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ADDICTION

LORNE R. CAMPBELL SR. M.D.

UBMD Family Medicine UBMD Addiction Medicine

OPIOIDADDICTION

LORNE R. CAMPBELL SR. M.D.

UBMD Family Medicine UBMD Addiction Medicine

Pain

The 5th Vital Sign

1996

American Pain Society

1977

Pain needs to be treated

Pain ManagementNot relatedto Addiction

2008

Add

iction

Prescription Opioids

Med

icat

ion

Prescription Opioid Sales

2000 2002 2004 2006 2008 2010 2011150

200

250

300

Opioid Prescriptions (In millions)

Pre

scri

pti

on

s in

million

s

Prescription Opioid Problems

2004 2006 2008 20100

50,000

100,000

150,000

200,000

250,000

300,000

350,000

DRUG USE IN 12 – 15 YEAR OLDS

Marijuana

Nicotine

Opiates

1996

2012

Buffalo

Prescriptions for Opiate Pain Medications

Deaths Due to Pre-scription opiates

AgonistOpiatesOpioids

MorphineCodeineOpiumHeroin

OxycodoneFentanylHydrocodoneMethadone

NaloxoneNaltrexoneAntagonist

OralDepo

They can change if they wantLazyCraz

yStupi

dThey lack will

powerThey made the

choice

Disease

Disease

80% of alladdiction problemshave a genetic root

Disease

Limbic system

Fro

nta

l Lob

e

Neuron

SynapseSynaptic cleft

Nerve Cell Dendrite

Dopamine Neurotransmitter

Synapse

Down Regulation

Synapse

AgonistAntagonistPartial Agonist

What Can You Do?

Screening

Brief Intervention

Referral to Treatment

ASKADVISEASSIST

ASK

ASK?

ASKDISCUSS USE

ASKON A REGULAR BASIS

When Should You Screen

Before You Write

ASK

Hypertension DiabetesAnemiaLiver diseaseHepatitisHepatitis CHepatitis BCirrhosisVitamin Deficiencies TraumaMalnutritionStrokesSevere Weight Loss CancerSexual Abuse ObesityDementia Accelerated AgingWerincke – Korsakoff GoutElectrolyte AbnormalitiesLipid AbnormalitiesInterference with HealingGastric Ulcers InjuriesBirth Defects

Heart disease Lung Disease

Digestive disordersImpotence

DepressionSexual Dysfunction

Urinary Tract DisordersRelationship problemsEarly Menopause

SeizuresGynecomastia

PsychosisTremors

HeadachesNausea

PancreatitisInfertility

MigrainesBleeding Disorders

ArthritisPoverty

Insomnia

Family Dysfunction Crime

Accidents

Problems Related to Addiction

When Should You Screen

ASK

Opioid Risk Tool

Provides 5-item initial risk assessment

Stratifies risk groups into low (6%), moderate (28%) and high (91%)

Family HistoryPersonal HistoryAgePreadolescent sexual abusePast or current psychological disease

Lost scriptsIncreased demand

Not using as prescribedStrange urine tox screens

Warning Signs

ADVISE

ADVISE

ASSIST

Most addicted patients don’t know they are.

Consider the consequences of

use as the problem.

Do not blame the patient.

Monitor yourself

Think Patient Has a Problem

Do NothingGet Angry

Brief Intervention

Reschedule for reassessment

Brief Assessment

Refer for Treatment

Where to Refer

UBMBADDICTION MEDICINE

1408 Sweethome RoadAmherst NY, 14228

247 5281