Slide 1

Metropolitan Drug Enforcement Unit Prescription Drugs / Heroin 2015

Slide 2

Trends are constantly changing in the area of drug abuseespecially with our youth. Popularity of drugs change with time. Mainstay drugs are getting more potent.

Slide 3

High Grade Marijuana Cocaine/Crack Cocaine Prescription Drugs Heroin Club Drugs Methamphetamine Ketamine Alcohol

Slide 4

Where there is one, you will find the other

Slide 5

Slide 6

Slide 7

Ranks as the second highest threat in our region. More Americans abuse prescription drugs than the number of Cocaine, hallucinogen, Heroin, and inhalant abusers combined. The increase in abuse of prescriptions has occurred the most among younger age groups. There are many reasons kids are abusing prescription drugs: Think the drugs are safe since the are medicine. Think the drugs are safe since the are medicine. Dont think the drugs are addictive. Dont think the drugs are addictive. According to a DEA Milwaukee District Office, 2012

Slide 8

Diverted Pharmaceuticals: Oxycodone Oxycodone Oxycontin most prevalent Oxycontin most prevalent Hydrocodone Hydrocodone Hydromophone Hydromophone Methadone Methadone

Slide 9

Each day, 46 people die from an overdose of prescription painkillers* in the US. Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills. http://www.cdc.gov/vitalsigns/opioid-prescribing/.

Slide 10

More overdose related deaths from prescription More overdose related deaths from prescription drugs than any illegal street drug. drugs than any illegal street drug.

Slide 11

Health care providers in different parts of the country don't agree on when to use prescription painkillers and how much to prescribe. Some of the increased demand for prescription painkillers is from people who use them non-medically (using drugs without a prescription or just for the high they cause), sell them, or get them from multiple prescribers at the same time. Many states report problems with for-profit, high-volume pain clinics (so-called "pill mills") that prescribe large quantities of painkillers to people who don't need them medically. http://www.cdc.gov/vitalsigns/opioid-prescribing/

Slide 12

Mom and Dad, Grandma, Grandpa, Aunts, Uncles, friends, friends of friends are the number #1 dealer to kids! Theft from medicine cabinet: 49% of teens obtained prescription drugs from a friend. 20% of parents have given their teen an un-prescribed drug. Most people dont keep track of the number of pills they have. STOP Rx ABUSE Ignorance is NO excuse, by Dr. Raj Arangarasan, National Institute on Drug Abuse, 2013

Slide 13

Prescription opioid pain medications such as OxyContin and Vicodin can have effects similar to heroin. The No. 1 sign that someone will use heroin is that he or she abused prescription painkillers like Vicodin and Oxycodone.

Slide 14

OxyContin abusers switch to Heroin due to the cheaper cost for the same high. Pills can run $1.00 per milligram so a single pill can cost as much as $80.00. A dose of Heroin is $20.00.

Slide 15

MONITOR - Restrict access to prescription drug medicine cabinets. Lock up the prescription! DISPOSE Properly dispose (drug collection) expired medications. ENGAGE - Talk to your kids about the dangers of drug abuse. 50% less likely to abuse prescription drugs when teens learn the risks of drugs from their parents. 50% less likely to abuse prescription drugs when teens learn the risks of drugs from their parents. STOP Rx ABUSE Ignorance is NO excuse, by Dr. Raj Arangarasan, National Institute on Drug Abuse, 2013

Slide 16

Slide 17

20142013 Brookfield1,3031,224 Menomonee Falls9491,149 Mukwonago559558 Muskego351663 Oconomowoc937792 Pewaukee738669 Waukesha1,1401,060 New Berlin7160 Delafield1250 T/Brookfield360 V/Hartland2200 Total7,074 (3.2 Tons)6,115

Slide 18

Slide 19

Heroin: Heroin: Most Common Drug Death Most Common Drug Death Record Number of Overdoses Record Number of Overdoses

Slide 20

The average age at first use among recent initiates aged 12 to 49. The average age at first use among recent initiates aged 12 to 49. 22.1 years old is the average age. 22.1 years old is the average age.

Slide 21

Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three routes of administration deliver the drug to the brain very rapidly, which contributes to its health risks and to its high risk for addiction. Drug-seeking, no matter the consequences.

Slide 22

Heroin users are using a recreational mentality. You can start by smoking or snorting. Twenty or 30 years ago, Heroin was 6 to 10 percent pure, so if people wanted to get high, the only choice they had was to inject it. These days, Heroin is 50 to 60 percent pure, so most users start by snorting it, then gradually progress to smoking and injecting it. Ultimately you meet bad people or just die without intervention.

Slide 23

Danger with Heroin use is lack of control. Heroin can range from 7% to 80% purity. Heroin can range from 7% to 80% purity. This lack of control of purity can result in hot shots of Heroin. This lack of control of purity can result in hot shots of Heroin. Overdose from the hot shot dose because the purity is too high. Overdose from the hot shot dose because the purity is too high.

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Periods of extreme euphoria followed by extreme depression. Sedated appearance. Unkempt appearance. Dramatic weight loss.

Slide 30

Metropolitan Drug Enforcement Unit 262-548-7148

Slide 31

Treatment It really does work

Slide 32

2010: 7 million using psychotherapeutic drugs Pain killers 5.1 million Stimulants - 1.1 million Tranquilizers 2.2 million Sedatives - 0.4 million over 80% all detox admission are for IV drug use How Did We Get Here ?

Slide 33

Misperceptions about their safety. Medications are prescribed by doctors, many assume its safe to take under any circumstances. Increasing environmental availability. Between 1991 and 2010, prescriptions for stimulants increased from 5 million to nearly 45 million and for opioid analgesics from about 75.5 million to 209.5 million. Varied motives for their use. Underlying reasons include: to get high; to counter anxiety, pain, or sleep problems; or to enhance cognition. Whatever the motivation, prescription drug abuse comes with serious risks. Why?

Slide 34

Addiction is a medically recognized Brain Disease Not a moral failing Not related to your relationship with God Strong genetic component Why?

Slide 35

Many become addicted due to real pain issues and get cut off by prescribing MD, then turn to street drugs. Opiates deplete the bodys supply of endorphins - our natural pain management system. Use to block the pain, then use to avoid withdrawal, and then use just to feel normal. Most users quickly switch to heroin because of the lower price. Why?

Slide 36

Many local and leading company have made changes CVS Pharmacy are banning some MDs. CVS Pharmacy are banning some MDs. Milwaukee County E.R.s agreement Milwaukee County E.R.s agreement Treatment providers can go through T19 reviewer and request a pharmacy history or a Lock-in Suboxone prescribers must first go through specialized training and have limits the first few years Response

Slide 37

Unexplained financial problems Scabs, bruises Relationship / work / school problems Poor Hygiene Unclean household Complaints of constipation, muscle aches Sedation Symptoms

Slide 38

Shallow Breathing, pale / clammy skin Impaired cognitive function, confusion Anxiety Euphoria Mood swings Symptoms

Slide 39

1 Cold Turkey - rarely successful on own - rarely successful on own 2 Medically Monitored, medicates for W/D symptoms medicates for W/D symptoms 3 Medically Supervised -Suboxone -Suboxone - Short term use in detox - Short term use in detox - longer term use, Outpatient - longer term use, Outpatient 4 Methadone - requires strong motivation & support - requires strong motivation & support Detox

Slide 40

Buprenorphine (Suboxone / Zubsolv) Methadone Naltrexone / Vivitrol Medications for Drug Addiction

Slide 41

Approved for use since 2002 MD must go through training before able to prescribe, limits on number of clients Mixture of burprenorphine and naloxone (opiate agonist & antagonist) (opiate agonist & antagonist) One stops withdrawal / cravings and the other prevents euphoria Suboxone

Slide 42

Increased ability to treat addicts outpatient allows for continuation in daily routine Stops withdrawal and blocks cravings Danger of overdose Still requires a taper before stopping Comes in single dose packets Never should be over 16mg / day Suboxone

Slide 43

Opiate antagonist Parent drug is Narcan Blocks cravings & euphoria Will make you dope sick if use street drugs Also comes in injectable form but may be costly Works on alcohol too Must be opiate free for 10 days before use Can interact with some OTC cold medications Naltrexone

Slide 44

Oldest substitution for opiate addiction Never intended as a cure / treatment Requires daily visits for first 4 or 5 months Infrequent therapy Very long taper Methadone

Slide 45

Wisconsin has exceeded 500 deaths per year, 4 out of the last 5 years ; 512 for 2010 From 2002 to 2010, Mortality rate has increased 3.8% From 2006 to 2011, newly reported cases of Hepatitis C have increased 13% State Drug Related Deaths

Slide 46

2005 to 2010 Heroin deaths - increased by more than 50% Opiates related deaths - increased 33% Benzodiazepines - increased 60% Cocaine - down over 50% State Drug Related Deaths

Slide 47

From 2002 to 2010 the cost to provide treatment has risen 126% to 287 million dollars risen 126% to 287 million dollars From 2006 to 2010, the number of people seeking treatment with public funds, dropped 14% From 2002 to 2008, the amount of funds spent by the state on treatment decreased 12% 92 million to 75 million 92 million to 75 million Treatment

Slide 48

Components of Comprehensive Drug Addiction Treatment

Slide 49

No single treatment is appropriate for all individuals Effective treatment attends to multiple needs of the individual, not just his/her drug use Treatment must address medical, psychological, social, vocational, and legal problems Matching Patients to Individual Needs

Slide 50

Depends on patient problems/needs Less than 90 days is of limited/no effectiveness for residential/outpatient setting A minimum of 12 months is required for methadone maintenance Longer treatment is often indicated Duration of Treatment

Slide 51

Detoxification safely manages the physical symptoms of withdrawal Only first stage of addiction treatment Alone, does little to change long-term drug use Medical Detoxification

Slide 52

Effective treatment need not be voluntary Sanctions/enticements (family, employer, criminal justice system) can increase treatment entry/retention Treatment outcomes are similar for those who enter treatment under legal pressure vs voluntary Motivation to Enter/ Sustain Treatment

Slide 53

Goal of treatment is to return to productive functioning Treatment reduces crime by 40-60% Treatment increases employment prospects by 40% Drug treatment is as successful as treatment of diabetes, asthma, and hypertension Effectiveness of Treatment

Slide 54

Complements and extends treatment efforts Most commonly used models include 12-Step (AA, NA) Most treatment programs encourage self-help participation during/after treatment Self-Help and Drug Addiction Treatment

Slide 55

Treatment is less expensive than not treating or incarceration (1 yr methadone maintenance = $4,700 vs. $18,400 for imprisonment) Every $1 invested in treatment yields up to $7 in reduced crime-related costs Savings can exceed costs by 12:1 when health care costs are included Reduced interpersonal conflicts Improved workplace productivity Fewer drug-related accidents Cost-Effectiveness of Drug Treatment

Slide 56

Drug treatment is disease prevention Drug treatment reduces likelihood of HIV infection by 6 fold in injecting drug users Drug treatment presents opportunities for screening, counseling, and referral HIV/AIDS, Hepatitis and Other Infectious Diseases

Slide 57

Bridge to Action...Communities Coming Together Bridge to Action...Communities Coming Together

Slide 58

Event Sponsor