for use since 2002
 MD must go through training before able to prescribe, limits on
number of clients
 Mixture of burprenorphine and naloxone
(opiate agonist & antagonist)
One stops withdrawal / cravings and the other prevents euphoria
Suboxone
 Increased ability to treat addicts outpatient allows for continuation
in daily routine
 Stops withdrawal and blocks cravings
 Danger of overdose
 Still requires a taper before stopping
 Comes in single dose packets
 Never should be over 16mg / day
Naltrexone

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Opiate antagonist
Parent drug is Narcan
Blocks cravings & euphoria
Will make you ‘dope sick’ if use street drugs
Also comes in injectable form but may be costly
Works on alcohol too
Must be opiate free for 10 days before use
Can interact with some OTC cold medications
Methadone


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Oldest substitution for opiate addiction
Never intended as a cure / treatment
Requires daily visits for first 4 or 5 months
Infrequent therapy
Very long taper
State Drug Related Deaths
 Wisconsin has exceeded 500 deaths per year, 4 out of
the last 5 years ; 512 for 2010
 From 2002 to 2010, Mortality rate has increased 3.8%
 From 2006 to 2011, newly reported cases of Hepatitis
C have increased 13%
State Drug Related Deaths
2005 to 2010
 Heroin deaths - increased by more than 50%
 Opiates related deaths - increased 33%
 Benzodiazepines - increased 60%
 Cocaine - down over 50%
Treatment
 From 2002 to 2010 the cost to provide treatment has
risen 126% to 287 million dollars
 From 2006 to 2010, the number of people seeking treatment with
public funds, dropped 14%
 From 2002 to 2008, the amount of funds spent by the state on
treatment decreased 12%
92 million to 75 million
Components of Comprehensive Drug
Addiction Treatment
Matching Patients to
Individual Needs
 No single treatment is appropriate for all individuals
 Effective treatment attends to multiple needs of the
individual, not just his/her drug use
 Treatment must address medical, psychological, social,
vocational, and legal problems
Duration of Treatment
 Depends on patient problems/needs
 Less than 90 days is of limited/no effectiveness for
residential/outpatient setting
 A minimum of 12 months is required for methadone
maintenance
 Longer treatment is often indicated
Medical Detoxification
 Detoxification safely manages the physical symptoms of
withdrawal
 Only first stage of addiction treatment
 Alone, does little to change long-term drug use
Motivation to Enter/
Sustain Treatment
 Effective treatment need not be voluntary
 Sanctions/enticements (family, employer, criminal
justice system) can increase treatment entry/retention
 Treatment outcomes are similar for those who enter
treatment under legal pressure vs voluntary
Effectiveness of Treatment
 Goal of treatment is to return to productive functioning
 Treatment reduces crime by 40-60%
 Treatment increases employment prospects by 40%
 Drug treatment is as successful as treatment of diabetes,
asthma, and hypertension
Self-Help and Drug
Addiction Treatment
 Complements and extends treatment efforts
 Most commonly used models include 12-Step (AA, NA)
 Most treatment programs encourage self-help
participation during/after treatment
Cost-Effectiveness of Drug Treatment
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Treatment is less expensive than not treating or incarceration (1 yr
methadone maintenance = $4,700 vs. $18,400 for imprisonment)
Every $1 invested in treatment yields up to $7 in reduced crime-related
costs
Savings can exceed costs by 12:1 when health care costs are included
Reduced interpersonal conflicts
Improved workplace productivity
Fewer drug-related accidents
HIV/AIDS, Hepatitis and Other Infectious Diseases
 Drug treatment is disease prevention
 Drug treatment reduces likelihood of HIV infection by 6 fold in
injecting drug users
 Drug treatment presents opportunities for screening,
counseling, and referral
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