The Opioid Epidemic
•The CDC has reported 52,404 total overdose deaths in 2015 and 33,091
(63.1%) involved opioids
•144 drug overdose deaths per day
•The number is up 11.4% in just one year (up from 129/day in 2014)
•Overdose deaths is the leading cause of injury death in the United
States, surpassing those deaths due to gun violence or automobile
injuries.
•The death rates from synthetic opioids (other than methadone)
increased by 72.2% from 2014-2015
•Deaths caused by heroin overdose increased by 20.6%
•19 states showed significant increases in drug overdose deaths from
2014.
Source: Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths—United States, 2010-2015. MMWR Morb
Mortal Wkly Rep.ePub: 16 December 2016. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1
The Impact of Opioids in South Carolina
5,702 patients were discharges from emergency departments (EDs) with issues
related to opiate abuse/dependence in 2015.
2,398 patients were discharged from EDs with issues related to opiate
overdose/poisoning in 2015.
135% increase in service utilization at state-funded substance use disorder
treatment programs for individuals looking for help with an opiate use
disorder- from CY 2006 (2,469) – to CY 2016 (5,803).
Opioid-Related Deaths
In 2015, there were 594 opioid-related deaths in SC vs. 311 homicides. Up
16.9% from 2014 (508).
Growing opioid epidemic in the US with increase in drug overdoses driven largely by
an explosion in addiction to prescription painkillers and heroin.
Estimated Age-adjusted Death Rates for Drug Poisoning by County, United States1
1999
1 Rossen
2014
LM, et al. (2016) “Drug poisoning mortality: United States, 1999–2014.” National Center for Health Statistics, CDC.
Overview of Opioids
•What are Opioids
◦Includes illegal drugs like heroin as well as prescription meds used to
treat pain such as Percocet, Oxycontin, etc. (more examples on following
slides)
•How opioids work:
◦They bind to specific receptors in the brain, spinal cord and
GI tract and also:
◦Minimizes the “perception of pain”
◦Stimulates the “reward centers” in the brain
◦Effects other systems that regulate mood, breathing and blood
pressure.
Opiates Are Drugs Derived from/similar to opium
OPIOIDS
NOT OPIOIDS
Cocaine or crack
Heroin
Methamphetamines
Morphine (named after Morpheus-Greek God of sleep)
Methadone
Benzodiazepines (Xanax, Valium, Ativan,
Klonopin)
OxyContin (long acting oral opioid)
Phenergan
Oxycodone (Percocet)
Seroquel
Hydrocodone (Lortab, Vicodin)
Neurontin
Fentanyl
Muscle Relaxers (Soma, Flexeril)
Many others….
Alcohol
Often, overdoses involve one or more of the drugs on the right in
combination with opioids.
How Does Overdose Occur?
•Taking meds originally prescribed for someone else
•Dosing error: by prescriber, pharmacist or patient’s misunderstanding
of directions for use
•Deliberate misuse of a prescription opioid or illicit drug like heroin
• Heroin on market today is extremely inexpensive yet so pure it can be
snorted.
• We are seeing synthetic forms of fentanyl being mixed into heroin that is
then snorted or injected. Both forms of administration can be deadly!
•When mixing opioids with alcohol or certain other meds (even overthe-counter meds)
Who Is At Risk?
Main categories include persons who:
• Are using prescription opioids for long-term cancer management
• Are using prescription opioids for non-medical use
• Use heroin-- mainly due to:
• Variation in strength/purity of “street” drugs or lack of knowledge of
dosage/strength of pharmaceuticals (ex. may be laced with fentanyl)
• Switching mode of administration (eating pills to snorting/snorting to injecting)
• Inexperienced or new users
• Using alone
Who Is at Risk Continued
Others at risk include persons:
• Receiving rotating opioid medication regimens (risk for incomplete cross-tolerance)
• Discharged from emergency medical care following opioid overdose/poisoning
• With a known/legitimate medical need for analgesia and a suspected or
confirmed history of substance abuse
• With a lowered tolerance:
• Completing mandatory or voluntary detoxification or abstinence only treatment program
• Past user or abuser of opioids and recently released from incarceration
• Mixing various drugs: opioids and benzodiazepines
• Who have poor physical health:
(i.e. liver damage, asthma, immune deficiency/AIDS, malnutrition, etc.)
What Is Being Done in SC to
Address the Opioid Epidemic?
Narcan ©(Naloxone HCI) Nasal Spray 4mg
How Naloxone Works
• Opioids attach to brain receptors that minimizes pain but
that also effects breathing
• Naloxone reverses the effects of opioids by binding more
strongly to the same receptors and temporarily “taking
over” and knocking the drug off these sites so that
breathing can be restored.
• Only works on opioids. It does not work for overdoses
caused by substances such as cocaine, amphetamines,
ecstasy, GHB, or alcohol.
• It does not have the potential for abuse and does not
increase risk-taking behavior. (cannot be used to get high
and it is not addictive)
• It has a long safety history and reported side effects are
rare.
• It can be easily and safely administered by laypersons.
The Joint Protocol
The joint protocol authorizes any pharmacist practicing in the State of
South Carolina and licensed by the South Carolina Board of Pharmacy
to dispense the following Naloxone-Hydrochloride products to
persons without a prescription as directed pursuant to § 44-130-40 of
the South Carolina Code of Law.
http://www.llr.state.sc.us/pol/pharmacy/news/Joint_Naloxone_Protocol.pdf
See copy of joint protocol in handouts
The SC Overdose Prevention Project
• Funding amount: $3,192,772
• Project Period: Five years
Partner Agencies:
• SC Department of Health and Environmental Control
(SC DHEC):
• Bureau of Emergency Medical Services (EMS)
• SC DHEC, Office of Public Health Statistics and
Information Services (PHSIS)
• The Fifth Judicial Circuit Solicitor’s Office
Suggested Reading Resource
•Facing Addiction in America: The Surgeon
General’s Report on Alcohol, Drugs and Health
•Dreamland: by Sam Quinones
A True Tale of America’s Opiate Epidemic