Transcript Slide 1
Primary Care Drug Diversion:
Psych co-morbidities in teenage patients with addictions and opioid dependence
Primary Care Drug Diversion:
Emergency Department CME Meeting
Minimizing Opiates in the Medicine Cabinet
William Morrone DO, ASAM, ACOFP, DAAPM Medical Director, Hospice of Michigan CT 101 Consulting Liaison Addictionologist @ Wolverine Human Services Assistant Director of Family Medicine @ Synergy Medical Education Alliance MSU - CHM
Ethical speakers are required to give:
• • • • • • • • CREDENTIALS A NEEDS STATEMENT FINANCIAL DISCLOSURES CONFLICTS OF INTEREST PURPOSE OF CURRICULUM A RISK DISCLOSURE CITATION GOALS
Who is speaking?
• • • • • • • • • ACOFP board certified primary care physician Family Medicine educator (Synergy Medical) Joint appointment to Dept. of Psychiatry Credentials in Pain and Addiction Credentials in Forensics/Deputy Med Examiner Armed Forces Institute of Pathology Masters Tox/Pharm U. Missouri at KC/Pharm Active pain consultant & Hospice Director Activist, advocate & addictionologist
Needs statement
8
$$ Disclosures $$
Lawyers
DMC MHPCO MOA MAOFP MAFP (MSMS) MSU-SCS AOAAM/AOA HealthPlus Memorial Healthcare MidMichigan Medical Center
Purpose of this curriculum and disclaimer
This curriculum includes the core information for the evaluation of patient risk for opioids. Treatment decisions should be made based upon the individual patient, the level of risk and available resources to reduce diversion. The standard of care constantly evolves and this lecture will review the current status. Physicians who use opioids are responsible for their own decisions. Dr. Morrone does not assume any patient care responsibilities. 11
Upon completion of this course participants will be able to:
• • • 1) Describe the prevalence of the illicit use of prescription drugs by Midland County youth.
2) Discuss the causes of the increase in illicit use of prescription drugs by Midland County youth.
3) List strategies to reduce and prevent youth from obtaining illicit prescription drugs.
Target of Change Issues
• • Teenagers at schools were drugs are used, sold and kept are more likely to use.
Illegality of drugs deters use.
CASA 2005 drug survey, (
C
enter on
A
ddiction and
S
ubstance
A
buse at Columbia University) “High stress, frequent boredom and too much spending money are a catastrophic combination for many American teens,” said CASA Chairman and President and former U.S. Secretary of Health, Education and Welfare
Joseph A. Califano, Jr.
Reasons behind drug diversion:
• • • • • • • • • # 1 undiagnosed psychiatric co-morbidity # 2 peer non-medical use of prescription # 3 drug access has too few barriers # 4 reluctance to monitor UDS, MAPS etc… # 5 unknown resources to help recovery # 6 inherit drug diverting teen from other PCP # 7 Parents are involved in diversion & misuse # 8 Parents are not involved in teen’s life # 9 teen insulated from criminal consequences
I have been to the dark side.
MMMC 2005-07 drug abuse admissions • •
15-19 y/o 20-24 y/o 13% 16%
• • • • 25-34 y/o 35-44 y/o 35-54 y/o 55 y/o + 16 % 22 % 19% 14%
Rule CHANGES in our model
• • • • • • • • MAPS use to identify patients/parents at risk.
Target parents taking Norco, Valium and Soma.
UDS the teens at risk.
Operation Medicine Cabinet programs (OMC).
Psychiatric screen teens for stress and ASPD. Naloxone in home and high risk environments.
Public school programs involving parents. Look for intoxication and withdrawal in teens.
Issue Date Michigan Automated Prescription System Fill Date Strength
24TH ST 3973 M-140 BOX 127 211 WEST MONROE
Rx Number Practitioner DEA# Practitioner Address Dispenser DEA# Dispenser Address
Xxxxxxxxxxxxxxxxxxxxxxxxxx SAGINAW,MI,486020000 MI,48724 02/27/2008 0697649 02/27/2008
FALES,THOMAS
I PA MF0845644
LLANTO,ALFONSO GENERALAO
MD
WALGREEN CO.
BW7042877 3566 MADISON
APAP/HYDROCODONE BITARTRATE
SAGINAW,MI,487061274 101 S JEFFERSON, ADVANCED DIAGNOSTIC IMAG40IN9 GW P GCENESEE AVE, DBA: WALGREENS # 06091 TAB 100.00 750 MG-7.5 MG
SWANSTRA PHARMACY
Xxxxxxxxxxxxxxxxxxxxxxxxxx BANGOR,MI,490130000 MI,49013 02/21/2008 4455762 02/21/2008 AL8119299 BS9992618
CODEINE/PROMETHAZINE
SYR 120.00 10 MG/5 ML-6.25 MG/5 ML WATERVLIET,MI,490980000 Xxxxxxxxxxxxxxxxxxxxxxxxx
LLANTO,ALFONSO GENERALAO
MD
SWANSTRA PHARMACY
BANGOR,MI,490130000 MI,49013 02/21/2008 4455760 02/21/2008 AL8119299 BS9992618 24TH ST 3973 M-140 BOX 127 211 WEST MONROE
APAP/HYDROCODONE BITARTRATE
WATERVLIET,MI,490980000 TAB 60.00 500 MG-10 MG Xxxxxxxxxxxxxxxxxxxxxxxxx
ONONUJU,CHIDOZIE JOSHUA
DO
FALER DRUG STORE
SAGINAW,MI,486020000 MI,48724 02/14/2008 0097483 02/14/2008 BO6319013 AF6556457 3566 MADISON 1320 NORTH MI AVE WENZEL EDWARD GUSTAVE
CODEINE/PROMETHAZINE
SYR 180.00 10 MG/5 ML-6.25 MG/5 ML SAGINAW,MI,486020000 Xxxxxxxxxxxxxxxxxxxxxxxxx
QUARTERS,JACK ELWOOD DO PRINCING'S PHARMACY
SAGINAW,MI,486020000 MI,48724 02/13/2008 0774680 02/13/2008 AQ3067825 AK5912402 3566 MADISON 1438 SCHUST RD 333 S MICHIGAN AVE
APAP/HYDROCODONE BITARTRATE
SAGINAW,MI,486040000 TAB 60.00 750 MG-7.5 MG
QUARTERS,JACK ELWOOD DO PRINCING'S PHARMACY
Xxxxxxxxxxxxxxxxxxxxxxxxx SAGINAW,MI,486020000 MI,48724 02/13/2008 0774681 02/13/2008 AQ3067825 AK5912402 3566 MADISON 1438 SCHUST RD 333 S MICHIGAN AVE
CODEINE/PROMETHAZINE
SYR 240.00 10 MG/5 ML-6.25 MG/5 ML SAGINAW,MI,486040000
Run Date :
3/19/2008 11:21:19AM
Warning :
This report contains confidential information,including patient identifiers,and is not a public record.
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What is drug diversion?
Ten Sixteen webpage www.1016.org
• • •
People come to Ten Sixteen Recovery Network with life stories that don't match their dreams. Hope has been lost. The staff at Ten Sixteen is here to help change that story.
It starts with trust. We listen. We don't make judgements. We build a partnership. We show the client this isn't how the story has to go after all. Life has possibilities. Through gut-wrenching honesty and hard work, they can free themselves from the past. They can find joy in a new way of living.
Our goal is far more than abstinence. It is about changing the whole person. Living with honesty and integrity. Being responsible. Developing a new vision for the future. Creating a plan to make that real. Finding the spirit to keep going. Finally free. Finally Strong. They have found where they belong, equipped to change their story. Hope is restored.
Ten Sixteen Outpatient
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Alcohol
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Marijuana
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Opiates
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Cocaine/crack
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Heroin
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Rx 45 % 26 % 9 % 8 % 1 % 1 %
Ten Sixteen inpatient drug use
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Alcohol
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Marijuana
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Cocaine/crack
•
Rx
47 % 6 % 12 %
34 %
DIGFAST on the radar?
• • • • • • •
D
istractible
I
ndiscretion
G
randiosity
F
light of ideas
A
ctivity increase
S
leep problems
T
alkative
Get your own web copy.
www.dbsalliance.org/pdfs/MDQ.pdf
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Narcotic CRIME trends
• • •
Midland 2000 -- 37.51 % Midland 2004 -- 50.83 % INCREASE of 36 %
• • • Third District -- 37.86 % Third District -- 45.36 % INCREASE of 20 %
• • • • • • • • •
Options and Examples
TEN Sixteen Network Dr. Rene Thomas-Clark pediatric psychiatrist Recovery Pathways, LLC licensed treatment Dr. Doug Foster, addiction psychiatrist (AAAP) Wolverine voluntary Vassar boot camp White Pine psychiatric inpatient residential Vista Maria psychiatric inpatient residential BRMC psychiatric inpatient mental health Dr. Dale D’Mello inpatient St. Lawrence MSU
Recovery Pathways
Kim Debelak Executive Director
Contract Counseling, Education, Mental Health & Substance Abuse Resources
Recovery Pathways, LLC
• 717 East Midland Street, Bay City, MI 48706 • • • (989) 928.3566 business office (989) 891.9199 fax Kim Debelak, Executive Director • [email protected]
Recovery Pathways uses CLIA waived UDS.
Recovery Pathways, LLC offers focused growth oriented services for communication, stress, depression, anger management, PTSD assault, anxiety, bipolar-mood, parent/child/family issues, addictions, identity issues, parent education, conduct disorder adjustment issues and frank substance abuse.
Special problems to teenagers
• • • • • • • Teenagers see themselves as indestructible.
Without juvenile justice they’re not motivated.
Faulty thinking and poor judgment remain.
Parents insulate and protect bad behaviors.
Peer pressure and friends don’t change enough.
Medicalization and CBT are expensive and slow. Primary care doesn’t have the time.
You should be drug testing everyone.
• • • • • • When teens are in trouble at school.
When teens are lying and they get violent.
When teens have friends change.
When teens don’t come home.
Annual physical or sports physical.
When teens are hiding cigarettes and alcohol.
“You can’t prevent it, if you don’t monitor it.” PUBH-6145: Epidemiology, Walden University MPH
Upon completion of this lecture participants will be able to:
• • • 1) Describe the prevalence of the illicit use of prescription drugs by Midland County youth.
2) Discuss the causes of the increase in illicit use of prescription drugs by Midland County youth.
3) List strategies to reduce and prevent youth from obtaining illicit prescription drugs.
Summary of Change Issues
• • Teenagers at schools were drugs are used, sold and kept are more likely to use.
Illegality of drugs deters use.
CASA 2005 drug survey, (
C
enter on
A
ddiction and
S
ubstance
A
buse at Columbia University) “High stress, frequent boredom and too much spending money are a catastrophic combination for many American teens,” said CASA Chairman and President and former U.S. Secretary of Health, Education and Welfare
Joseph A. Califano, Jr.