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OPIOIDS
WHAT ARE OPIOIDS
• Psychoactive substances
derived from the poppy plant,
or their synthetic analogues
• Derived from the resin that
comes from the seed pod of
the plant
• Used in medications to treat
pain
EXAMPLES OF OPIOIDS
• Prescription Opioids
• Oxycodone (Oxycontin)
• Hydrocodone (Vicodin)
• Codeine
• Morphine
• Illicit Opioids
• Heroin
• Synthetic
• Fentanyl
• Carfentanil
ALIASES, FORMS, AND METHODS OF ABUSE
• Street Names: Big H, Black Tar, Brown Sugar, Dover's Powder, Hillbilly Heroin,
Horse, Junk, Lean or Purple Drank, MPTP (New Heroin), Mud, OC, Ox, Oxy,
Oxycotton, Paregoric, Sippin Syrup, Smack
• Forms: Tablets, capsules, skin patches, powder, chunks in varying colors (from
white to shades of brown and black), liquid form for oral use and injection,
syrups, suppositories, and lollipops
• Methods of abuse: Can be swallowed, smoked, sniffed, or injected.
OPIOID EFFECTS
• Prescribed to treat pain, suppress cough, cure diarrhea, and put people to sleep
• Effect on body
• Depends heavily on the dose, how it’s taken, and previous exposure to the drug
• Negative effects include: slowed physical activity, constriction of the pupils, flushing of
the face and neck, constipation, nausea, vomiting, and slowed breathing
OPIOID EFFECTS
• Effect on mind - Produces a general sense of well-being
• Reduces tension, anxiety, and aggression
• Unwanted effects: Drowsiness, inability to concentrate, and apathy
• Can create dependence
• Long after the physical need for the drug has passed, a person may continue to
think and talk about using drugs and feel overwhelmed coping with daily activities
OPIOID EFFECTS
• As the dose increases, both pain relief and the harmful effects become more pronounced
• Physical dependence is a consequence of chronic opioid use, and withdrawal takes place when drug use is discontinued
• Early withdrawal symptoms: watery eyes, runny nose, yawning, and sweating
• As withdrawal worsens, symptoms can include: restlessness, irritability, loss of appetite, nausea, tremors, drug craving, severe depression, vomiting, increased heart rate and blood pressure, and chills alternating with flushing and excessive sweating
• Most withdrawal physical symptoms disappear within days or weeks, depending on the particular drug
OPIOID EFFECTS
• Overdose effects – Can be fatal
• Respiratory failure – lack of sufficient oxygen in the blood
• Vital organs like the heart and brain start to fail
• Leads to unconsciousness, coma, death
• Physical signs of opioid overdose include: Constricted (pinpoint) pupils, cold
clammy skin, confusion, convulsions, extreme drowsiness, and slowed breathing
U.S. EPIDEMIC
• In the U.S., 5,480 people initiate nonmedical use of prescription opioids on a daily basis
• Amounts to 2 million persons/year
• Reasons for increase in misuse/abuse
• Ease of access
• Prescriptions for these medications have increased dramatically since the 1990’s
• Misinformation pertaining to the addictive properties of opioids
• Misconception that prescription drugs are less harmful than illicit drugs
U.S. EPIDEMIC
• Misuse of prescription drugs highest among young adults ages 18 to 25
• 14.4 percent reporting nonmedical use in the past year.
• Among youth ages 12 to 17, 4.9 percent reported past-year nonmedical use of
prescription medications
OVERDOSE DEATHS
• 63,632 drug overdose deaths occurred in 2016
• Rate of 19.8 per 100,000 persons.
• Prescription and/or illicit opioids were involved in 66.4% of drug overdose fatalities.
• Among opioid-involved deaths, the most commonly involved drugs were synthetic
opioids other than methadone (e.g. fentanyl) (19,413 deaths),
• Prescription opioids (17,087 deaths)
• Heroin (15,469 deaths)
• Cocaine involved in 10,375 deaths.
US BURDEN
• Unintentional poisonings were the leading cause of injury-related death in the
U.S. during 2016
• Economic toll > $1 trillion from 2001 through 2017
• $95.8 billion in 2016
• Nearly two-thirds related to health care, substance abuse treatment, and lost
productivity costs
STATES - 2008
STATES - 2016
GLOBAL BURDEN
• Globally:
• 275 million people who used drugs at least once during 2016
• 53 million used opioids
• 27 million people suffered from opioid use disorders
• 450,000 drug overdose deaths (2015)
• 118,000 due to opioids
OPIOID OVERDOSE DEATHS BY
COUNTRY, 2013
RISK FACTORS
• People at higher risk of opioid overdose
• Having multiple prescriptions including benzodiazepines
• Taking high daily dosages of prescription pain relievers
• Having mental illness or a history of alcohol or other substance abuse
• Household members of people in possession of opioids
HEROIN
HEROIN
• Opioid synthesized from morphine
• Usually appears as a white or brown powder or as a black sticky substance,
known as “black tar heroin”
• Can be injected, inhaled (snorting or sniffing), or smoked
• All three routes deliver the drug to the brain very rapidly, which contributes to its
health risks and to its high risk for addiction
• Associated with a number of serious health conditions including fatal overdose,
spontaneous abortion, and infectious diseases such as hepatitis and HIV
HEROIN USE RISK FACTORS
• Strongest Risk Factor - Past
misuse of prescription
opioids
• Non-Hispanic whites
• Males
• People addicted to
marijuana and alcohol
FENTANYL
• Typically used to treat patients with severe pain or to manage pain after surgery
• Fentanyl associated with recent overdoses are produced in clandestine laboratories
• Fentanyl sold on the street can be mixed with heroin or cocaine powder form looks similar to heroin
• 50 times more potent
• The high potency of fentanyl greatly increases risk of overdose
• Especially if the person is unaware the drug contains fentanyl
National Drug Overdose Deaths, By Drug
All Ages: 1999 – 2017
CARFENTANIL
• Synthetic opioid
• Used as a tranquilizing agent for elephants
and other large mammals
• Can resemble powdered cocaine or heroin
• Approximately 10,000 times more potent
than morphine
• 100 times more potent than fentanyl
• Fentanyl can be lethal at the 2-milligram range
RESPONSE TO OPIOID OVERDOSE
• Preventable with basic life support and timely administration of naloxone (Narcan)
• Narcan completely reverses the effects of opioid overdose
• No side effects
• In many countries there limited availability of naloxone
• Some countries have made Narcan available in pharmacies without a prescription
• A recent survey in the United States found that the distribution of approximately 50,000
Narcan kits through local opioid overdose prevention programs had resulted in more than
10,000 uses to reverse overdoses
• A number of countries and jurisdictions have started to adopt this approach
OPIOID OVERDOSE PREVENTION
• Increasing the availability of opioid dependence treatment, including for those
dependent on prescription opioids
• Less than 10% of people worldwide in need of such treatment are receiving it
• Reducing irrational or inappropriate opioid prescribing by physicians
• Limiting inappropriate over-the-counter sales of opioids
• Increasing access to Narcan
• Promote use of prescription drug monitoring programs
WHAT IS BEING DONE
• The Centers for Disease Control and Prevention (CDC) has developed
guidelines to improve the way opioids are prescribed
• Provide recommendations for the prescribing of opioid pain medication for
patients 18 and older in primary care settings
• Recommendations focus on:
• Determining when to initiate or continue opioids for chronic pain
• Opioid selection, dosage, duration, follow-up, and discontinuation
• Assessing risk and addressing harms of opioid use
WHO RECOMMENDATIONS
• Narcan be made available to people likely to witness an opioid overdose, as
well as training in the management of opioid overdose
• Use of a range of treatment options for opioid dependence
• Includes psychosocial support, opioid maintenance treatments such as methadone and
buprenorphine, supported detoxification and treatment with opioid antagonists such
as naltrexone
• Encourages countries to monitor drug use trends
THANK YOU