“HEROIN, METH & RX DRUGS: THE NEW FACE

OF ADDICTION”!“FIRST TUESDAYS @ 12 NOON” JUNE, 2016 WEBCAST

MARGIE ROOP, LPCC-S; CEAP; SAP LIFESERVICES EAP

1-800-822-4847

YOUR PRESENTER: MARGIE ROOP, LPCC-S; CEAP; SAP

LifeServices’ Regional Director, Ohio regionSupervisory Clinical Counselor, Certified EAP; Substance Abuse Professional under U.S. Department of Transportation rules.21 Years in EAP field; 37 years in the mental health/substance abuse fields.Live in Barberton, OH, near Akron. Married 30 years, one son, age 25, two dogs. I love to swim, travel, sing, read, & go to thrift shops!“I know what I know from the over 1,000 persons I’ve met within the EAP counseling setting & the hundreds of workplace settings I’ve visited.”

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TODAY’S TOPIC

• HAS CHANGED & SHAKEN THE FACE OF OUR SOCIETY

• OUR SENSE OF SAFETY & SECURITY

• OUR SENSE OF VULNERABILITY

• OUR CONFIDENCE IN THE

MEDICAL, MENTAL HEALTH &

LAW ENFORCEMENT COMMUNITY

HEROIN, METH & RX DRUGS: THE NEW FACES OF ADDICTION

• UNFORTUNATELY, THIS IS AMERICA'S “NEW NORMAL”• FEW HAVE BEEN UNTOUCHED BY SOMEONE’S DESCENT INTO

ADDICTION• ALL SOCIOECONOMIC STRATA HAVE BEEN AFFECTED

PERMEATING ALL WORKPLACES; WHITE & BLUE COLLAR SETTINGS; ALL AGE GROUPS; ALL ETHNIC GROUPS; ALL RACES; ALL NATIONALITIES; RELIGIOUS GROUPS.• SO, WHAT’S NEXT?

ACCORDING TO NATIONAL INSTITUTE ON DRUG ABUSE* (NIDA) WWW.DRUGABUSE.GOV, NORA VOLKOW, M.D., DIRECTOR

•2.1 MILLION PEOPLE IN THE U.S. ARE ADDICTED TO RX & OPIOID PAIN MEDICATIONS (2012).•467,000 ADDICTED TO HEROIN.•THE # OF “UNINTENTIONAL” OVERDOSE DEATHS

FOR RX PAIN RELIEVERS HAS SOARED IN THE U.S.; MORE THAN QUADRUPLING SINCE 1999.• “AMERICA’S ADDICTION TO OPIOIDS: HEROIN & RX DRUGS”, JANUARY

27, 2016, DR. VOLKOW’S ADDRESS TO THE U.S. CONGRESS.

CONTRIBUTING FACTORS TO THE PROBLEM

• 1. DRASTIC INCREASES IN THE # OF

OPIOID RXS WRITTEN & DISPENSED.

• 2. GREATER SOCIAL ACCEPTABILITY FOR USING MEDICATIONS FOR

DIFFERENT PURPOSES.

• 3. AGGRESSIVE MARKETING BY PHARMACEUTICAL COMPANIES.

• ALL TOGETHER, THESE HAVE HELPED TO CREATE THE BROAD

“ENVIRONMENTAL AVAILABILITY” OF RX MEDICATIONS, IN GENERAL, &

OPIOID ANALGESICS, IN PARTICULAR.

NEGATIVE CONSEQUENCES•GREATER AVAILABILITY OF OPIOIDS & OTHER RX DRUGS HAS BEEN ACCOMPANIED BY AN ALARMING INCREASE IN THE # OF NEGATIVE CONSEQUENCES RE: THEIR ABUSE:• THE ESTIMATED # OF ER

VISITS INVOLVING NON-MEDICAL USE OF OPIOID ANALGESICS INCREASED FROM 144,000 IN 2004 TO 305,900 IN 2008.

IT’S START &

PROGRESSION

• 1990’S-MANAGED CARE ATTACKED FOR CAUSING DOCTORS TO UNDER-PRESCRIBE

MEDICATION FOR THE MANAGEMENT OF PAIN.• TOGETHER, THE MEDICAL, PHARMACEUTICAL

& INSURANCE COMMUNITIES COORDINATED TO PROVIDE WHAT THEY FELT WERE MORE EFFECTIVE MEDICATION/TREATMENT FOR

PAIN.

THE OPIOID OXYCONTIN (HYDROCODONE)WAS INTRODUCED• AS WERE OTHER RX OPIOIDS: PERCOCETTES, VICODIN, DARVOCET, CODEINE

• EFFECTIVE IN RELIEVING PAIN, HOWEVER, DUE TO THEIR CHEMISTRY/POTENCY, WERE QUICK TO CAUSE ADDICTION WITH PATIENTS.

• PAIN CLINICS BEGAN TO OPEN & FLOURISH AS PATIENTS BECAME DEPENDENT ON THESE DRUGS: A MEDICAL “SPECIALTY” WAS BORN!

• SOON, PATIENTS WERE NEEDING MORE OF THE DRUGS; THE PAIN SPECIALISTS WERE REFUSING TO PRESCRIBE, THEREFORE, PATIENTS STARTED “DOCTOR SHOPPING.”

IF THEIR DOCTORS

REALIZED…• THEY WERE BEING SOUGHT

OUT JUST FOR THE RXS, THEY’D STOP TREATING THE PATIENT.• PATIENTS THEN WENT TO EITHER STEALING RX DRUGS

FROM LOVED ONES OR HITTING THE STREETS TO PURCHASE

OTHERS’ RX OPIOID DRUGS OR HEROIN.

PAIN MANAGEMENT CLINICS• PAIN CLINICS TODAY ARE MUCH MORE AWARE OF

THE POTENTIAL FOR ADDICTION & ARE ACTUALLY BEING CRITICIZED FOR UNDER-PRESCRIBING PAIN MEDICATION.• THE U.S. D.E.A. HAS FOCUSED MUCH ATTENTION ON

SUSPECTED “PILL MILLS” CAUSING MANY LEGITIMATE PAIN SPECIALISTS TO MORE CLOSELY SCRUTINIZING WHO THEY TREAT (SMART).

TYPICAL PROGRESSION TO

HEROIN…IS QUICK, AS OXYCONTIN IS, FROM A CHEMICAL STANDPOINT, HEROIN!!PERSONS MAY SMOKE, SNORT, OR

INJECT HEROIN.MAY WILLINGLY OR UNWILLINGLY

USE HEROIN LACED WITH FENTANYL=40X MORE POTENT

OPIOID THAN HEROIN.

HELPFUL RESOURCE• GO TO “YOU TUBE” & LOOK

UP: “PRESCRIPTION FOR ABUSE KCTS 9 DOCUMENTARY” VIDEO.

• A PHYSICIAN LOSES HER SON TO HEROIN OVERDOSE; EXPLORES HOW HIS ADDICTION STARTED WITH A LEGITIMATE OPIOID PRESCRIPTION FOR PAIN.

• THIS MOTHER GIVES A CONCISE HISTORY OF HOW MOST ADDICTED TO THE OPIOIDS GOT STARTED, HOW THEIR DISEASE PROGRESSED, & OTHER STORIES FROM AFFECTED PARENTS.

• HELPFUL RESOURCES ARE ALSO OFFERED.

HEROIN• WHITE OR BROWNISH POWDER• BLACK OR STICKY SUBSTANCE KNOWN AS “BLACK TAR HEROIN”• SHORT-TERM EFFECTS: IN 3-5 SECONDS EXPERIENCE A ”RUSH”;

EUPHORIA, WARM FLUSHING OF SKIN, DRY MOUTH, HEAVY FEELING IN

HANDS & FEET, CLOUDED THINKING, ALTERNATE WAKEFUL & DROWSY

STATES, ITCHING, NAUSEA, VOMITING, SLOWED BREATHING & HEART RATE.

PARAPHERNALIA & OTHER SIGNS OF

HEROIN USE

• HEROIN IS SMOKED BY USING A METHOD CALLED “CHASING THE DRAGON”: HEATING UP SOME POWDER ON FOIL & INHALING THE FUMES THROUGH A SMALL TUBE.• NEEDLES TO INJECT• BURNED & MISSING SILVER SPOONS:

COOKING THE HEROIN OVER A FLAME. THE BURNING CAUSE A BLACK SPOT ON BOTTOM OF SPOON.• BOWLS & PIPES

SIGNS OF HEROIN USE

• SMALL COLORED BALLOONS USED TO PACKAGE & TRANSPORT HEROIN.

• COTTON BALLS AS FILTERS FOR INJECTING

• CIGARETTE PIECES ABOUT ¼” LONG USED FOR FILTER FOR INJECTING

• BOTTLE TOPS

• SODA CANS WITH BOTTOMS CUT OUT• SHOES LACES; CUT LONG RUBBER

BANDS FOR INJECTING

• CLEAR SHELL CAPSULES

HEROIN • COVERING ARMS ALL

THE TIME; WEARING LONG SLEEVES• OWNING LOTS OF

LIGHTERS• EXPENSIVE PERSONAL

& HOUSEHOLD ITEMS ARE MISSING; TRADING WITH PAWN SHOPS INCREASINGLY COMMON.• OWNING A NEW LOCK

BOX THAT THEY WON’T ALLOW OTHERS TO ACCESS.

METHAMPHETAMINE• CALLED: METH, CRYSTAL, CHALK, ICE.• EXTREMELY ADDICTIVE STIMULANT

DRUG• CHEMICALLY SIMILAR TO AMPHETAMINE• TAKES FORM OF WHITE, ODORLESS,

BITTER-TASTING CRYSTALLINE POWDER.• TAKEN ORALLY, SMOKED, SNORTED, OR

DISSOLVED IN WATER & INJECTED.

METH• PRODUCES AN IMMEDIATE, INTENSE EUPHORIA DIRECTLY TO THE BRAIN.

• PLEASURE FADES QUICKLY SO USERS OFTEN TAKE REPEATED DOES IN A “BINGE & CRASH”

PATTERN.• CAUSES THE PRODUCTION OF HIGH LEVELS

OF THE NEUROTRANSMITTER DOPAMINE IN THE BRAIN (INVOLVED WITH REWARD,

MOTIVATION, MOTOR FUNCTION & PLEASURE).

• REPEATED USE OF METH WILL CAUSE DEPLETION OF THE BRAIN’S NATURAL

MANUFACTURE OF DOPAMINE, CAUSING RELIANCE ON THE DRUG FOR THE REWARD,

MOTIVATION, PLEASURE & MOTOR FUNCTION).

• NOW DEPEND ON THE DRUG TO FUNCTION!

METH….EVEN SMALL AMOUNTS WILL CAUSE: INCREASED WAKEFULNESS, PHYSICAL ACTIVITY, DECREASED APPETITE, INCREASED RESPIRATION, RAPID HEART RATE, IRREGULAR HEART BEAT, INCREASED BLOOD PRESSURE, INCREASED BODY TEMPERATURE.

METH USE…LONG-TERM

•WILL CAUSE INCREASED WEIGHT LOSS, SEVERE DENTAL PROBLEMS “METH MOUTH” & SKIN SORES DUE TO SCRATCHING (DUE TO SENSATION HALLUCINATION OF BUGS CRAWLING BENEATH THEIR SKIN).

PRESCRIPTION OPIOID DRUGS• CODEINE-TABLETS OR LIQUID: INJECTED; SWALLOWED: MIXED WITH SODA OR FLAVORINGS.• FENTANYL-LOZENGE,

SUBLINGUAL TABLET, FILM, BUCCAL TABLET: INJECTED, SMOKED, SNORTED.• HYDROCODONE

(VICODIN, LORTAB, LORCET & OTHERS): CAPSULE, LIQUID, TABLET: SWALLOWED, SNORTED, INJECTED.• HYDROMORPHONE

(DILAUDID): LIQUID, SUPPOSITORY: INJECTED, RECTAL.

PRESCRIPTION OPIOID DRUGS

•MEPERIDINE (DEMERAL): TABLET, LIQUID: SWALLOWED, SNORTED, INJECTED.•MORPHINE: TABLET,

LIQUID: SWALLOWED, INJECTED

•OXYCODONE (OXYCONTIN, PERCODAN, PERCOCET & OTHERS): CAPSULE, LIQUID, TABLET: SWALLOWED, SNORTED, INJECTED.

PRESCRIPTION OPIOID DRUGS

•OXYMORPHONE (OPANA): TABLET: SWALLOWED, SNORTED, INJECTED.

DEATH FROM OPIOIDS

POSSIBLE HEALTH EFFECTS OF OPIOID USE

SHORT-TERM • PAIN RELIEF,

DROWSINESS, NAUSEA, CONSTIPATION, EUPHORIA, CONFUSION, SUPPRESSED BREATHING (HYPOXIA)WHICH CAN LEAD TO DEATH!

LONG-TERM

•UNKNOWN…..

OTHER HEALTH-RELATED ISSUES…

PREGNANCY: MISCARRIAGE, LOW BIRTH WEIGHT, NEONATAL ABSTINENCE SYNDROME.

OLDER ADULTS: HIGHER RISK OF ACCIDENTAL MISUSE OR

OVERDOSE DUE TO MULTIPLE RXS WHICH INCREASE RISK OF

DRUG INTERACTIONS; BREAKDOWN OF DRUGS SLOWS WITH AGE; MANY OLDER ADULTS

ARE TREATED WITH RX MEDICATIONS FOR PAIN.

IN COMBINATION WITH ALCOHOL

•DANGEROUS SLOWING OF HEART RATE & BREATHING LEADING TO COMA OR DEATH.

TREATMENT OPTIONS-MEDICATIONS

• METHADONE-(DOLOPHINE): AN OPIOID USED TO TREAT PAIN & A MAINTENANCE THERAPY OR TO HELP WITH DETOXIFICATION WITH OPIOID DEPENDENCE. DETOX CAN BE COMPLETED IN LESS THAN ONE MONTH, OR UP TO SIX MONTHS.• BUPRENORPHINE-(BUNAVAIL, SUBOXONE, ZUBSOLV,

BUPRENEPRINE)-SUBLINGUAL FILM OR TABLET TO TREAT OPIOID ADDICTION WITHIN THE PRIVACY OF A PHYSICIAN’S OFFICE OR WRITTEN FOR PRESCRIBED USE AT HOME.• NALTREXONE-(REVIA, DEPADI, VIVITROL)-REVERSES THE

EFFECTS OF OPIOIDS & IS USED PRIMARILY IN THE MANAGEMENT OF ALCOHOL/OPIOID DEPENDENCE. NOT TO BE CONFUSED WITH NALOXONE-USED IN EMERGENCY CASES OF OPIOID OVERDOSES.

“ADDICTIONOLOGIST”

• A MEDICAL DOCTOR WHO HAS THE KNOWLEDGE & SKILLS TO PREVENT, RECOGNIZE & TREAT ADDICTION.

• AMERICAN BOARD OF ADDICTION MEDICINE (ABAM) IS THE CERTIFYING BODY & OUR NATION’S FIRST MEDICAL SPECIALTY BOARD THAT CERTIFIES ADDICTION MEDICINE PHYSICIANS ACROSS A RANGE OF MEDICAL SPECIALTIES.

• THEIR DESIGNATION: A DIPLOMAT OF THE AMERICAN BOARD OF ADDICTION MEDICINE OR “DABAM”.

BEHAVIORAL THERAPIES

•IN-PATIENT TREATMENT-UP TO 30 DAYS•RESIDENTIAL TREATMENT-30 DAYS UP TO

ONE-TWO YEARS.•INTENSIVE OUT-PATIENT PROGRAMS

SUPPORT GROUPS

•ALCOHOLICS ANONYMOUS (AA)

OR NARCOTICS ANONYMOUS

(NA)

•12-STEP FELLOWSHIP PROGRAMS

FOR PERSONS WHO DESIRE TO

NOT DRINK OR USE DRUGS

•BASED ON ANONYMITY

•SPIRITUALITY & FOCUS ON A

HIGHER POWER.

THIS. IS. A. DISEASE.

• NOT A MORAL FAILING!• IT IS A BRAIN DISEASE: “IT IS THEREFORE, PHYSIOLOGY &

BIOCHEMISTRY-NOT A MORAL FAILING-THAT CAUSES PEOPLE TO TAKE RX MEDICATIONS TO THE POINT THE OPIOIDS CAUSE TERRIBLE WITHDRAWAL SYMPTOMS IF NOT TAKEN”, LEE TANNENBAUM, M.D., FOUNDER OF BEL AIR CENTER FOR ADDICTIONS, BEL AIR, MD. AUTHOR OF THE ADDICTION CONSPIRACY. WWW.BELAIRCENTERFOR ADDICTIONS.COM• LOOK UP: WWW.OHIO.COM, ARTICLE “TREAT ADDICTION AS A

DISEASE”, WRITTEN FOR THE BALTIMORE SUN & APPEARED IN THE AKRON BEACON JOURNAL, 6-2-16.

THE BRAIN• ONE OF THE BRAIN’S CONSTANT GOALS IS TO MAINTAIN A CHEMICAL BALANCE.• WHEN A HIGH

TOLERANCE OCCURS BECAUSE OF FREQUENT USE, & WHEN USE DRUG USE STOPS, THE SUDDEN, SHARP DROP IN NEUROTRANSMITTERS UPSETS THE CHEMICAL BALANCE.• BRAIN ACTIVATES A

DEEP, INSTINCTIVE DRIVE TO GET MORE DRUGS & RESTORE THE HIGHER NEUROTRANSMITTER LEVELS THE BRAIN IS NOW USED TO HAVING!

CRAVINGS• PRODUCED BY IMPULSES

IN THE BRAIN AS NEUROTRANSMITTERS COMMUNICATE.

• BRAIN WORKS AGAINST THE WILL OF THE PERSON (TO NOT USE THE OPIOID) AS THE BRAIN IS DEPRIVED OF SOMETHING IT THINKS IT NEEDS TO SURVIVE.

• BRAIN’S ONLY GOAL IS TO OBTAIN THAT SUBSTANCE AGAIN.

• OUR SENSE OF WELL-BEING & OUR CAPACITY TO ORGANIZE OUR LIVES & TO RELATE TO OTHERS DEPEND PROFOUNDLY ON THE FUNCTIONAL INTEGRITY OF THE SEROTONERGIC SYSTEM!

HOW THE ISSUE GETS MORALIZED• BECAUSE THIS DISEASE….HURTS!!• LOVED ONES, CO-

WORKERS, COMMUNITIES, SOCIETIES, LARGELY BECAUSE OF THE BEHAVIORS ASSOCIATED WITH THE DISEASE: LYING, STEALING, IRRESPONSIBILITY, FINANCES, ABERRANT BEHAVIORS, ACCIDENTS, PSYCHOLOGICAL DISTRESS, HEALTH PROBLEMS, CRIME.

SOCIETY & HOW THEY TREAT OPIOID USERS• THAT THEY FAILED AT A

PERSONAL LEVEL.• EVEN OUR LANGUAGE SHOWS

HOW WE VIEW THEM, I.E., THOSE WHO TEST DRUG-FREE ARE “CLEAN”; THOSE DRUGS IN THEIR SYSTEM ARE “DIRTY.”•WE DO NOT VIEW OTHER

DISEASES SUCH AS HEART DISEASE OR CANCER IN SUCH A WAY…!

HELPFUL RESOURCE RE: THE BRAIN•DANIEL G. AMEN, M.D., PSYCHIATRIST. FOUNDER OF

THE AMEN CLINICS. WWW.AMENCLINICS.COM•UTILIZES “SPECT” IMAGING IN ADDICTION

TREATMENT.• IDENTIFIED SIX TYPES OF ADDICTION-PRONE BRAIN

PATTERNS.• TRUE PARADIGM SHIFT IN ADDICTION TREATMENT

THROUGH OPTIMIZING & HEALING THE BRAIN.

RESPONDING• “QUESTIONABLE” ITEMS IN YOUR HOUSE OR WORKPLACE? LEARN MORE ABOUT PARAPHERNALIA.

• ITEMS MISSING IN YOUR HOME OR WORKPLACE? INVESTIGATE!

• FIRM BOUNDARIES/RULES ABOUT NO DRUG USE WHILE THE PERSON LIVES UNDER YOUR ROOF! FOLLOW-

THROUGH WITH CONSEQUENCES (THEY MUST LEAVE OR SEEK TREATMENT).

• FOLLOW YOUR DRUG-FREE SAFETY PROGRAMS P & PS!! DO REASONABLE SUSPICION TESTING!!

• PAY ATTENTION TO YOUR GUT; IT KNOWS!• DON’T ARGUE WITH THE PERSON, ESPECIALLY IF THIS IS BECOMING AN ONGOING BATTLE. FOLLOW-THROUGH WITH

CONSEQUENCES.

LYING & STEALING.

•TYPICAL BEHAVIORS OF ADDICTION.

•WHY ARE THEY ALWAYS ASKING

FOR SMALL AMOUNTS OF MONEY?

DO YOU EVER GET PAID BACK?

•DO YOU USUALLY FEEL LIKE

YOU’RE NOT GETTING AN HONEST

ANSWER?

TAKE CARE OF YOURSELF!

• ATTEND AN ALANON, OPEN AA, NARANON, OPEN NARCOTICS ANONYMOUS MEETING, CALL LOCAL COUNTY MENTAL HEALTH & SUBSTANCE ABUSE BOARDS; LOCAL TREATMENT CENTERS.• LEARN ABOUT ENABLING: DO NOT

DO FOR THE ADDICT WHAT THEY COULD BE DOING FOR THEMSELVES.• VISIT: SUBSTANCE ABUSE & MENTAL

HEALTH ADMINISTRATION: WWW.SAMHSA.ORG

LIFESERVICES EAP

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WWW.LIFESERVICESEAP.COM

WWW.SLIDESHARE.NETLOOK UP MARGIE ROOPARTICLE: “BEHAVIORS TO NEVER IGNORE IN THE

WORKPLACE”POWERPOINTS: • “ANGER: WHO’S MOST AT RISK?”• “IDENTIFYING STRESSED-OUT EMPLOYEES & HOW TO

INTERVENE”• “BULLYING IN THE WORKPLACE”• “DEALING WITH DIFFICULT CUSTOMERS & WE’RE ALL THE

CUSTOMER”• “HOSTILE OR RESPECTFUL WORKPLACE?”• “COMMUNICATING WITH DIFFICULT PEOPLE”• “REASONABLE SUSPICION”• “IDENTIFYING & RESPONDING TO UNSAFE BEHAVIORS”• “STRESS & THE ECONOMY”

WWW.LINKEDIN.COM/IN/LIFESERVICESEAP.COMLOOK UP MARGIE ROOP• “CREATING A CALM

ENVIRONMENT AT WORK”

• “RELAXATION TECHNIQUES”

• “HAVING FUN IN THE WORKPLACE”

• “TIPS FOR RELAXING”

• “DEALING WITH HOLIDAY STRESS”• “I’M NOT SANTA CLAUSE, I’M

JUST THE MANAGER: HELPING YOUR EMPLOYEES DURING THE HOLIDAYS”

• “HO-HO-HO, HELP ME, IT’S THE HOLIDAYS”

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RESOURCES

CONTACT MARGIE ROOP: MROOP@LIFESERVICESEAP.COM

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