Transcript Paet 1

• Community Mobilization
Seven Strategies to Affect Community Change
1. Provide information
Seminars/workshops
2. Enhance skills
As above
3. Provide support
Enable attendance
4. Enhance access/reduce barriers
May be reversed
5. Change consequences
Reward positive and punish negative behaviors
6. Change physical design
Parks, lighting etc.
7. Modify and change policies
Laws and policies
U. of Kansas Work Group
• Current Trends
Emerging Drug Items Identified in U.S. NFLIS
Tox Labs: 2010 – 1/2 2012
(1/2 2012 incomplete)
SOURCE: U.S. DEA, Office of Diversion Control, NFLIS data, 2012.
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Synthetic Drugs Will Turn You into a
Zombie?
TRAINER’S NAME
TRAINING DATE
TRAINING LOCATION
Synthetic Cannabinoids:
The Major Compounds
a) Naphthoylindoles
b) Cyclohexylphenoles
R1
OH
OH
R3
O
R2
N
JWH-018
JWH-073
JWH-398
JWH-200
JWH-081
JWH-015
JWH-122
JWH-210
JWH-019
JWH-007
AM-2201
JWH-020
JWH-387
AM-1220
JWH-412
5-Fluoropentyl-JWH-122
R1
R2
R3 R
4
CP-47,497-C8
10
SOURCE: Agudelo et al. (2012). Effects of Synthetic Cannabinoids on the Blood Brain Barrier, Presented at 74th Annual CPDD.
Synthetic Cathinones:
“Bath Salts”
•
•
•
•
•
•
Could be MDPV, 4-MMC,
mephedrone, or methylone
Sold on-line with little info on
ingredients, dosage, etc.
Advertised as legal highs, legal meth, cocaine, or ecstasy
Taken orally or by inhaling
Serious side effects include tachycardia, hypertension,
confusion or psychosis, nausea, convulsions
Labeled “not for human consumption” to get around
laws prohibiting sales or possession
SOURCE: Wood & Dargan. (2012). Therapeutic Drug Monitoring, 34, 363-367.
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Designer Drugs
Bath salts
The number of calls to poison centers concerning "bath salts" rose from 304 in
2010 to 6,138 in 2011, according to the American Association of Poison Control
Centers. More than 1,000 calls had been made in 2012 by June. [8]
Synthetic Marijuana
In addition to K2 and Spice, other street names include Black Mamba (Turnera
diffusa), Bombay Blue, Fake Weed, Genie, and Zohai.[9] According to Partnership at
Drugfree.org, other names also include Bliss, Blaze, JWH -018, -073, -250, Yucatan Fire,
Skunk and Moon Rocks.[13]
DXM
What is
? Dextromethorphan is a
psychoactive drug found in common over the counter
cough medicines.
SOURCE: NIDA. (2001). NIDA Research Report Series: Hallucinogens and Dissociative Drugs.
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Pain Management
The Risk-Benefit Framework:
Judge the Treatment, not the
Patient
INAPPROPRIATE
• Is the patient good or bad?
• Does the patient deserve
pain meds?
• Should this patient be
punished or rewarded?
• Should I trust him/her?
APPROPRIATE
Do the benefits of this
treatment outweigh the
untoward effects and
risks in this patient or to
society?
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What Is the Addiction Risk?
• Published rates of abuse and/or addiction in chronic pain
populations are 3-19%1
• Suggests that known risk factors for abuse or addiction in the
general population would be good predictors for problematic
prescription opioid use
– Past cocaine use, history of alcohol or cannabis use2
– Lifetime history of substance use disorder3
– Family history of substance abuse, a history of legal problems and drug
and alcohol abuse4
– Heavy tobacco use5
– History of severe depression or anxiety5
1 Fishbain
et al. Clin J Pain, 1992; 2 Ives et al. BMC Health Services Research, 2006; 3 Reid et al.
JGIM, 2002; 4 Michna el al. JPSM, 2004; 5Akbik H., et al. JPSM, 2006.
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When Are Opioids Indicated?
• Pain is moderate to severe
• Pain has significant impact on function
• Pain has significant impact on quality of life
• Non-opioid pharmacotherapy has been tried and
failed
• Patient agreeable to close monitoring of opioid
use (e.g., pill counts, urine screens)
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Opioid Efficacy in Chronic Pain
• Pain relief modest
– Some statistically significant, others trend toward benefit
– One meta-analysis decrease of 14 points on 100 point scale
• Limited or no functional improvement
• Most literature surveys & uncontrolled case series
• Randomized clinical trials (RCTs) are short duration < 4
months with small sample sizes < 300 pts
• Mostly pharmaceutical-company sponsored
Balantyne JC, Mao, J. N Engl J Med, 2003.
Martell et al. Ann Intern Med, 2007; Eisenberg et al. JAMA, 2005.
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Opioid Dependence vs. Chronic Pain Managed
with Opioids?
The diagnosis of Opioid Dependence requires 3 or more criteria occurring
over 12 months
1.
2.
3.
4.
5.
6.
7.
Tolerance – YES
Withdrawal/physical dependence – YES
Taken in larger amounts or over longer periods – MAYBE
Unsuccessful efforts to cut down or control – MAYBE
Great deal of time spent to obtain substance – MAYBE
Important activities given up or reduced – MAYBE
Continued use despite harm – MAYBE
American Psychiatric Association. DSM IV-TR, 2000.
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• Veterans
FAX
CESAR
November 19, 2012
Vol. 21, Issue 46
A Weekly FAX from the Center for Substance Abuse Research
University
of
Maryland,
College
Park
Alcohol Reported as Primary Substance of Abuse in
62% of Veterans’ Treatment Admissions
There were nearly 58,000 admissions of veterans to substance abuse treatment facilities in 2010, according to the most recent data from
the Treatment Episode Data Set (TEDS). TEDS, a database of treatment admissions to primarily publicly-funded substance abuse
treatment facilities, excludes admissions to Veterans Affairs (VA) facilities. Therefore, the veteran admissions in TEDS represent
veterans who chose to seek substance abuse treatment in a non-VA facility.* While alcohol was most likely to be reported as the primary
substance of abuse among veterans and nonveterans alike, veterans were much more likely than nonveterans to report alcohol as their
primary substance of abuse (62% vs. 42%). Veterans were less likely than nonveterans to report marijuana (7% vs. 15%) or heroin (8%
vs. 16%) as their primary substance of abuse. No other substance besides alcohol was reported by more than 10% of veterans as a
primary substance of abuse, suggesting that use prevention, intervention, and treatment programs for military personnel and veterans
should focus their resources on alcohol.
Primary Substance of Abuse in Treatment Admissions Ages 18 and Older, by Veteran Status, 2010
(N=57,934)
100%
Ve te ra ns
Nonve terans
80%
60%
40%
62%
42%
20%
10% 9%
15%
7%
16%
8%
6%
9%
4%
6%
0%
Alcohol
Coc a ine
Ma rij ua na
He roin
Othe r Opia te s
Me tha m phe ta m ine
Pri m a ry Subs ta nce o f A bus e
*It is possible that veterans receiving treatment from VA treatment facilities may have a different pattern of primary substances of abuse than those found in TEDS.
NOTES: A veteran is defined by TEDS as a person 16 years or over who has served (even for a short time), but is not now serving, on active duty in the US Army,
Navy, Marine Corps, Coast Guard, or Commissioned Corps of the US Public Health Service or National Oceanic and Atmospheric Administration, or who
served as a Merchant Marine seaman during World War II. Persons who served in the National Guard or Military Reserves are classified as veterans only if
they were ever called or ordered to active duty, not counting the 4-6 months for initial training or yearly summer camps.
SOURCES: Adapted by CESAR from Substance Abuse and Mental Health Data Archive (SAMHDA), online analysis of the concatenated1992-2010 Treatment
Episode Data Set (TEDS), based on data received through 10/10/11, conducted 11/14/12 (available online at
http://www.icpsr.umich.edu/icpsrweb/SAMHDA); and
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality, “Half of Substance
Abuse Treatment Admissions among Veterans Aged 21 to 39 Involve Alcohol as the Primary Substance of Abuse,” Data Spotlight, November 8, 2012
(available online at www.samhsa.gov/data/2k12/TEDS2010N/TEDS2010NWeb.pdf).
301-405-9770 (voice) 301-403-8342 (fax) [email protected] www.cesar.umd.edu 
Veterans, PTSD, and Substance Use Disorders
•More than two of ten Veterans with PTSD also have SUD.
•Almost one out of every three Veterans seeking treatment for
SUD also has PTSD.
•In the wars in Iraq and Afghanistan, about one in ten returning
soldiers seen in VA have a problem with alcohol or other drugs.
•New research from the University of Michigan suggests that
veterans battling post-traumatic stress (PTSD) and substance abuse
disorders face a greater risk of death.
•Primary Substance of Abuse in Treatment Admissions Aged 21 to 39,
by Veteran Status: 2010
•60
•Veterans
Nonveterans
•50.7
•50
•Percent
•40
•34.4
•30
•20
•16.8
•1 7.6
•12.2 12.0 12.2
•9.0
•10
•6.2 7.6 6.3 7.2
•0
•Alcohol
•Heroin Other
•Opiates
•Marijuana Meth•Cocaine/
•amphetamine Crack
Where to Go from Here
http://www.healthquality.va.gov/Substance_Use_Disorder_SUD.asp
The guideline describes the critical decision points in
the Management of Substance Use Disorder and
provides clear and comprehensive evidence based
recommendations incorporating current information
and practices for practitioners throughout the DoD
and VA Health Care systems. The guideline is
intended to improve patient outcomes and local
management of patients with substance use
disorder.
The guideline is formatted as five algorithms, with
annotations:
Algorithm A
- Screening and Initial Assessment for Substance Use Disorder
Algorithm B
- Management of SUD in Specialty SUD Care
Algorithm C
- Management of SUD in (Primary) General Healthcare
Algorithm P
- Addiction-Focused Pharmacotherapy
Algorithm S
- Stabilization and Withdrawal Management