FREE ELECTRONIC LIBRARY - Abstracts, online materials

Pages:   || 2 |

«Initiative promoted by Dane County  District Attorney Ismael Ozanne. Hired Opiate Substance Abuse Counselor  to focus solely on Opiate-related ...»

-- [ Page 1 ] --



Opiate Initiative

Initiative promoted by Dane County

District Attorney Ismael Ozanne.

Hired Opiate Substance Abuse Counselor

to focus solely on Opiate-related offenses.

Dane County District Attorney’s Office /

Deferred Prosecution Unit.

Deferred Prosecution Unit

Participants can divert out of formal criminal court  process.

Complete intake and sign contract whereby  agreeing to several tasks to be completed by contract end or sooner.

Goal is to not repeat criminal behavior, make  positive changes, and in turn, the DA’s Office agrees not to proceed with prosecution.

Most participants are able to have charges  dismissed.

Opiate Participants My position from DOJ Grant.

 Contracts and expectations different than most  other DPU Clients.

Weekly face to face meetings, UA’s, treatment  goals proximal; minimum 8 written assignments.

Combined counselor, case manager, monitor,  referral agent, and support.

A diversion program, third tier of Drug Court.

 Opiates Opiates are limited to the natural alkaloids found  in the resin of the opium poppy. This includes morphine, codeine, thebaine, and of course, opium. In some definitions, the semi-synthetic substances that are directly from the opium poppy are also considered opiates, like heroin.

The term, Opiates, therefore, is commonly used  to refer to all opiate/opioid drugs.

Opioids A drug which produces morphine-like activity,  has the functional properties of an opiate.

Semi-synthetics and synthetics.

 This includes a wide variety of “painkillers”,  usually referred to today as Opioid Analgesics, replacing term narcotics and narcotic analgesic.

Fully synthetic opioids created separate from  natural opiates include methadone, meripidine, fentanyl, pethidine, tramadol.

Opioids Semi-synthetic opioids created from natural  opiates include hydrocodone, hydromorphone, oxycodone, oxymorphone, and buprenorphine, to name a few.

Heroin is a semi-synthetic.

 Opioids Endogenous opioids are those that are produced  naturally and stimulate our opioid receptors.

Endorphin: a specific endogenous opioid.

 Endorphins and other endogenous opioids are  proteins that act upon an opioid receptor.

Our bodies produce its own opioids in times of  stress/pain; enkephalins, dynorphins, endorphins.

These are all natural and short acting.

 Abbreviated History Opiates USA An entire semester class could easily be  devoted to the many facets of USA opium/opiate history; including international relationships; US policies, laws, & ramifications; production of drugs;

distribution of drugs; changing sentiments of addictions and its impact; physician roles; and the impact upon addicts.

Prescription Opioids/Analgesics Some painkillers stronger than others.

 The weaker end of the scale are drugs such as  codeine and propoxyphene (Darvon)/end 11/10.

For the higher end: Methadone, morphine,  hydromorphone, fentanyl, oxymorphone, and Buprenorphine.

Some opioids also have good cough-reflex  agents like codeine and hydrocodone.

Prescription Analgesics Some of these drugs retain a substantial degree  of their efficacy when administered orally.

Meperidine (Demerol), methadone, and oxycodone are prime examples.

Yet other drugs, like morphine or  hydromorphone, are greatly administered intravenously.

Many time a prescriber will recommend two  opioids: one for ongoing, chronic pain, and one for break-through pain.

What about Oxycodone OC/OP?

OxyContin (OC), ER Oxycodone, is a very  powerful opioid analgesic. It came without acetaminophen, making the dose pure opioid;

pills crushed to snort or shoot.

It was changed to Oxycodone OP (Opana, 2010)  Pill could not be crushed and abused in the same way as OC. A coating of polyethylene oxide polymer, rendering pill to not crush easily, and when mixed with liquid, it turns to a gel.

Abusers have solvents to extract the oxy, or, a  razor has been used to scrape off coating.

Prescription Opioids According to the CDC, amount of prescription  opioids sold to pharmacies, doctors and hospitals quadrupled from 1999 to 2010.

According to American Society of Interventional  Pain Physicians (ASIPP), US has 4.6% of the world population and consumes 80% of the world’s oxycodone supply and 99% of Hydrocodone, as well as two-thirds of the world’s illegal drugs.

14,800 fatal overdoses involving painkillers in US  in 2008.

Prescription Opioids According to the CDC, 46 people die every day  as result of overdose of an opioid analgesic.

Health care professionals wrote 259 million  scripts for opioid analgesics in 2012.

Some states have more analgesic scripts per  person than others; WI falls into the lowaverage range with 76 analgesic scripts per 100 people. Highest was AL & TN with 143 per 100 people. (2012) Some states have reduced due to PDM’s.

 ER/LA Opioid Analgesics REMS Extended-Release & Long-Acting Opioid  Analgesics Risk Evaluation & Mitigation Strategy.

FDA-Required REMS Program for serious drug  risks.

FDA wants to ensure the benefits of such drugs  outweigh the risk of adverse consequences, therefore, REMS is strategy to better manage this potential.

REMS: prescriber training on all ER/LA’s; The  Patient Counseling Document; Medication Guide Abuse Deterrent Technology FDA working on abuse deterrent formulations  (ADF). Hosted public meeting 10/30/14for development & regulations of abuse-deterrent opioid medications.

Reformulated OxyContin CR, 2010; Nucynta ER  (Tapentadol), 2011, and Opana ER, 2012.

INTAC: Grunenthal’s tamper-resistant  formulation. Uses polyethylenoxide (PEO) in a Hot-melt extrusion process; no aversive add-ins.

Other Deterrents Oxecta: an oxycodone product that is also hard  to crush, same unmanagable gel when wet, and an added substance of sodium laurel sulfate, which irritates nasal passages.

Adding naloxone to opiates, similar to Suboxone.

 Buprenorphine in transdermal patch so that it  could not be extracted.

Punch hole Buprenorphine, which signals  counselor or case manager when a tablet taken.

Forms of Ingestion Opioid pills can be taken orally, crushed and  snorted, crushed and injected.

Fentanyl Patches: cut open and eaten, sucked  on, a cut section placed sublingually, or smoked.

Poppy Seed Tea: brewed with “poppy straw”  (seedpod and/or stem), usually ground; poppy seeds and grapefruit juice shaken together, reducing the pH level, optimal for morphine extraction.

Long-Term Effects… Using opioids frequently and over a long time  period can increase tolerance to the drug, meaning that higher doses, and/or more frequent doses of the medication must be taken to achieve the same effect. It is easy to develop physical dependence, causing a person to experience withdrawal symptoms when the drug is not present.

Severe and chronic constipation.

 Opiate Withdrawal GI Upset: stomach cramping, nausea, vomiting,  diarrhea.

Tremor: slight observable to gross movements  and muscle twitching.

Sweating: chills or flushing, often notice facial  moisture or sweat beads.

Restlessness: difficulty sitting still, shifting  movements of legs or arms.

Anxiety: increased irritability, distraction of  attention.

Opiate Withdrawal Body Aches: self-reported aching of bones,  joints, muscles; rubbing of joints or muscles.

Yawning: pronounced or repeated yawning.

 Gooseflesh: mild to prominent piloerrection of  skin, or hairs standing up.

Pupils: pupils moderately to prominently dilated.

 Pulse: pulse rate 90-120.

 COWS: Clinical Opiate Withdrawal Scale  Medications to Assist Clonidine: ( HPB medicine) 0.1 mg, I tab every 6 hours: helps with cravings with  opiates Ondansetron: (Zofran) 4 mgs., 2 tabs every 6 hours: helps prevent nausea  Promethazine: (Phenergan) 25 mgs., every 4-6 hours: helps prevent nausea  Loperamide: (Imodium AD) 2 mgs., as needed to treat diarrhea; helps rejuvenate  bowels Dicyclomine: (Bentyl) 20 mgs., 1 tab TID: helps with Irritable Bowel  Tizanidine: (Zanaflex) 2 mgs., 1 tab TID: muscle relaxant  Ibuprofen: (Motrin) 200 mgs., 2 tabs every 6 hours, for soreness and pain  Cetirizine: (Zyrtec) 5 & 10 mgs., liquid, chewables, for sleep.

 Diphenhydramine: (Benadryl) 25 mgs., as needed, assist with sleep  Diphenhydramine (25 mgs.) & Acetaminophen (500 mgs.): Tylenol PM, assist with  sleep Withdrawal Aid: Dietary Supplement; 27 herbs, a tapering pill schedule.

 Elimidrol: Dietary Suppliment; ???

 Aloe Vera: can be used to treat hot flashes  Heroin In 2011, 4.2 million Americans 12 and older  used heroin at least once in their lives. It is estimated that approximately 23% of those who use heroin become addicted.

Substance Abuse and Mental Health  Administration (SAMHSA) est. 669,000 heroin addicts in US in 2012, up from 373,000 in 2007.

Both young men and women, ages 18-26.

 Heroin Known by Smack, Mud, Dope, Horse, Junk, China White,  Dragon, Diesel, and many others.

A major CNS Depressant, a Schedule I Controlled  Substance.

The most fast-acting of the opiates: especially when  injected, effects wear off 3-5 hours, or sooner.

Cut with cocoa powder, brown sugar, face make-up,  powder milk, and many other drugs.

Snort, inject, skin-pop, chase the dragon.

 Heroin Is more lipid soluble than morphine, therefore  penetrates the blood brain barrier faster.

Thus, greater euphoria and more intense, due to  a higher concentration.

This includes its major metabolite: 6-MAM,  (monoacetylmorphine) Perceived as a better opiate because of higher  concentrations in less time.

Heroin Overdoses US Attorney General, Eric Holder, released  statistic of a 45% increase in heroin deaths from 2006-2010.

Some states have astronomical increases:

 Maryland at 88% from 2011-2013.

WI heroin related deaths in 2012 was 206;

 increased to 227 in 2013.

2011: Wisconsin state crime labs processed 579  cases in 37 counties; 2012: 648 cases in 56 counties 2013: 1,056 cases from 57 counties.

 Heroin Overdoses Increase in dose or purity.

 Diminished tolerance due to changes in use  patterns, periods of abstinence, jail.

Aspiration of vomit while unconscious.

 Allergic reaction to Quinine, too much Quinine.

Place conditioning or environmental tolerance:

 use in same digs can display increased tolerance where repeated usages occur. Changing rituals/effects.

Psychological states of mind can alter effects.

 Heroin Heroin and Opiate Overdoses Combined Drug Interactions (CDI)  Sedatives/Depressants are deadly: Alcohol,  Barbiturates and Benzodiazepines.

Synergistic effects of these with opiates is  profound.

Long-term, and sometimes short-term, use  affects cognition, interferes with memory, causing potential amnesia.

Cocaine and Downers…speedballing.

 Opioid Intoxication Appearance is that the person is just sleeping.

 Number of breaths decrease and snoring may  be louder, i.e., opioid overdose breathing!

Opioids are potentially coma-producing.

 Death from opioid overdose the result of  respiratory arrest, heart still beats, color blue!

Tendency, as with alcohol, is to think they will  “sleep it off”.

Dane County, WI 2009: 15 Opiate related deaths, mostly heroin;

 81 overdoses.

2010: 23 Opiate related deaths; 97 overdoses.

 2013: 32 heroin related deaths in first 10  months 2013, 30% increase from 2012.

Several heroin addicts have overdosed multiple  times, all the while knowing the risks of death.

Dane Cty hospital visits for non-fatal overdoses  increased from 114/2006; 271/2011; 292/2012.

Heroin Heroin Production Biggest producer is Afghanistan.

 2004: 87% of world’s heroin.

 Cultivation of opium in Afghanistan remains  huge business.

Golden Triangle: Myanmar, Thailand, Vietnam,  Laos, and Yunnan Province of China.

Black Tar Heroin Mostly produced in Latin America and Mexico.

 Has varying degrees of purity due to a very crude  refinement process (Wright-Beckett) Can be very sticky and gummy, or hard like coal.

 Injection more risky over time due to clogged needles  and more rapid hardening of veins.

Mexican Heroin Production For many decades, the crude and less-refined Mexican  heroin was only a “poor man’s” substitute to Asian White, and later to Columbian heroin.

During 1990’s, Mexico capitalized on opportunities,  brought experts, chemists, and “consultants” from Asia to teach them the finer methods of growth and production.

Heroin purity up  Ritual of Heroin Ritual of Heroin Heroin brings up the sun, heroin brings in the  dark.

Heroin is not it; she is/he is.

 You make sure she/he is with you as you leave  town, and your first thought in coming back.

You are wrapped up with her/him in a warm  blanket.

A gentle and constant orgasm.

 Ritual of Heroin A false sense of security and protection, pain  and fear dissipate.

The very fast rush followed by tranquility, “on  the nod”. Time slows, emotion goes.

Cocooned and emotionally safe.

 Even months/years into recovery, in times of  anxiety, stress, pressure, that cocoon appeals.

Heroin is King/Queen: Inner circle connected by  money, incongruence of caring/protection.

The Face of Addiction The faces of addiction are the faces from  addiction.

They are filled with despair.

 Despair: from the Latin root, sperare, or hope.

 De-sperare is to lose all hope.

It presents as a profound dispiritness.

 The faces show the hearts filled with perceived  failure of character in a fertile darkness turned into despair.

Pages:   || 2 |

Similar works:

«Consumer, Physician, and Payer Perspectives on Primary Care Medication Management Services with a Shared Resource Pharmacists Network Marie Smith, PharmD and Michlle Breland, PhD University of Connecticut, Storrs, CT Objectives 1. Conduct focus groups with consumers and primary care physicians to: a. assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care med management services in a shared resource network. b. determine...»

«THE QUEEN OF FATS CALIFORNIA STUDIES IN FOOD AND CULTURE DARRA GOLDSTEIN, EDITOR THE QUEEN OF FATS WHY OMEGA-3s WERE REMOVED FROM THE WESTERN DIET AND WHAT WE CAN DO TO REPLACE THEM SUSAN ALLPORT UNIVERSITY OF CALIFORNIA PRESS B E R K E L EY LO S A N G E L E S LO N D O N University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its...»

«CHAPTER 19 THE BEST CONTROL FOR FLEAS AND MANGE Did you every wonder about the warning on a flea collar that warns you not to touch it, but it is “safe” enough for your pet to wear 24 hours a day, week after week after weak after weak.?DIAGRAM OF FLEA LIFE CYCLE OF FLEA PEST OVERVIEW THE SIX-LEGGED VAMPIRE THAT JUMPS Although there are over 2,200 species of fleas worldwide, with over 250 species of fleas described just in North America, only a few are commonly encountered by humans with...»

«Mosh: A State-of-the-Art Good Old-Fashioned Mobile Shell Keith Winstein and Hari Balakrishnan M.I.T. Computer Science and Artificial Intelligence Laboratory, Cambridge, Mass. {keithw,hari}@mit.edu Remote terminal applications are almost as old as packet-switched data networks. Starting with RFC 15 in 1969, protocols like TELNET, SUPDUP, and BSD’s rlogin and rsh have played an important role in the Internet’s development. The reader of ;login: has undoubtedly used the most popular of these:...»

«Runcorn All Saints EYG Runcorn All Saints Primary School, Church Street, Runcorn, Cheshire, WA7 1LD Inspection date 13/10/2014 Previous inspection date Not Applicable This inspection: 2 The quality and standards of the early years provision Previous inspection: Not Applicable How well the early years provision meets the needs of the range of children who 2 attend The contribution of the early years provision to the well-being of children 2 The effectiveness of the leadership and management of...»

«PROGRAM 4th Crowdinvesting Symposium Financial Decision Making and the Internet 4 November 2016 Max Planck Institute for Innovation and Competition, Munich This conference is part of the research project “Crowdinvesting in Germany, England and the USA: Regulatory Perspectives and Welfare Implications of a New Financing Scheme“, which was kindly supported by the German Research Foundation (Deutsche Forschungsgemeinschaft) under the grant number HO 5296/1-1. WELCOME Dear participants, We...»

«Elizabeth Macarthur High School M A C C H AT 38 Waterworth Drive, Narellan Vale NSW 2567 Phone: 4646 1899 Fax: 4647 1569 Issue 5—August 2013 Zone Champions Y ear 9 and 10 Debating Team won their third round on the 27th June at Leumeah High School. This win gave them the title of Zone Champions. The next round is against Bass Hill High School on August 13. The members of the Debating Team are: Joshua Costlow, Romel Tallow Samantha Harkness Jordan Schnieder Baladev Dayaram Mohammad Hassan...»

«click for previous page CARAN Alec 1 FAO SPECIES IDENTIFICATION SHEETS FAMILY: CARANGIDAE FISHING AREA 51 (W. Indian Ocean) Alectis indicus (Rüppell, 1830) OTHER SCIENTIFIC NAMES STILL IN USE: None VERNACULAR NAMES: FAO : En Indian threadfish Fr Cordonnier plume Sp Pámpano Indico NATIONAL: DISTINCTIVE CHARACTERS: Body deep, becoming more elongate with growth, and very compressed. Profile of nape and head somewhat angular; suborbital depth relatively broad, contained 0.8 to 1.0 times in upper...»

«COM 305 LISTENING Summer Term 2012 LEARNING GUIDE: Rick Bommelje Office: Fairbanks Building, Room 205 407-646-2625 Office hours by appointment rbommelje@rollins.edu www.Listen-Coach.com COURSE DESCRIPTION CATALOG DESCRIPTION: The study of the art of listening and its importance in our personal and professional lives. Students learn to analyze, assess, and improve their own listening abilities. Research indicates that the majority of our communication time is spent in listening. However, it is...»

«CHAPTER 12 Cross-Cultural Communication Deborah Tonnen.,:; INTRODUCTION: THE IMPORTANCE OF CROSS-CULTURAL COMMUNICATION The study of cross-cultural communication is central to both theoretical and applied linguistics. Examining the causes of misunderstandings in cross-cultural communication sets in relief the processes that underlie all communication but often go unnoticed when it proceeds successfully. Thus discourse analysts find cross-cultural communication a useful research site, apart...»

«RangeMax Wireless-N DSL Gigabit Modem Router Setup Manual NETGEAR, Inc. 350 East Plumeria Drive San Jose, CA 95134 November 2009 208-10345-02 v1.0 ©2009 by NETGEAR, Inc. All rights reserved. Trademarks NETGEAR and the NETGEAR logo are trademarks of NETGEAR, Inc. Microsoft, Windows, and Windows NT are registered trademarks of Microsoft Corporation. Other brand and product names are registered trademarks or trademarks of their respective holders. Statement of Conditions In the interest of...»


<<  HOME   |    CONTACTS
2017 www.abstract.dislib.info - Abstracts, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.