Part 1
Opening remarks
Fire exits
Cell phones
Paper work for Credit and for Narcan
Website availability of presentations
Intro of dignitaries if present
Order of the day
CASA Report and WHO report
40milllion addicted
80 million risky users at a cost of more than 600 Billion per year
Medication Assisted Treatment
Care Reform and Parity
Community Mobilization
Q&A
Lunch
Current Trends in Substance Use
Pain Management Issues in Treatment Settings
Veteran’s Issues and Substance Use
Q&A
# PM Narcan Training for those interested
CASA Columbia Report
• 40 million Americans addicted
• About 29 million being spent to treat
• 80 million Americans risky users
• No direct funding for this group (except for SBIRT)
From Feb 2012 SAMHSA report
•Admissions aged 15 to 17 most frequently reported marijuana (71.9percent) or
alcohol (17.7 percent) as their primary substance of abuse
•About 14.3 percent of older adolescent admissions reported first using their primary
substance of abuse at age 11 or younger, and over half (56.3 percent) reported first
using their primary substance between the ages of 12 and 14
•Almost one third (32.2 percent) of admissions aged 15 to 17 had been admitted to
treatment at least once prior to their current treatment episode
•Among older adolescent admissions, the most commonly reported principal source
of referral to treatment was the criminal justice system (51.2 percent)
Past Month Illicit Drug Use among Adults
Aged 50 to 59: 2002-2011
8
50 to 59
50 to 54
55 to 59
7
7. 0
6.7
6. 0
Percent Using in Past Month
6
6. 3
5. 7
5. 4
5. 2
4.4+ 4.4+
3.9 +
4
5. 0
4.8
5
3.4 +
3.8 +
3.4 +
3
2.6 +
4.1
6. 3
5. 7
6.0
5. 0
4.6 +
4.3 +
3.1 +
2.7 +
7. 2
4.1
2.4 +
1.9+ 2.0+
2
1
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
PRESCRIPTION PAIN KILLERS
The Centers for Disease Control and
Prevention has classified the misuse of these
powerful painkillers as an epidemic, with 1.3
million emergency room visits in 2010, a
115% increase since 2004. Overdose deaths
on opioid pain relievers surpassed deaths
from heroin and cocaine for the first time in
2008.
•Suffolk County Preventing Misuse of Prescription Opioid Drugs 2012
•.
•2
Nassau County
“Statistics show that 70% of children who abuse prescription
drugs get them from family or friends.”
County Executive Mangano
•“Admissions for alcohol abuse have always represented the largest number of admissions, but
have been steadily decreasing.
•The number of admissions for heroin and prescription drugs as a primary substance of abuse
has increased over the last several years.
• Admissions for opioids alone have increased by 60% between 2007 and 2010.
•Admissions for prescription drugs including Xanax and OxyContin, and other opioids such as
Vicodin and Percocet, have all increased across all the different services in Nassau County.
•There were 747 admissions in 2007, that number increased to 1,356 in 2010, an increase of
82%.
•Admissions for OxyContin alone increased 160% during the same time period.
•Admissions to Crisis Services, which represent the highest level of care in the county, for
OxyContin increased 250% from 80 admissions in 2007 to 281 in 2010.
•Of particular concern is that the number of admissions of young adults in the 19-26 age groups
has significantly increased.
•These admissions place even more importance on prevention efforts aimed towards the
younger population still in middle and high school and to engage parents and communities in
prevention activities.”
Suffolk County Data
•In Suffolk County, deaths involving opiates have risen since
2004.
•The number of deaths in which non-heroin opiates played a
part in the cause of death increased by 70% between 2004 and
2011.
• The incidence of one opiate in particular, oxycodone, more
than tripled between 2004 and 2011.
•Oxycodone appears in nearly one-third of all reports and
fentanyl in nearly one-quarter of the reports.
SILK ROAD As of 2012, annual sales are estimated to be 22 million
US dollars
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Drug Recipes Index
Growing Magic Mushrooms
Growing Marijuana
How to Pass a Drug Test---Detection Times---Methods of
Drug Testing---Drug testing Standards and Accuracy--Note on Commercial Products---Tests to Detect Counter
Measures---Producing Clean Urine---Drug Screens--Doping Samples---Substitution---Stealing Urine---If You
Fail the Test---Who does Drug Testing---Ethics of Drug
Testing
MEDICATION ASSISTED TREATMENT
(MAT)
MAT is the use of medications, in combination
with counseling and behavioral therapies, to
provide a whole-patient approach to the
treatment of substance use disorders.
Potential Benefits
Improve survival
Increase retention in treatment
Decrease illicit opiate use
Decrease hepatitis and HIV seroconversion
Decrease criminal activities
Increase employment
Improve birth outcomes with perinatal addicts
Medications for Alcohol Dependence
Naltrexone (ReVia®,Vivitrol®,Depade®)
Disulfiram (Antabuse®)
Acamprosate Calcium (Campral®
Medications for Opioid Dependence
Methadone
Buprenorphine (Suboxone® Subutex®)
Naltrexone
Other Agents
•
•
•
•
•
BACLOFEN
BUPROPION
VARENICLINE
ONDANSETRON (Zofran)
NALMEFENE
Varenicline and Alcohol
•Alcohol dependence and tobacco dependence are
frequently co-morbid conditions. It has been
reported in rodent studies that varenicline reduced
alcohol intake.
•Ericson (J Pharmacol Exp Ther. 2009; 329(1):225-30)
•Mckee (Biol Psychiatry. 2009; 66(2):185-90)
ONDANSETRON
(Zofran)
Used to treat nausea in chemotherapy patients.
NALMEFENE
•Opioid antagonist similar to naltrexone
•Recent research demonstrated that it may have advantages to
naltrexone because there is:
no risk of liver toxicity,
higher biologic activity than naltrexone
longer acting.
•Dr. Barbara Mason's research showed that patients treated
with nalmefene during a 12-week trial were 2.4 times less
likely to relapse from alcohol than those treated with a placebo
Ibogaine
Ibogaine and its derivatives show promise at
blocking withdrawal symptoms and drug
cravings long enough to provide an opportunity
for extending behavioral treatment, thereby
improving treatment outcomes.
Can LSD cure alcoholism? Trials show 59 per cent of problem
drinkers improve after a single dose.
OLD TREATMENTS
Kudzu root, flower, and leaf are used to make medicine. It has been used in
Chinese medicine since at least 200 BC. As early as 600 AD, it was used to treat
alcoholism
Sensory imagery
Acupuncture
Mindfulness training
New Treatments
Studies focusing on
• gamma-aminobutyric acid receptors
• voltage-gated ion channels
• transcranial magnetic stimulation
• dopamine D3 receptor (D3R)
• α-type peroxisome proliferatoractivated receptors (PPARα) (clofibrate)
Randomized controlled trial of a novel cannabis use intervention
delivered by telephone
Aims
To evaluate the efficacy of a telephone-based intervention
consisting of four sessions of motivational interviewing (MI) and
cognitive behavioral therapy (CBT) designed to assist individuals
to reduce their cannabis use and related problems.
Conclusions
A brief course of motivational interviewing plus cognitive
behavioral therapy delivered by telephone can help to reduce
cannabis dependence and promote abstinence in the short term.
• Legal Action Center