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PASSIO - 180306 Trends in Opioid Abuse

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Andrew Yee

on 10 March 2018

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Transcript of PASSIO - 180306 Trends in Opioid Abuse

The Prescription OPIOID EPIDEMIC
Joint Commission on Accreditation of Healthcare Organizations
Centers for Disease Control.
Vital sings: overdoses of prescription opioid pain relievers-United States, 1999-2008. MMWR. 2011;60(43).

Euphorigenic.
Legal, approved by FDA and prescribed by doctors.
Seen as safer than other drugs.
Trustworthy and predictable.
Dosage clearly specified on tablet/pill.
No stigma of a “junkie”.
SOURCE OF DRUGS
Police and Regulatory Agencies
They (
“pill brokers”
) were in our neighborhood one night asking for people with the red, white and blue card, which is the
Medicare/Medicaid card
. And if you had one, they'd sign you up right there. I think they paid them
$50 for signing up
right there on the spot. They also paid them
$80 for the doctor's visit
, and
$200 for the pills
.

STATE OF HEALTH
PREVIOUS SUBSTANCE ABUSE
INITIAL OPIOID EXPOSURE
“Minutes after doing them my first time
I felt like there was not a care in the world to me.
Nothing and no one existed except for me and the amazing high I was feeling….”
“It was like god was petting me.”
Unanticipated
“Benefits"
OPIOID ABUSERS
"Finally relief. Not only for the pain of the broken collar bone but,
most importantly for my mind. I loved the filling of euphoria.
I finally felt comfortable in my own skin. I could talk to anyone I felt what I thought I was supposed to fill like. Extremely happy. I knew I found the secret to my happiness.
Well I was wrong it ruined my life.
"
“They made me feel like
I could talk to people and not be scared or embarrassed
to walk around and just talk and be part of society.”
CONFRONTING THE EPIDEMIC
Yes & No
“Became
easier to find
heroin than good oxys. Also heroin was
cheaper
.”
“Because of the
change in the OxyContin formulation
I tried heroin for the first time. I did that in part because you
couldn’t smoke or snort
the OxyContin pills anymore so I resorted to something you could do that with”


“I heard heroin would
get me higher and was cheaper
and when the Oxys changed so did my choice of drug.”


Heroin is cheaper and stronger
than prescription drugs, and the
supply is typically pretty consistent
. It is also much easier to use intravenously than pills and other prescriptions, which often take more complex methods to break down.”
Evidence of
“Dealers and people around them are
middle class white kids
, not even kids we were all in the age range of 25-41. It just became easy, and we weren’t really looked at as being addicts because
everyone thinks heroin addicts are all homeless, shady looking, dirty junkies
.”
Changing
Over 75% of heroin users in the past few years resided in suburban or rural areas.
first opioid of abuse
1. Cicero TJ, Ellis MS, Surratt HL Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014 July; 71(7):821-6.

2. Cicero TJ, Ellis MS. Abuse deterrent formulations and the prescription opioid abuse epidemic in the United States: lessons learned from OxyContin. JAMA Psychiatry. 2015 Mar 11.

3. Cicero TJ, Ellis MS, Surratt HL. Shifting patterns of prescription opioid and heroin abuse across the United States. N Engl J Med. 2015 Oct 29:373:1789-1790.

4. Cicero TJ, Ellis MS, Kasper ZA. A tale of two ADFs: Differences in the effectiveness of abuse deterrent formulations of oxymorphone and oxycodone extended-release drugs. Pain. 2016 June; 157(6):1232-8.

5. Cicero TJ, Ellis MS, Kasper ZA. Psychoactive substance use prior to the development of iatrogenic opioid abuse: a descriptive analysis of treatment-seeking opioid abusers. Addictive Behaviors. 2016 Aug 15.

6. Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017 November;74:63-66.
Publications
TRENDS IN OPIOID ABUSE
Prescription Abuse and Resurgence of Heroin
Theodore J. Cicero, PhD
DEPARTMENT OF PSYCHIATRY
1980
1990
2000
2010
2020
1. Temperature
2. Pulse
3. Respiratory Rate
4. Blood Pressure
5. Pain
Vital Signs
Increase use of opioids to relieve pain.
RECOMMENDATION
#1
EXtended Release
#2
OXYCODONE
Initially thought to have little abuse potential
Snorting/IV injection became common
Became the most widely abused prescription opioid
THE EPIDEMIC EMERGES
WHY PRESCRIPTION OPIOIDS?
MOST RISKY
LEAST RISKY
Vicodin
PEROCOCET
OxyContin
HEROIN
“I mean…a
doctor prescribes them to you
…can’t be that bad.”
“When you’re on the street, the
person that’s doing heroin is a “junkie.”
If you look at a person that’s doing Percocets they would just say, “Well I just do Percocets.” You know what I mean?
For a long time when I did Percocets and didn’t do dope, I looked at people as if they were junkies, but I wasn’t."
Primary Sources of Prescription Drugs
AGE RELEVANCE
Relevance of Gender
Male
Female
Male
Female
Psychopathology
Anxiety
Depression
Bipolar Disorder
ADD
Drug Use Before Opioid
Coincident Drug and Opioid
Drug Use Only After Opioid
No Other Drug Use
Opioid Misuse
75%
85%
Self-medicate for
Psychiatric-related Issues
"Escape from Life"
Self-report
Self-report
No difference between those who started using a doctor's prescription and those who experimented.
"The escape was from the real pain I had from the back problems, but also it allowed your mind to release and think in comfort, rather than in a stressful way.
I have never been as successful or motivated or feel good as when I was on opioids.
"
SUPPLY-SIDE EFFORTS
Prescription Monitoring Programs (PMPs)
Crackdown on 'Pill Mills'
Physician Education
Abuse-deterrent Formulations (ADFs)
Have they Worked?
Heroin
Oxycodone
Hydrocodone
ISSUES WITH HEROIN
Cost and Availability
Cheaper...
Easier to get...
Easier to inject...
Purer than ever...
WHY HAS HEROIN USE GROWN SO RAPIDLY?
Reduced Stigma
Demographics
PREVIOUS USERS
NEW USERS
Young, minority male living in an urban center.
Older, white male/female living in a suburban/rural area.
HEROIN
DESIGN
Andrew Yee
yeea@wustl.edu
PRESENTER
Theodore J. Cicero
cicerot@wustl.edu
No Financial Disclosures
PERCENT OF RESPONDENTS
PERCENT OF RESPONDENTS
SF36 SCORE
SALES
DEATHS
TREATMENT
AGE
AGE
NORMAL
PRESCRIPTION
(1 - 10 SCORE)
"I was in the arms of god. He was running his fingers through my hair. I was comfortable. I could hear his heartbeat. He brought me closer to him and I felt so comfortable that nothing in the world was going to bother me. No issues were able to get to me. I wouldn't be depressed or anxious anymore."
availability
HEROIN
Full transcript