Transcript Prescription Pain Medicine (Opioids) and Heroin

Overdose Lifeline, Inc. is an Indiana
non-profit dedicated to helping
individuals, families and communities
affected by the disease of addiction.
overdose-lifeline.org
Contact information
Kourtnaye Sturgeon, 317-409-7256, [email protected]
overdose-lifeline.com/education
Prescription Pain Medicine (Opioids) and Heroin
Prevention Education Program
​Copyright 2015 Overdose Lifeline, Inc. All rights reserved.
About the prevention education program
An efficacy-based, turn-key program that can be rolled out anywhere in the U.S.
• Designed to prevent the first use
• Targeting students grades 6 – 12, adaptable for families, adults and other groups
• Flexible, fits to classroom and assembly/convocation settings
• Built for 45-minute time block, can expand for longer time periods
• Currently undergoing evidence-based review with Indiana University - Purdue
University
• Available for licensing: Presenter training and support for those wishing to
deploy the program within their community or state
Educational program pilot period
January – May 2015, Overdose Lifeline, Inc. partnered with
Indianapolis Metro Police Department (IMPD) to deliver the
Education and Prevention program across 5 Indianapolis area
high schools, reaching more than 1900 students.
• Collecting feedback from educators and students
• Modifying the program based upon pilot experience
Program data and evidence-based study
The “This is (Not) About Drugs” educational program is currently
undergoing evidence-based review with Indiana University - Purdue
University with classroom observations/surveying launching in Fall 2016.
In the interim the student worksheet data analysis shows program
produced significant attitudinal changes in the student audience.
Summary: 246 students were given the pre test prior to the training and
were again measured using the same test after receiving the training
(post test). For the pre test a mean score of 15.5 was found and for the
post test a mean score of 21.4 was found, indicating an average
improvement in the scoring of 5.9.
Educational program objectives / outcomes
After completing the lesson, students will know and understand
1. Drug use can lead to heroin use, addiction, overdose, and death
2. The risks of heroin and prescription pain drug misuse
3. The impact of heroin, drugs and alcohol on the individual and the
family and friends
4. Alternatives to using heroin, drugs, and alcohol
5. The many ways to ask for help and available information and
resources
Most important message
• Prescription Pain Pills = Heroin, they are Opioids
• They are highly addictive. When you use opioids and heroin,
you lose your ability to choose
• You can become addicted and you can overdose with just 1
use, with the 2nd, the 3rd , etc.
• Heroin and prescription pills are rarely the starting point First is marijuana, alcohol and other drugs
Educational program package
The lesson plan and program materials are mapped to the program
objectives and designed to provide the student with the opportunity to
learn through a guided and practical exercise -- deepening the students
understanding and retention.
Lesson Plan,
Presenter Training
and Support
Pre-Lesson
Assessment
Films
Discussion
with
Companion
PowerPoint
Post-Lesson
Assessment
After the
Lesson
Takeaway
and Website
Survey Data
Student and
School
Lesson plan, background, training & support
• The Lesson Plan provides an outline and presenter script to follow from
the lesson start (“Introduce the lesson”) through the lesson completion
• Discussion Guide contains information regarding addiction, prescription
pain pills and heroin that the presenter may wish to incorporate into the
lesson
• Presenter Resource Center on overdose-lifeline.org for on-demand
recorded training and mock presentation
• On-going presenter support and updates from Overdose Lifeline
Pre- and post-lesson assessment
“This is (Not) About Drugs” Worksheet
The student worksheet ”Before the Lesson” activity
captures the student’s established perception and opinion.
The statements model the lesson objectives, using
terminology from the film to help with the students
retention and acquisition of the information.
The student worksheet “After the Lesson" activity asks the
student to re-assess the same statement after they have
benefited from the film and the discussion.
The survey questions provides Overdose Lifeline feedback
to help improve the lesson for future groups.
An online version of the worksheet is available – phone,
tablet, computer/laptop – requiring internet access.
Do Not Write Your Name
on the Worksheet
The films
Option 1: Pull the films into the lesson
companion PowerPoint through YouTube.
This options requires that you have access
to the internet for the presentation.
Option 2: Runs from a flash drive that
pulls the films into the lesson companion
PowerPoint from the film files that reside
on the flash drive.
Discussion
The discussion portion of the lesson allows students to express their
opinion/feelings about what they just watched and the presenter to guide
the discussion.
Presenter support available:
• Companion PowerPoint with presenter notes
• Mock Presentation in the Presenter Resource Center
• Discussion Guide
Student takeaway and website
A takeaway flyer (or post card or wallet card) and a
companion website containing the film, more
information, and resources is available to support the
student after the lesson.
Overdose-Lifeline.org/AfterTheLesson
Student takeaway options
2-Sided Postcard (6X4)
Flyer – Available for download (8.5X11)
and local printing in black and white or
color.
Wallet Card. Back: Common (Four most important messages). Front”
Eight versions containing the “After the Lesson” website url and
students from the film.
Postcard and Wallet Card source files available upon request for local printing. As well,
inquire re: having your order added to ODL’s to take advantage of bulk printing rates.
Flyer and Post Cards can be customized to include local resources from your community.
Survey Data and Analysis
• Student Worksheet (Pre- and Post-Assessment)
• Preferred: Online version via student cell phone, tablet, or laptop
• https://www.surveymonkey.com/r/PRESENTER-TRAINING
• Paper version. ODL can offer tabulation assistance
• School Contacts / Administration “After the Lesson” Survey
• https://overdose-lifeline.formstack.com/forms/lesson_evaluation
• Presenter Feedback
Feedback
South Vermillion High School Principal Don Harman believes the work of Overdose Lifeline is vital. “I would encourage
every high school principal to contact them and have them speak to your student body. To me, that right there – every
high school and I hate to say this, some middle schools – that message needs to get out there."
“The best kind of drug case is the case that we don’t have because somebody makes the choice to not use. And if
people, young people especially, that may not have had a lot of information about narcotics - specifically heroin and
addiction - if they have more information, then it will increase the possibility that they’re going to make good
decisions, not bad decisions.”
-- Brent Eaton, Hancock County Prosecutor
“Indiana Students Against Destructive Decisions (SADD) sees the unique value in this educational program, as
Overdose Lifeline works with law enforcement to deliver a message that must be shared with young people in the
Indianapolis area. Programs like this have great potential to create positive change in our communities.”
-- Jamie Vickery, State Coordinator Indiana SADD
"I appreciate Overdose Lifeline, Inc. for coming out to our high school to present this lesson on heroin prevention. Heroin
use has become an epidemic in our state and it's vital that our young people become aware of what could potentially
happen to them if they experiment with heroin or opioids." -- Jeff Wright, Indiana High School, Health Teacher
Students “what did you learn”
“Don’t do any kind of drugs because you will probably
end up somewhere where you never thought you
would be.”
“I learned that no matter how confidant you are that
you won't get addicted to a drug after taking one
dose, you can easily come addicted and its not within
your control. Even trying drugs that aren't as
powerful, will lead to more dangerous drugs that can
severely affect your life.”
“I learned that people normally do other drugs before
doing heroin or prescription pain medicine. It is sort
of like a ladder.”
“Prescription drugs and heroin are the same type of
drug and are equally dangerous. Both are opioids,
and both have the potential to end your life.”
“I learned that drugs can really mess up someone's
life. More than anyone thinks in the first place, but
listening to someone describe how hard it was to get
through hit me in ways that are indescribable.”
“I learned that drugs are never the right path to go
down and that you should always stay away from
them. Always keep good positive people in your life to
make you a better person so you don't go down the
wrong path.”
“That practically any drug out there could really screw
up your plans for life. If I want to do big things, I can't
let something stupid like a little pill effect my grades,
my goals, and my friendships/relationships. “
Terms of use and fees
•
•
•
•
•
Register with ODL and agree to receive email re: program news and updates
Complete required live, web-based training course and coaching ($150/individual)
Pay usage fee (starting at $250, based upon county population)
You may not charge schools for the program, you may accept donations
Do not alter or edit the program materials in any manner without prior written
authorization from Overdose Lifeline
• Maintain, “brought to you by Overdose Lifeline, Inc.” notice and logo marks on
program materials and communications
• Presentation Reporting:
• Record scheduled presentations via ODL online web form
• Let schools know to expect an email from ODL with invitation to complete the “After the Lesson
Survey”
• As presenter, provide feedback regarding your experience with program and materials via ODL
Additional Services
• Customization of "After the Lesson" student post-card for local printing: $50
• Data entry, tabulation and reporting of student worksheet to meet grant
requirements
• <200 worksheets = $200
• 201-500 worksheets = $250
• 501 - 750 worksheets = $300
• 751-1000 worksheets = $350
Discussion Guide
• Helpful Notes for the Presenter
• Heroin and Prescription Pain Medicine (Opioids) Facts
• Impact on the Body/Brain
• Addiction
• Two Stages of Withdrawal
• Overdose/Poisoning
PART 2
Helpful notes for the presenter
• Build a rapport with the students before you start the session.
• Example: Tell a joke or personal story so the students don’t see the presenter as a
separate “expert”
• Establish common ground, but don’t fabricate a personal story.
• While the film is playing, sit with the students – be a part of their
community.
• Bring candy and hand out to encourage questions and participation in the
discussion.
• Communicate that this is about saving lives – the information that will be
shared can help save their own lives and the lives of others – ask the
student to share what they have learned with others.
Helpful notes for the presenter, continued
• Be sure not to create a stigma surrounding addiction. Explain that
addiction is not due to a of lack of willpower. Nor is it a mental illness.
Addiction is a chronic brain disease -- that can be compared to other
chronic diseases like diabetes. Chronic diseases don't really go away
but a person can recover with regular care and attention, maybe
medicine, to avoid getting worse or dying.
• A person does not choose to become an addict, the person's body
responds differently when exposed to alcohol and drugs.
• Being addicted to alcohol or drugs does not make a person flawed
or wrong. They just need help and regular care and attention.
Helpful notes for the presenter, continued
• Ask the students if they have been affected by drugs and addiction
through family or friend, presenter raise their hand too – also creates
common ground.
• During the discussion ask the students by a show of hands, how many
knew that heroin and prescription pain medicine were the same thing
before the film.
• Usually ¼ or fewer know this connection before the lesson, stress that this is
really important information and one of the main reasons that you are there
with them today. Ask them to share this with others to help others avoid the
life threatening risks of heroin.
• Make sure to communicate that prescription pain medications are
needed and useful when properly taken and monitored by a doctor.
Helpful notes for the presenter, continued
• Use open ended questions and encourage participation whenever possible.
Example of closed-ended question
“Did you feel sad for the people who shared their stories in the film?”
Example of open-ended question
“What are some words that come to mind when you think about the people who
shared their stories in the film?”
• When presenting within a school environment ask the school in advance if
they want to refer students with additional questions to the school
counselor, nurse, health teacher, etc.
• Consider inviting a “guest speaker” from the recovery community to share
their story and experience.
• Ask them to familiarize themselves with the 4 “Most Important Messages” and
integrate into their story (if applicable)
• Establish requirements: 2+ years in recovery. Abstaining from all chemicals. Working a
program.
Heroin & prescription pain medicine (opioids) facts
• Heroin and Prescription Pain Medicine are the same thing, both fall within
the Opioids class of drugs.
• Opioids are highly addictive, dangerous and leading cause of death in U.S.
• Overdose can occur on the 1st, 2nd, 3rd, etc. use – one cannot control when
an overdose will occur.
• When one chooses to take an opioid drug, ones choice to continue to use or
stop is taken away from them as the chemistry of the drug takes over ones
body, central nervous system and brain mechanism
• Opioids are highly addictive, when no longer available, severe withdrawal
occurs
• Initial Opioid withdrawal lasts for 7 days to 2 months, Post-AcuteWithdrawal (PAW) continues for approximately 2 years with risk of relapse
high during PAW episodes
A brief history of opiates/opioids
Derived from the Opium Poppy
Plant
• Has legitimate medical use
• High potential for addiction
and abuse and overdose
36 million abuse opioids
worldwide
Sources: SAMSHA 2014 National Survey on Drug Use and Health and the World Drug Report 2015
Overdose 2014 trends
Types of opioids
Prescription Pain Medicine = Heroin, they are Opioids.
Highly Addictive. High Risk of Overdose and Death.
CDC 2014 overdose death rate
Prescription pain medicine
46
Each day, 46 people die from an overdose of prescription
pain medicine in the US.
259M
Health care providers wrote 259 million prescriptions
for pain medicine in 2012, enough for every American
adult to have a bottle of pills.
4X
There has not been an overall change in the amount of pain
that Americans report, yet the amount of prescription
painkillers dispensed in the U.S. quadrupled since 1999.
Source: CDC Vital Signs Statistics, July 2014
Source: National Survey on Drug Use and Health (NSDUH 2011-2013)
Age and the risk factors
There are two main factors
that lead to substance use
disorders/addiction – early
onset of use and biologic
factors.
Signs and symptoms of opioid or heroin use
PHYSICAL
BEHAVIORAL
PARAPHENALIA
Small (constricted) pupils
Changes in friends/grades/activities
Burned and missing spoons
Shallow or slow breathing, Slow
pulse rate/heart rate
Changes in appetite or sleep patterns
Small pieces of foil that have burn
marks (including gum wrappers)
Analgesia (feeling no pain)
Changes in weight
Small tubes or cut straws
Sedation
Deterioration of physical
appearance/personal grooming habits
Needles, small colored balloons (used
to package and transport heroin)
Euphoria (feeling high)
Confusion or poor judgement
Nausea, vomiting
Missing money and items (pawned)
Itching or flushed skin
Constipation
Slurred speech
Poor coordination
Covering arms - wearing long sleeves
Addiction is a chronic, progressive,
relapsing brain disease
It is considered a brain disease because drugs change the brain—they
change its structure and how it works.
Addiction is a lot like other diseases, such as heart disease or diabetes.
Both disrupt the normal, healthy functioning of the underlying organ,
have serious harmful consequences, and are preventable and treatable,
but if left untreated, can last a lifetime, can progress to death.
Chronic diseases don't really go away but a person can recover with
regular care and attention, medicine, to avoid getting worse or dying.
Impact on the Body/Brain - Addiction
• Prescription opioid pain medications and heroin bind to molecules on cells
known as opioid receptors. These receptors are found on nerve cells in
many areas of the brain and body, especially in brain areas involved in the
perception of pain and pleasure.
• Medications that affect the brain can change the way it works—especially
when they are taken over an extended period of time or with escalating
doses.
• They can change the reward system, making it harder for a person to feel
good without the drug and possibly leading to intense cravings, which make
it hard to stop using.
• When a person is addicted to a drug, finding and using that drug can begin
to feel like the most important thing—more important than family, friends,
school, sports, or health.
• The effect of opioids on the developing brain of a teenager compounds the
addiction outcomes – making it all the more risky for teenagers.
Impact on the Body/Brain –
The Two Stages of Withdrawal
• Opiate withdrawal symptoms can last anywhere from one week to one month. Especially the emotional
symptoms such as low energy, anxiety and insomnia can last for a few months after stopping high doses of
opiates.
• The second stage of withdrawal is called the Post Acute Withdrawal Syndrome (PAWS). During this stage you'll
have fewer physical symptoms, but more emotional and psychological withdrawal symptoms.
• Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain
improves the levels of your brain chemicals fluctuate as they approach the new equilibrium causing postacute withdrawal symptoms.
• Post-acute withdrawal feels like a rollercoaster of symptoms. In the beginning, your symptoms will change
minute to minute and hour to hour. Later as you recover further they will disappear for a few weeks or
months only to return again. As you continue to recover the good stretches will get longer and longer. But the
bad periods of post-acute withdrawal can be just as intense and last just as long.
• Each post-acute withdrawal episode usually last for a few days. There is no obvious trigger for most episodes.
You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just
as quickly as it started. After a while you'll develop confidence that you can get through post-acute
withdrawal, because you'll know that each episode is time limited.
• Post-acute withdrawal usually lasts for 2 years. This is one of the most important things you need to remember,
prepare for and guard against potential relapse.
Impact on the Body/Brain - Overdose
Heroin and opioids tell your body to stop breathing and can also cause your blood
pressure to dip significantly and cause your heart to fail.
Signs of depressant drug overdose (e.g. heroin, morphine, oxycodone, fentanyl,
methadone) include:
• shallow breathing or not breathing at all
• snoring or gurgling sounds (this can mean that a person’s airway is partly blocked)
• blue lips or fingertips
• If you pick up their arm or leg, it will just fall and flop
• no response to stimulus
• disorientation
• unarousable (can’t be woken up) unconsciousness.