Opioids and Abuse

MELANIE MILROE
HAMPTON UNIVERSITY SCHOOL OF PHARMACY
DOCTOR OF PHARMACY CANDIDATE 2018
What are Opioids?

A drug class that acts on opioid receptors to produce morphine like

effects
Used to relieve pain
Examples: Morphine, Oxycodone, Fentanyl
Controlled Substances Schedules

Schedule I- Highest potential for abuse

NO approved medicinal use
Examples- Heroin, marijuana, ecstasy
Schedule II- High potential for abuse
Approved medicinal use
Examples- Norco, Percocet, Dilaudid
Schedule III, IV, and V- Potential for abuse
Approved medicinal use
Examples- Suboxone, Xananx, Lyrica
Opioid Effects

Eurphoria
Drowsiness
Disorientation
Respiratory depression
Constricted pupils
Nausea

Effects Last 3-6 hours

Overdose
Overdose Effects

When a person overdoses on opioids, the receptors become

overwhelmed from the volume of that drug. Overwhelming these
receptors causes:
Respiratory depression
Hypotension
Bradycardia
The Source- Prescribers!!!

In 2014, doctors wrote almost 200 million prescriptions for opioid pain killers
The vast majority (81%) of opioids are eventually misused
However, more than half of nonmedical users obtain their drugs from
family or friends
According to cbsnews.com, President Obama believes that America's
addiction to painkillers is as great a threat as terrorism
People who are addicted to prescription painkillers are 40x more likely to
be addicted to heroin
Other Sources..

78 people die each day from overdoses of

opioids
prescription drugs
Heroin
One person dies everyday from an overdose in Chicago
Overdose deaths are highest in West Virginia, New Mexico, New
Hampshire, Kentucky and Ohio
Virginia Overdose Statistics
Virginia Overdose Statistics cont.
National Overdose Statistics
National Overdose Statistics cont.
A Deadly Combo

The extremely high rates of overdose are fueled by the toxic mix of
fentanyl powder and heroin
30-50 times more powerful than heroin
100 times more powerful than morphine
Shuts down kidneys, liver, swells the brain
Federal drug agents say that Mexican cartels have increased the
production of fentanyl and are smuggling it into the US.
According to cbsnews.com, in 2013 there were 84 fentanyl-and-heroin
overdose deaths in Ohio, but a year later there were 503
The Antidote
NALOXONE (NARCAN)
Naloxone (Narcan)

Naloxone (Evzio, Narcan) is an opioid antagonist used to treat narcotic overdose in an

emergency situation
Naloxone blocks opioid receptors in the brain and nervous system. Blocking these
receptors treats the respiratory depression caused by opioids.
Onset of 3-5 minutes and lasts 30-90 minutes
Naloxone can be used to reverse the effects of:
Fentanyl
Hydrocodone
Methadone
Morphine
Oxycodone
Tramadol
Naloxone Prescribing and Dispensing

The law authorizes a pharmacist to dispense naloxone in accordance to an

oral, written, or standing order issued by a prescriber.
When naloxone is requested, the pharmacist must provide counseling
(administration, response, dosing, effectiveness, etc.), and a REVIVE! Brochure
The pharmacist who dispenses naloxone shall dispense the drug and other
items for the kit as prescribed and in accordance with this protocol.
A standing order shall be valid for no more than two years from the date of
issuance and shall contain the following information at a minimum:
Name of pharmacy authorized to dispense naloxone pursuant to standing order;
Contents of kit
Prescribers signature
Date of issuance.
Kit Contents
Intranasal Auto-Injector Intranasal
Naloxone 2mg/2ml Naloxone 0.4 Narcan Nasal Spray 4mg, #2
prefilled syringe, # 2 mg/0.4 ml
syringes #1 twin pack SIG: Administer a single spray
intranasally into one nostril.
Administer
SIG: Spray one-half of the SIG: Use one autoinjector additional doses using a new
syringe into each nostril upon signs nasal spray
upon signs of opioid of opioid overdose. with each dose, if patient
overdose. Call 911. May Call 911. May does not
repeat x 1. repeat x 1. respond or responds and then
Mucosal Atomization relapses
into respiratory depression.
Device (MAD) # 2 SIG: Use No kit is required. Additional
as directed for naloxone Product is doses may be given every 2 to
administration. commercially 3 minutes
available. until emergency medical
Kit must contain 2 prefilled assistance
syringes and 2 atomizers arrives.
and instructions for
No kit is required. Product is
administration. commercially available.
Labeling and Records

Each vial or syringe of Naloxone shall be dispensed and labeled with the
exception that the name of the patient is not on the label.
Pharmacists shall maintain a record of dispensing
Dispensing to First Responders

A pharmacy, wholesale distributor, third party, or manufacturer may

distribute naloxone via invoice to the proper authorities who have
successfully completed a training program
Where do the authorities complete training?
REVIVE! Program

REVIVE! is the Opioid Overdose and Naloxone Education (ONE) program

for the Commonwealth of Virginia.
Provides training to professionals, stakeholders, and others on how to
recognize and respond to an opioid overdose emergency with the
administration of naloxone (Narcan)
Reducing the Epidemic
Solutions

President Obama proposed a $1.1 billion plan to combat the addiction

epidemic
CDC has come out with new guidelines for primary care physicians that
aim to reduce the overprescribing of opioids. For example,
Prescription pain killers should not be the first option when managing common
ailments such as back pain, arthritis, etc.
Patients should be encouraged to try exercise, physical therapy or OTCs
If prescription opioids must be prescribed, it should be the lowest effective dose
possible
If patient is significantly improving, doctor may continue to prescribe
Solutions cont.

According to USA Today, doctors are urged to consider prescribing

buprenorphine to treat opioid addiction
available in pill or dissolvable strip form
Some will trade their buprenorphine for a different street drug
Something New!

This year, an FDA committee voted in favor for the approval of

Probuphine, an implant that provides a steady dose of buprenorphine.
Officially approved in May
Shown to be more effective than the strips
How does it work?

Implant is put just underneath the skin of the inner arm and releases a
steady dose of buprenorphine
lasts for 6 months
It helps stabilize the brain chemistry and takes away cravings
New Drug Concerns?

In order to safely transition from the oral buprenorphine to the implant, the
patient must wait 4 weeks until the Probuphine will deliver the same
amount of drug that the oral dose supplies. During those 4 weeks, the
patient is to continue taking the oral dose.
Transition period could lead to relapse
Risks include bleeding and infection
From new incision every 6 months
Thank You!!!
References

http://www.dbhds.virginia.gov/individuals-and-families/substance-abuse/revive
http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7338
http://www.dbhds.virginia.gov/individuals-and-families/substance-abuse/revive
https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
https://www.dhp.virginia.gov/pharmacy/news/NaloxoneProtocolForPharmacists.pdf
http://www.cbsnews.com/news/president-obama-american-opioid-addiction-as-great-a-threat-as-terrorism/
http://www.cbsnews.com/news/fentanyl-opioid-overdoses-kill-10-people-in-12-days-in-sacramento-area/
http://www.cbsnews.com/news/dangerous-heroin-fentanyl-opioid-combination-fuels-overdoses/
http://www.drugfree.org/news-service/fentanyl-laced-heroin-worsening-overdose-crisis-officials-say/
http://www.cbsnews.com/news/opioid-painkiller-guidelines/
http://www.usatoday.com/story/news/health/2016/08/22/pediatric-group-says-doctors-should-treat-teen-opioid-addicts-
medicine/89042316/
http://www.cbsnews.com/news/fda-panel-favors-approval-of-implant-to-treat-opioid-addiction/