Transcript 2 - Amazon Web Services

GOODBYE MY SWEET,
HANDSOME BOY
JUDY RICHTER, LMSW
IDENTIFYING THE PROBLEM
Increase in number of young
adults aged 18 to 26 coming into
the ER with Heroin overdose
often in cardiac arrest.
THE MISSION
 Collaboratively the Drug Task Force promotes
awareness, educates, and strives to support
patients and families struggling with addiction.
 We accomplish this as a hospital based
interdisciplinary task force by: educating
caregivers; advocating for cutting edge medical
care for addicted persons; and informing the
community about addiction.
STASTISTICS

A total of 700 people on
Long Island have died from
Heroin since 2014.
STATISTICS
 Narcan has saved over 1,000 lives in
Suffolk and Nassau Counties.
 March 3, 2016 Gov. Cuomo announced
Narcan is now available over the
counter from all NY independent
pharmacies.
 480 CVS will be registered opiate
overdose programs.
STIGMA
 Health care professionals are crucial in the
identification and accessibility to treatment
for people with substance use disorder.
 A large majority of health care professionals
lack adequate education and training in
working with patients with addiction.
STIGMA
Negative attitudes of health care
professionals diminish patient’s
feelings of empowerment and
subsequent treatment.
TRENDS IN ADOLESCENT DRUG USE
 EYEBALLING
 TAMPING
 SYNTHETHICS k2
EYEBALLING
 Is the practice of pouring alcohol through the eye
socket.
 Sweeping college campuses in UK and USA.
 Teenagers are doing this to avoid alcohol on their
breath.
 Individuals doing this claim eyeballing induces
feelings of drunkenness at rapid speeds.
EYEBALLING
EYEBALLING
 It is competitive and pain is part of the
competitiveness.
 It can cause long term damage,
burning, inflammation, scaring of the
cornea, and does not show symptom's
for months.
TAMPING
Vodka tampon- is NOT the
name of a punk rock band.
TAMPING
 Tampons are soaked in alcohol and are
inserted into the rectum or vagina. The
alcohol is absorbed through the blood
stream.
 It’s 10 to 20 times more lethal than drinking
alcohol.
 Boys participate in tamping more than girls
SYNTHETHICS
 K2 is a synthetic cannabis. It is man made
with mind altering chemicals that are either
sprayed on dried plant material so they can
be smoked or used as liquids to be vaporized
and inhaled in e-cigarettes.
 They are particularly popular with young
people.
SYNTHETICS
 For several years synthetic weed mixtures
were easy to obtain. However, now due to
their high potential for abuse and no
medical benefit they are illegal to sell, buy,
or possess.
SYNTHETICS
K2 goes by a number of designer names such as:
 Spice
 Joker
 Black Mambo
 Krush
 Kronic
 Green Giant
 Wicked X
 Mr. Smiley
 Moon Rock
SYNTHETICS
 User’s report some effects similar to
marijuana :
 Elevated mood
 Altered perception
 Psychosis-delusional or distorted thinking
 Relaxation
SYNTHETICS
 Synthetics are often wrapped in foil
packets that can be marked as home
incense, or herbal smoking blends.
 Packaging often has claims that the
contents are safe and natural.
 K2 cannot be detected in standard drug
test.
SYNTHETICS
These products are sold online
and in drug paraphernalia
stores, bodegas, gas stations,
and convenience stores.
ADVERSE EFFECTS OF K2
 Rapid heart rate
 Vomiting
 Violent behavior
 Suicidal thoughts
 High blood pressure
 Seizures
 Kidney damage
SYNTHETICS
 K2 is addictive and withdrawal
symptoms include:
 Headaches
 Anxiety
 Depression
 Irritability
FACTS
 If someone is going to become addicted
to drugs it will most likely happen
during adolescence.
 If you can avoid drug use until you are
22 to 23 years old the probability that
you will ever get addicted to anything is
less then 1 Percent.
FACTS
 In 2013 more than half of kids who
graduated from high school had
misused prescription pills.
 More than half of the marijuana
sold on Long Island is laced with
methamphetamine which is not
visible to the user.
FACTS
 Every drug that is used effects a
chemical in the brain called dopamine.
 Dopamine helps regulate movement of
emotional responses and it enables us
not only to see rewards, but take action
to move towards them.
MEDICATION ASSISTED TREATMENT
 Medications are a critical component of
opioid addiction treatment.
 Medications developed to treat opioid
addiction work through the same receptors
as the addictive drug, but are safer and less
likely to produce the harmful behaviors that
characterize addiction.
MEDICATION ASSISTED TREATMENT
3 Types of Medication Assisted Treatment:
1.) AGONIST: activate opioid receptors
2.) PARTIAL AGONIST: which activate opioid receptors,
but produce a demished response.
3.) ANTAGONIST: block the receptor, and interfere with
the rewarding effects of opioids.
MEDICATION ASSISTED TREATMENT
Physicians prescribe a particular
mediation based on a patient’s
specific medical needs and other
factors.
MEDICATION ASSISTED TREATMENT
EFFECTIVE MEDICATIONS INCLUDE
METHADONE
 A slow acting opioid agonist.
 Taken orally so it reaches the brain slowly,
dampening the high and preventing
withdrawal.
 Has been used since 1960 to treat heroin
addiction.
MEDICATION ASSISTED TREATMENT
METHADONE
 Only available through approved out patient
treatment programs
 It is dispensed to patients on a daily basis.
MEDICATION ASSISTED TREATMENT
BUPRENORPHINE (SUBUTEX, SUBOXONE)
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

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A partial opioid agonist.
Relives drug cravings with out producing the high
or dangerous side effects of other opioids.
Is taken orally
Physicians need to be certified to prescribe it.
Effective for use starting in early withdrawal.
MEDICATION ASSISTED TREATMENT
NALTREXONE ( VIVITROL)
 Opioid antagonist.
 Not addictive or sedating
 Does not result in physical dependence.
 Given as a monthly injection it eliminates need
for daily dosing.
 Vivitrol is given after a patient has been detox
from Opiates 5 to 7 days.
MEDICATION ASSISTED TREATMENT
 Scientific research has establish that
Medication Assisted Treatment of opioid
addiction increased patient’s sobriety
retention and decreased drug use.
Medication Assisted Treatment
Research reveals new strategies for addiction
medication.
Improved medications:
PROBUPHINE is a long acting version of
Suboxone that is showing promise in clinical
trails. It is an IMPLANT inserted under the
skin that delivers medication for 6 months at
a time
MEDICATION ASSISTED TREATMENT
VACCINE RESEARCH
 VACCINES are being developed to help combat
addictions, including heroin. A heroin vaccine
currently under development is projected to corral
heroin in the blood stream, prevent it from reaching
the brain, and exerting it’s euphoric effects.
THE LITTLEST ADDICTS
Whether their mother was using illicit opioid street drugs
or misusing prescription pain killers, babies born to
addicted mothers all have one thing in common-
THEY ARE AT RISK FOR WITHDRAWAL AFTER
DELIVERY
This is referred to as:
NAS-Neonatal Abstinence Syndrome
NEONATAL ABSTIENCE SYNDROME
NEONATAL ABSTIENCE SYNDROME
Signs of NAS:
 Difficulty with tone and movement.
 Infants with these problems can have tight muscles
and tremors.
 Problems with feeding, weight loss, failure to thrive.
 Difficulty with maintaining a quite alert state which
is needed to interact with their caregivers.
NEONATAL ABSTIENCE SYNDROME
 Irritability
 Difficulty with touch, sound movement, or visual
stimulation.
 Gagging, vomiting, diarrhea, fast breathing, or
hiccupping
 50 - 70 % of NAS babies require treatment for
withdrawal.
NEONATAL ABSTIENCE SYNDROME
Treatment
 If medication intervention is necessary, physicians
typically use morphine. Methadone can also be used.
 Medication is gradually weaned off prior to hospital
discharge.
NEONATAL ABSTIENCE SYNDROME
 Average newborn spends 2 to 3 days in the hospital.
 A baby with NAS spends an average of 16 days in the
hospital.
 A newborn with NAS have a higher rate of being
readmitted with in the first month after discharge.
NEONATAL ABSTIENCE SYNDROME
Long term outcome/prognosis:
 Some of these infants have other difficult co-existing
factors.
 Maternal drug use, exposure to violence, poor
nutrition, or inadequate well baby care.
 Substance exposed children are at higher risk for
medical, developmental, emotional, and behavioral
concerns as they grow.
NEONATAL ABSTIENCE SYNDROME
 In America, a baby is born dependent on Opiates
every 19 minutes.
 In 2013 there were more than 27,000 diagnosed
cases of drug dependent newborns.
NEONATAL ABSTIENCE SYNDROME
 Suffolk County ranks second in NYS for addicted
newborns; 171 infants were born with opioids in their
system in 2014.
 Nassau county had 53 addicted newborns in 2014.
NEONATAL ABSTIENCE SYNDROME
WHY ARE PREGNANT WOMEN NOT
GETTING THE HELP THEY NEED?
 Living in the shadows for fear of stigma, shame,
guilt.
 They are not being honest with their doctors
 Want to stop but can’t
 They think the baby will not be effected
NEONATAL ABSTIENCE SYNDROME
What is being done?
 Some physicians are using SBIRT (short brief
intervention and referral to treatment).
 Women who do come forward to get treatment are
put to the top of the list.
 TREATMENT CENTERS:
Morning Star , Stony Brook University Hospital,
NUMC, Zucker Hillside Hospital.
NEONATAL ABSTIENCE SYNDROME
WHAT ARE OTHER STATES DOING?
The Tennessee Solution:
 A law that will criminally prosecute a pregnant
women abusing drugs. This law allows prosecutors
to charge women with assault if they can prove drug
use during pregnancy harmed the newborn.
 Safe Harbor Act grants pregnant women priority
access to addiction treatment protecting the custody
of the infant as long as they receive help.
NEONATAL ABSTIENCE SYNDROME
The OHIO Recovery Plan.
 A grant that allows women to receive drug treatment
and in depth counseling.
 MAT for Opiate addiction.
 Relapse prevention program after the baby is born
 Transportation or babysitting assistance for medical
treatment appointments.
 Vouchers for transitional housing.
NEONATAL ABSTIENCE SYNDROME
NEW YORK’s Plan:
 Senator Schumer has asked the National Institute of
Health and Federal Center for Disease Control &
Prevention to research ways to help pregnant women
who are addicted.
 Senate Majority Leader John J. Flanagan and the
Joint Senate Task force on Heroin and Opiate
Addiction announced that the Senate will include a
total of $167 million in funding to strengthen
prevention, treatment, recovery, and education as
part of its 2016-17 budget proposal.
REFERRALS & BARRIERS to TREATMENT
REFERRALS:
 Addiction Service Packet
 Inpatient Rehab – Residential
 Outpatient
BARRIERS
 Lack of bed capacity
 Long waiting list
 Unlike withdrawal from alcohol or benzodiapines,
withdrawal from Heroin does not cause death and
therefore patient do not meet criteria for in patient
detox.
REFERRALS & BARRIERS to TREATMENT
OUTPATIENT TREATMENT:
 Patients must visit an OP treatment center a few
times a week
 OP centers have more availability
 Patients have an opportunity for MAT
 Patients with no insurance have limited
opportunities for treatment
REFERRALS & BARRIERS to TREATMENT
THE AFFORDABLE CARE ACT:
 Insurance must cover cost for mental illness &
substance abuse treatments in the same way it covers
physical care.
 This Bill has been delayed
 Does not fix the bed capacity problem
 Insurance companies typically only approve 7 days
MEDICAL CONSEQUENCES OF DRUG ABUSE
 THIS TOPIC IS SOMETHING WE NEED TO TALK
MORE ABOUT.
 THE MEDICAL COMPLICATIONS OF ADDICTION
ARE SERIOUS.
MEDICAL CONSEQUENCES OF DRUG ABUSE
MEDICAL COMPLICATIONS OF HEROIN USE
SHORT TERM EFFECTS:
 DEPRESSED RESPIRATION
 CLOUDED MENTAL FUNCTIONS
 NAUSEA VOMITING
 SUPRESSION OF PAIN
MEDICAL CONSEQUENCES OF DRUG ABUSE
LONG TERM EFFECTS:
 INFECTIOUS DISEASE HIV, HEPATITIS B & C
 BACTERIAL INFECTION
 INFECTION OF HEART LINING AND VALVE
 ARTHRITIS
 LIVER AND KIDNEY DISEASE DIALYSIS
 COMPARTMENT SYNDROME
 CELLULITIS & COLLAPSED VIENS
MEDICAL CONSEQUENCES OF DRUG ABUSE
PLEASE WELCOME:
PATTI
QUESTIONS or COMMENTS?