Opioids

www.ZeroAttempts.org

A Son’s Addiction vs. A Daughter’s Addiction: Gender Differences In Drug Use and Recovery
When Opioid Pain Relievers Are Prescribed For Your Child: What You Should Know

Are There Any Alternatives When A Physician Offers My Child Opioids for Pain?

VA Efforts to Prevent and Combat Opioid Overmedication - Watch 11/15/17 hearing 2:15:27
Call opioid addiction what it is - and act (USA Today May 8, 2018)
What Happens When My Son or Daughter Goes Through Opioid Withdrawal?
Why Can’t My Kid Stop Using Opioids?”
Countering the problem of opioid addiction
Oregon has one of the highest rates of prescription opioid misuse in the nation

Getting Help

Top 10 Oregon counties for prescribing opioids - Curry County No. 1
Oregon leads U.S. in seniors hospitalized for opioids

2015 state rates of opiod-related hospital stays* per 100,000 people age 65 and over

Oregon opioid overdose deaths ranked by county, 2001-2015
The Oregon Health Authority's Opioid Data Dashboard interactive graphic
Reducing Opioid Overdose and Misuse
What drugs are the most commonly abused?
Poly drug use

Opiate Painkillers and Poly-Drug Abuse Among Young People
Polydrug Use: Get the Facts

Resources: Addiction; Parent Toll-Free Helpline: 1-855-DRUGFREE or drugfree.org

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14:42
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Effects of Opioids on the Brain
Everything you think you know about addiction is wrong | Johann Hari
How to Help Your Child Struggling with Substance Use
How addiction changes your brain
Mechanism of Drug Addiction in the Brain, Animation

A Son’s Addiction vs. A Daughter’s Addiction: Gender Differences In Drug Use and Recovery


Addiction is a living nightmare for both men and women. However, there are real differences in the development of substance use disorders in men and women, how they experience the consequences of their use, and their particular needs for treatment and ongoing recovery. Below, take a look at the major differences between men and women with substance use disorders and the importance of gender-specific addiction services.

Women

Today, we know that there are a number of biological differences between men and women that impact the development of addiction. Women develop alcohol-related dependence faster and with a lower amount than men do. This is because women generally have more body fat and lower volume of body water to dilute alcohol. Women also develop health-related problems, such as breast cancer and nerve damage, due to substance use faster than men do.

Psychologically speaking, women are more likely than men to have co-occurring substance use and mental health conditions. Women more often meet diagnostic criteria for mood disorders, depression, agoraphobia, PTSD, anxiety and eating disorders. They are also more likely to have been sexually or physically abused or experienced interpersonal violence. Rates for sexual abuse in childhood and adulthood are reportedly higher in women than for men. These experiences can have a large impact on the what types of services they require during their recovery. This includes clinically-sound, trauma-informed programming that treats addiction alongside other mental health conditions. Trauma-specific intervention programs generally recognize the interrelation between trauma and symptoms of trauma, such as substance use, eating disorders, depression and anxiety.

Perhaps most importantly, we know that women are more stigmatized for their substance use conditions. They report higher feelings of guilt and shame surrounding their substance use. These feelings are often related to the gender-specific roles, often associated with caregiving. Many women also tend to have one parent who has abused substances, which may factor into the development of addiction.

If you’re looking for treatment for your daughter, niece, granddaughter or another young woman in your life, and as a result of the significant differences in the way in which substance use conditions present for women, consider services that are tailored to women’s needs and obstacles they experience. Services for women in substance abuse treatment should include women-only programming (due to trauma history and other issues), strong female leaders and providers, peer support and cultural training and programming that addresses the unique needs of women in treatment.

Men

Regardless of age or race, men use alcohol and drugs more frequently and in greater quantities than women. They often start using alcohol and other drugs for different reasons than women. For many young men, male institutions and social rites of passage (sports, fraternities, etc.) encourage the use of alcohol. Men generally start binge drinking at an earlier age than women. Binge drinking is also more prevalent in men and is more likely to result in alcohol-related problems. Due to higher frequency and quantities as well as binge drinking habits, men are five times more likely to develop a substance use disorder.

Though we know that although men are less likely to be forthcoming, many have significant histories of childhood physical and sexual abuse or current victimization by domestic partners. They are more likely to die from suicide, despite being less likely to attempt suicide. They often feel excessive amounts of shame when dealing with emotional and substance abuse problems, making it less likely that they will seek out medical or behavioral health counseling for their problems. Once in treatment, men often struggle with talking about their emotions and how to deal with them appropriately.

If you are looking for treatment for your son, nephew, grandson or another young man in your life, consider programming that addresses effective communication training, sexual identity issues and skills for managing difficult emotions. Also look for mental health services that address sexual issues, PTSD and anger management. Like with women, all-male group therapy has proven to be highly effective and structured activities with other men can provide the necessary peer support. Individual therapy with a positive male role model as well as female clinicians who model appropriate female-male relationships are also beneficial in the recovery process.

Why Gender-Specific Programming Works

There is a significant disparity in substance use disorders rates between men and women. These differences range from greater access and opportunity for use to increased social pressure and possibly a greater genetic disposition to use substances. Men and women may find that they benefit, in critical ways, from having gender-specific programs available to them. Men and women do better in treatment and continued care when they have treatment customized to meet their particular needs.

If your child is transgender or identifies in another way, it’s especially important to find programming that is LGBTQI-sensitive and trauma-informed.

Recovery and positive clinical outcomes are possible with more specialized care.
Source: drugfree.org/parent-blog/a-sons-addiction-vs-a-daughters-addiction-gender-differences-in-drug-use-and-recovery/?utm_source=email&utm_medium=parent&utm_campaign=gender-differences-addiction

When Opioid Pain Relievers Are Prescribed For Your Child: What You Should Know


Used appropriately, medicines can improve our lives. When misused and abused, however, the consequences can be devastating. The overprescribing and misuse of prescription pain relievers has been a major cause of today’s epidemic of opioid addiction and overdose deaths, with four out of five heroin users reporting that they misused prescription opioids before using heroin.

This overview is intended to help you know what questions to ask when a healthcare provider recommends or prescribes a pain reliever for your child, and how to be sure that your child takes the medication as prescribed without misusing the medication or sharing it with others.

What are some common opioid pain relievers?

  • Hydrocodone (Zohydro)
  • Hydrocodone + Acetaminophen (Vicodin)
  • Oxycodone (Oxycontin, Roxicodone)
  • Oxycodone + Acetaminophen (Percocet)
  • Codeine, Morphine, Fentanyl
  • Tylenol with codeine

There are also non-opioid pain relievers (gabapentin, for example) that also have a potential for misuse and abuse, but much lower than that of opioids.

Why is the Misuse of Prescription Pain Relievers So Dangerous?

Opioid pain relievers are powerful drugs — very similar to heroin in their chemical makeup, and habit-forming by their very nature. This is why the U.S. Centers for Disease Control (CDC) strongly recommends against the prescribing of opioids for long-term treatment of chronic pain. Even for treatment of acute (short term) pain, opioid pain relievers should only be prescribed and taken sparingly.

The risk of addiction is particularly concerning when the patient is a teen or young adult because their brains are still developing and therefore biologically predisposed to experimentation. So if your teen or young adult is prescribed opioid pain relievers,you or your child’s caregiver should control the medication, dispense it only as prescribed and monitor their children closely for signs of misuse or growing dependence.

In addition to the danger of dependence, misuse of opioids can cause dramatic increases in blood pressure and heart rate, organ damage, difficulty breathing, seizures and even death.

Why Would a Young Person be Prescribed an Opioid Pain Reliever?

Opioid pain relievers are most often prescribed following surgery or to treat cancer pain –- so many young people will not be in a position to be prescribed opioids. But opioids may be prescribed for young peoplein the event of accidental injury -– a sports-related injury, for example, or a biking accident in which a fracture or even a severe sprain occurs. Another reason for which opioids are often prescribed to young people is oral surgery to remove wisdom teeth. Additionally, there are other ailments –- sickle cell disease or other pediatric chronic pain conditions –- for which opioids may be recommended.

What Questions Should You Ask Your Child’s Healthcare Provider When an Opioid Pain Reliever is Recommended or Prescribed?

  • Is a prescription opioid necessary to treat my child’s pain? Might an over the counter (OTC) pain reliever such as acetaminophen (e.g., Tylenol), in combination with a non-steroidal anti-inflammatory drug (NSAID) be just as effective? For chronic pain, can we explore alternative treatments such as physical therapy, acupuncture, biofeedback or massage?
  • How many pills are being prescribed, and over how long a period? Is it necessary to prescribe this quantity of pills?
  • What are the risks of misuse? (The prescriber should be able to answer this question for the specific drug being prescribed.)
  • Should my child be screened to determine his/her risk of substance use disorder (SUD) before this medication is prescribed? If not, why not? (Common risk factors include co-occurring mental health disorders such as depression or ADHD, as well as a family history of addiction or a recent trauma such as a death in the family or a divorce.)

What Should You Do if an Opioid Pain Reliever Has Been Prescribed for Your Child?

  • Safeguard medication at home – i.e., don’t just leave it in the medicine cabinet where anyone, family or visitors, can access it. Dispose of unused medication at a local “takeback” event or -– as an alternative where no takeback opportunities exist — by mixing the medication with coffee grounds or other unpleasant garbage and throwing it out.
  • As mentioned above, supervise the dispensing of the medication, counting the pills in the bottle to be sure they are being taken as prescribed. Clearly document when the prescription was filled and when a refill will be needed -– and be suspicious of any missing medication.
  • Communicate with your child about the risks of misuse, and be very clear that the medication is not to be shared with others.
  • Communicate regularly with your child about the level of pain he/she is feeling, making sure the pain is diminishing with time and staying alert for any signs that your child is growing dependent on the medication.

What Signs of Misuse or Dependence Should a Parent Be Alert For?

  • Signs of misuse can include drowsiness, nausea, constipation, slowed breathing and slurred speech.
  • You should be concerned if your child is asking for pain medication more frequently than prescribed, or if he/she is insistent on refilling the prescription. If necessary, the prescriber should be consulted to determine if pain is persisting beyond its expected term.
  • Signs of withdrawal –- which would occur if a child has become dependent on an opioid and then stops taking it –- include anxiety, irritability, loss of appetite, craving for the drug, runny nose, sweating, vomiting and diarrhea.

If you are concerned that your child may be dependent on pain medication, consult the prescriber (who may in turn consult with a pain specialist), and they should also consider having a substance use counselor complete an assessment. An assessment should include a thorough look at the extent of your child’s drug and alcohol use, his/her mental and physical health as well as personal, medical and family history.

Download our Opioids eBook

Get a comprehensive overview of the opioid epidemic — how opioids affect the body, the risks involved and how you can help your family stay safe. HEROIN, FENTANYL & OTHER OPIOIDS A Comprehensive Resource for Families with a Teen or Young Adult Struggling with Opioid Use (52 page PDF)
Source: drugfree.org/parent-blog/parents-know-opioids-pain-relievers-prescribed-child/?utm_source=email&utm_medium=parent&utm_campaign=when-opioids-prescribed

Are There Any Alternatives When A Physician Offers My Child Opioids for Pain?


Whether your child has struggled with opioid dependence or other substance use issues previously, or whether you’re just concerned about the current opioid crisis, there’s good reason to want your son or daughter’s pain to be managed by something other than prescription opioid pills. Eventually, your child might have an orthopedic injury or need a tooth pulled at the dentist, so what happens then?

While opioid medications may be effective for treating pain in the short-term, they have an extremely high propensity for addiction and do nothing to address its underlying cause.

The good news is that there are many alternatives to opioids that can help alleviate your son or daughter’s pain. We’ve helped to spell them out for you and have provided guidance on how to ask your doctor about these alternatives:

What Are Some Alternative Medications for Pain That Can Replace Opioids
What if My Child Has Chronic Pain?
Are There Any Surgical Solutions for Chronic Pain?
Read the Full List

 

What Happens When My Son or Daughter Goes Through Opioid Withdrawal?


One of the reasons that opioids, which include heroin and prescription pain pills like OxyContin or Vicodin, are so addictive is that when a person stops after consistently using, he or she begins to experience painful withdrawal symptoms.

“I wouldn’t wish it on my worst enemy,” said Mike, a 24-year-old Naltrexone (Vivitrol) patient committed to recovery. “It’s the worst thing you could think of.”

Because of learned responses in your loved one’s brain that come from opioid use, once he or she has “detoxed” — meaning that the body is free of the drug — he or she is still highly susceptible to relapse.

In the video below, experts Alicia Murray, DO, a Board Certified Addiction Psychiatrist, and Adam Bisaga, MD, a Professor of Psychiatry at Columbia University, describe what opioid withdrawal is really like and how use of medications in a treatment plan can help ease (or alleviate) the brain’s learned responses and aid in your son or daughter’s recovery:

2:04
Opioid Withdrawal

“Why Can’t My Kid Stop Using Opioids?”


Many parents ask themselves this question. But as more and more scientific studies are confirming, the drugs that your son or daughter is using are actually creating changes in his or her brain. So, in a way, your child is not the same person he or she was before using opioids.

Watch experts Adam Bisaga, MD, a Professor of Psychiatry at Columbia University, and Alicia Murray, DO, a Board Certified Addiction Psychiatrist, discuss the changes that occur in the brain when heroin, prescription pain pills or other opioids are used, and how they can make your child think only about the drug:  

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14:42
3:47
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4:15
Effects of Opioids on the Brain
Everything you think you know about addiction is wrong | Johann Hari
How to Help Your Child Struggling with Substance Use
How addiction changes your brain
Mechanism of Drug Addiction in the Brain, Animation
 

What drugs are the most commonly abused?


Each year, the National Institute on Drug Abuse (NIDA) tracks drug use trends among high school students (8th, 10th and 12th grades) through the Monitoring the Future Study (MTF). The following is a list of the most commonly abused drugs among 12th graders, starting with the most frequent: marijuana, Adderall, Vicodin, tranquilizers, cough medicine, sedatives, hallucinogens, MDMA/ecstasy, OxyContin, cocaine, salvia and Ritalin.
Source: www.ncadd.org/about-addiction/underage-issues/frequently-asked-questions-from-young-people

Countering the problem of opioid addiction


The United States is in the middle of a public health epidemic, with more than 40 people dying each day from prescription opioid overdoses. Health care systems across the nation are racing to implement policy and practice interventions to address the epidemic. At Kaiser Permanente, our Safe and Appropriate Opioid Prescribing Program has been one of our most successful efforts to confront the problem — not only for our members, but in the communities we serve.

The principle behind the program

In 2009, our physicians looked at the most frequently prescribed drugs for Kaiser Permanente members in Southern California. They were surprised to find that drugs for hypertension and diabetes were not at the top of that list. Instead, opioid medicines and highly addictive narcotics were the most common. In addition, people were getting prescriptions at higher doses than we had previously seen.

Around the same time, new research was being published on the hazards and ineffectiveness of opioids for the management of chronic pain. Given all this evidence, we decided we needed to break the cycle and find alternatives. Rather than risk patients being addicted and overdosing, we would seize the opportunity to improve the quality and safety of drug prescribing at Kaiser Permanente.

Starting in 2010, we launched the Safe and Appropriate Opioid Prescribing Program, a comprehensive initiative to transform the way that chronic pain was viewed and treated. We implemented several efforts to reduce opioid prescriptions, including prescribing and dispensing policies, monitoring and follow-up processes, and clinical coordination through our electronic health record system.

Changing prescribing patterns

Through this program, we’ve effectively and appropriately reduced:

  • Prescription of high-risk, long-acting opioids
  • Prescription of opioids at high doses and in large quantities
  • The combined prescription of opioids with carisoprodol (known as Soma) or Benzodiazepine

Results continue to demonstrate that the program is reducing overprescription of opioids and reducing the risk of overdose and death in our members.

Beyond protecting our members, Kaiser Permanente’s focus on prescribing the lowest effective dose and supply has helped reduce the risk of opioids getting to the street. We know that unused medications in the medicine cabinet can find their way into our communities.

Caring for chronic pain

According to current clinical evidence and the Centers for Disease Control and Prevention (CDC) guidelines, opioids are not effective in treating chronic pain. Therefore, Kaiser Permanente has turned to a more multidisciplinary approach. We focus on making sure patients get the most effective treatments based on current evidence. This could include non-opioid medications, physical therapy, acupuncture, exercise, injections, cognitive behavioral therapy, and other methods.

After implementing the Safe and Appropriate Opioid Prescribing Program across Southern California, patients themselves reported feeling generally positive about our new approach to pain management. Many are, in the end, feeling better once they are off the very large doses of opioids they were on in the past.

Replicating this program across the country

As a result of a systematic and comprehensive set of strategies and tactics over several years, we’re seeing similar results in other states where Kaiser Permanente operates. We’re encouraged for the long term because other health care systems could implement this program, too.
Source: thrive.kaiserpermanente.org/thrive-together/live-well/countering-the-problem-of-opioid-addiction?wt.tsrc=email_pih&cat=2d_coverage

Top 10 Oregon counties for prescribing opioids


The top 10 counties in Oregon for opioid prescriptions

Opioid prescriptions dropped in most Oregon counties between 2010 and 2015, according to new federal data.

But there were four outliers: Malheur, Morrow, Union and Wallowa counties, where providers handed out more opioids per capita in 2015 compared with five years prior, according to data obtained by The Oregonian/OregonLive from the U.S. Centers for Disease Control and Prevention. The top 10 prescribing counties on a per capita basis were in rural parts of the state.

Though prescribing is dropping, the dips are not the same across the board. Oregon leads the country in seniors who are hospitalized for opioid abuse, dependence, overdose and adverse effects.

No. 1 Curry County is the top opioid prescriber in Oregon: 1,800 morphine milligram equivalents per person.

No. 2 Baker County ranked No. 2 on the CDC list, with 1,612 morphine milligram equivalents prescribed per person in 2015.

No. 3 Malheur County came in third, with nearly 1,600 morphine milligram equivalents prescribed per capita in 2015.

No. 4 Union County came in fourth in the CDC rankings, prescribing just over 1,560 morphine milligram equivalents per capita in 2015.

No. 5 Tillamook County providers handed out about 1,550 morphine milligram equivalents per capita in 2015, making it No. 5 on the list of opioid prescriptions per county in Oregon.

No. 6 Lincoln County In the CDC data, Lincoln County ranks No. 6 in Oregon, with about 1,540 morphine milligram equivalents prescribed per capita in 2015.

No. 7 Coos County came in seventh in the CDC data, with nearly 1,480 morphine milligram equivalents prescribed per capital in 2015.

No. 8 Josephine County came in as No. 8 in the CDC data, with about 1,420 morphine milligram equivalents prescribed per capita in 2015.

No. 9 Clatsop County came in ninth in the CDC data. Prescribers gave out nearly 1,410 morphine milligram equivalents per capita in 2015.

No. 10 Jackson County Rounding out the list of the top 10 counties in terms of opioid prescriptions is Jackson County. Prescribers there handed out about 1,340 morphine milligram equivalents per capita in 2015.
Source: www.oregonlive.com/health/index.ssf/2017/07/oregons_rural_counties_have_hi.html

Oregon leads U.S. in seniors hospitalized for opioids


The opioid epidemic sweeping the country has taken a heavy toll on older people in Oregon as nowhere else – an unexpected trend that has caught doctors by surprise.

Oregonians age 65 and up are landing in the hospital for opioid overdoses, abuse, dependence and adverse effects at a greater rate than any other state, federal figures show.

A dozen other states including Washington and California also show seniors with high hospitalization rates for opioids, including Vicodin, OxyContin and Percocet.

But Oregon's rate has nearly tripled in the past decade. The state has outpaced the country for three straight years – climbing to a peak of 700 hospitalizations per 100,000 elderly patients in 2015. That translates to 4,500 people.

Addiction specialists didn't anticipate such stark results from data collected by the U.S. Agency for Healthcare Research and Quality and are calling for deeper study to figure out why.

"This is not something we can blow off," said Dr. Shorin Nemeth, regional medical director for palliative care at Providence Health and Services. "This is a vulnerable population."

Nemeth had no idea about the problem until contacted by The Oregonian/OregonLive. Startled to see the statistics, he talked to peers outside Providence. They had no clue either, he said.

Public health officials in Oregon are aware of opioid abuse among older people, but they haven't taken a step back to look at what's driving the phenomenon or told providers what to do about it. They're focused instead on curbing opioid use overall.

"It appears that we are moving in the right direction but we're not there yet," said Dr. Katrina Hedberg, the state epidemiologist and health officer. "We're hoping that prescribing fewer opioids will lead to fewer people who are hospitalized."

Two factors might make Oregon stand out: Doctors have continued to prescribe more opioids to older people and the state has been a national leader in encouraging more liberal use of medication for pain.

It's also possible that old age and the kinds of drugs prescribed to seniors are contributing to the spike. Some opioids are more powerful than others. Some linger longer in the body. Dose is important, too. As is the health condition of the patient.

"Anytime we see increased rates among certain populations or increased rates over time, that's something that needs to be looked at closer," said Gery Guy, a health economist and opioid specialist at the U.S. Centers for Disease Control and Prevention. "It is very concerning."

2015 state rates of opiod-related hospital stays* per 100,000 people age 65 and over
*This rate does not incllude emergency room visits

''Worst pain" in my life

Jerry Hall took 100 milligrams a day at the height of his opioid addiction — five times the normal amount.

Like many people, he started relying on prescription medication for chronic pain but slowly slid into addiction.

Now 60 and living in Southwest Portland, Hall first developed back pain three decades ago when a ram charged at him on a farm in Newberg and threw him 40 feet into the mud.

"I didn't know where I was for a few minutes," Hall said.

Sometimes his pain was so severe that he couldn't work for days as a truck driver. His doctors prescribed Vicodin, he said, but he didn't get addicted.

That changed after a hernia surgery in 2010 and subsequent pain in his left hand. He suspects it was related to a misplaced intravenous line.

"It was the worst pain I'd had in my whole life," Hall said. "It felt like it had its own heart beat."

The agony didn't go away. His doctors gave him oxycodone, a common opioid.

The drug helped dull the persistent throbbing but his hand didn't heal.

The prescriptions kept coming.

Opioids pushed for pain

Oregon has been at the forefront of a movement to control people's pain, including an early emphasis on palliative care and hospice services.

When Hall first got injured, opioids were becoming more widely used as pain treatment in Oregon and nationwide.

In 1995, Oregon passed a pain treatment act, which protected doctors from discipline when they prescribed opioids for severe pain, provided they followed the law. The following year, the American Pain Society launched a nationwide campaign that called on doctors and nurses to ask people about their level of pain. This has become a routine medical practice.

State medical groups, accrediting bodies and even federal drug regulators encouraged the use of opioids for pain.

A national epidemic

Every day, 1,000 people of all ages across the country are treated in emergency rooms for misusing prescribed opiates.

Besides the human toll, prescription opioids cost the United States nearly $79 billion a year.

In 2015 (latest data available):

  • Nearly 13,000 people died from heroin, including 102 in Oregon
  • About 15,000 people died from overdoses on prescription opioids
  • 2 million had prescription opioid use disorder

    Source: U.S. Centers for Disease Control and Prevention.

The drugs mask symptoms by attaching to receptors in the brain. They block pain, slow breathing and have a calming effect.

"Those of us who were doing medical training in the '90s got a heavy dose of it," said Dr. Todd Korthuis, an addiction treatment specialist at Oregon Health & Science University.

Oregon doctors, often on the leading edge of palliative care, were generous in prescribing.

"We were all awash with it when I started here in 2002," Korthuis said. "Over half of my clinic patients were prescribed opioids."

He suspects the current rates stem from Oregon's liberal prescribing practices years ago. Providers, with a push from medical leaders and drug companies, didn't question how many pills they were prescribing. They were focused on treating pain.

"It was all about compassionately taking the best possible care of the patient as the field understood it," Korthuis said.

Opioid prescriptions in Oregon have dropped but not across the board.

An analysis by The Oregonian/OregonLive shows that the raw number of prescriptions for seniors rose slightly in 2016 compared with 2015. But the older population grew overall, pushing down the per-capita prescription rate by 4 percent.

For people 45 to 64, opioid prescriptions per capita dropped 7 percent among a population that stayed steady. That signals the efforts to stem prescriptions for this group are taking hold.

In 2012, Oregon providers handed out nearly 820,000 opioid prescriptions to those 65 and older. That jumped to 1.1 million in 2016, or 1.6 prescriptions per senior, according to the analysis of U.S. Census and state data.

Snagged for cheating

Jerry Hall's doctors became concerned about his continued opioid use around 2012, the same year he went on disability because of various health issues.

They put him on a monitoring program, made him sign an agreement to take only prescribed pills and introduced random urine testing to ensure he wasn't downing other narcotics.

They prescribed 20 milligrams of oxycodone a day, he said. He emptied the bottle in a couple of weeks. To fill the gap, he said he snagged pills from family, friends and neighbors. Some were free. Others cost up to $10 each.

Eventually, he got caught cheating.

In 2013, during a random urine test, doctors found unprescribed methadone in his system and they stopped his prescriptions.

Hall went into severe withdrawal.

"First you're freezing, then you're burning up," he said. "I couldn't have anything touch me. I couldn't lay down. I couldn't sleep."

He couldn't even hold his beloved cats.

He tried to quit but the symptoms raged, sometimes for four days at a time. With no idea how long they would last, he devoted his life to getting more pills.

He paid his rent and fed his cats. He spent all the rest on opioids, even eating from food pantries.

Hall's experience is far from unique, said Dr. Bryan Dixon, an addiction psychiatrist at Cedar Hills Hospital, a behavioral health treatment center in Portland.

"It doesn't matter if you're 18 or 80," Dixon said. "Once you're dependent, opiates are incredibly difficult to stop."

Hall knew he was addicted but he didn't tell his family, friends or acquaintances. He was too ashamed.

Providers curtail prescriptions

Federal and state health officials have been slowly tackling the overuse of opioids.

In Oregon, the focus on prescription drug abuse has centered on young people. In 2010, a summit including then-Gov. Ted Kulongoski revealed the state's 18- to 25- year-olds had the highest rate of prescription abuse in the country.

The state set up a prescription monitoring program the next year and in late 2015 issued a well-publicized public warning to announce that large medical groups in the Portland area had agreed to curtail opioid prescriptions for chronic pain.

The Centers for Disease Control and Prevention followed in a few months with extensive guidelines advising providers to limit the use of opioids. One section warns about the risk of seniors taking opioids. They can fall, become confused or experience a bad reaction if they take a cocktail of medications.

The Oregon Health Authority issued supplemental guidelines last year that call for the use of alternative treatments or the lowest effective dose of opioids, but the guidelines don't address age groups. Washington state has its own guidelines as well, including a section on seniors.

Hedberg, the state's top medical officer, said the state is trying to curtail opioid prescriptions for everyone, not just one age group.

It stands to reason that seniors with opioid problems would end up in the hospital more often than the general population, she added. Older people simply have more ailments, she said.

But so do seniors in other states that have much lower rates for those 65 and older, like Florida and New York.

It could be that Oregon has a higher rate of seniors with an opioid abuse problem or that state providers are more likely to hospitalize them for treatment, Hedberg said.

Public health officials have no plans to dive into this issue: They've adopted an overall strategy of curtailing prescriptions, tracking trends and trying to get more people with dependency issues on treatment.

This year, Oregon is getting an extra $7 million from the federal Health and Human Services Department to fight opioid addiction and overdoses.

The state plans to use the money to increase access to medication-assisted care. It will target Oregon tribes and rural areas, which lack treatment centers, Hedberg said.

There's no plan to focus on seniors.

Risk factors abound

The Oregonian/OregonLive interviewed pharmacy experts, primary care doctors, pain specialists and addiction experts in the Portland area about why Oregon has such a high rate.

None had a definitive answer.

Many people who started taking the pills a decade or two ago likely stayed on them or resumed treatment as they aged and experienced arthritis or had hip or knee replacements, said Dennis McCarty, a substance abuse treatment specialist at OHSU.

Doctors might overlook risks for substance abuse in older people because they consider addiction a problem of younger people, they're often focused on younger patients with addiction problems, said Dr. Steven Stanos, medical director of pain services at Swedish Hospital in Seattle and president of the American Academy of Pain Medicine.

Or they might associate symptoms such as falls, delirium and memory loss, with aging instead of opioids.

Seniors also may wind up in the hospital more often because they don't metabolize medications as well as younger people, and many take several medications, which can increase health risks.

Yet steering seniors away from opioids in some cases isn't always a good idea. The drugs aren't considered to be a problem for hospice patients or to treat pain associated with cancer.

"It's a challenge in these older patients because many times they have severe pain," Stanos said. "That keeps them from functioning."

Many pain medications that doctors might prescribe to avoid opioids can cause problems in seniors.

Amitriptyline and gabapentin, both used for nerve pain and depression, can cause delirium. Some anti-inflammatories, like ibuprofen, affect kidney function and can trigger stomach ulcers.

Oregon and other states with such high rates of senior hospitalizations should take the problem to doctors and insurers to investigate, specialists said.

"The data should be analyzed in terms of what is the cause of this," said Cynthia Reilly, a Pew Charitable Trusts specialist on substance abuse. "It's something they should take a closer look at."

New drug helps

Jerry Hall increasingly feared his addiction would kill him.

So in early 2015, he saw Dr. Brinton Clark, medical director of Providence Medical Group Northeast. She started him on Suboxone, a medication used to treat opiate dependence.

"That was the day that changed my life," Hall said.

Suboxone contains two elements, naloxone, which is used to treat a narcotic overdose, and buprenorphine, which treats pain but isn't as addictive as many other opioids.

It can still cause withdrawals.

Clark has tapered Hall's dose, starting with a moderately high dose of 20 milligrams a day. He's now down 3 milligrams.

"He's a star patient," Clark said. "He's close to being off."

Hall said if he had known opioids would take over his life and how difficult it would be to get off them, he never would have taken the drugs.

"I would have taken an aspirin," he said.
Source: www.oregonlive.com/health/index.ssf/2017/07/oregon_has_top_rate_in_us_of_s.html

Oregon opioid overdose deaths ranked by county, 2001-2015


Over more than a decade, the opioid epidemic escalated in Oregon as deaths skyrocketed.

In 2000, nearly 58 people died of opioid-related causes statewide, according to the Oregon Health Authority. In 2011, that rose to 292 fatalities.

Overdoses from prescription painkillers have been a big cause.

In 2011, 216 people died from the painkillers in Oregon, compared with 122 heroin deaths.

The outlook has improved, with deaths from prescription painkillers and heroin falling by 2015 when pills killed 180 people and heroin accounted for 91 fatalities.

The following bar charts show death rates for all opioids – heroin, prescription pills, methadone, even psychotropics -- over half-decade periods from 2001 to 2015.

Source: Source: Oregon Health Authority ; data are derived from death certificates that include heroin as cause or contributor to death. Known suicides are excluded.

Oregon Opioid Overdose Deaths Ranked by County - 2001-2015 (100k)

County

2015 Population
Rank
2001-2005
2006-2010
2011-2015

Baker

16,052
11
0.00
11.11
7.44

Benton

86,495
19
2.49
3.09
4.65

Clackamas

389,438
14
3.01
6.90
6.65

Clatsoop

37,382
4
9.55
13.03
10.25

Columbia

49,389
12
3.51
8.54
7.31

Coos

62,775
22
2.24
7.28
3.52

Crook

20,956
8
0.00
0.00
8.66

Curry

22,338
16
5.48
8.97
5.39

Deschutes

166,622
17
1.70
4.97
5.18

Douglas

107,194
13
3.11
6.52
7.11

Gilliam

0.00

Grant

0.00

Harney

0.00

Hood River

0.00

Jackson

208,363
10
5.15
8.65
8.27

Jefferson

0.00

Josephine

83,409
9
3.81
10.44
8.41

Klamath

65.972
18
0.00
7.79
4.86

Lake

0.00

Lane

357,060
7
5.32
9.59
9.11

Lincoln

46.347
2
4.05
11.33
11.23

Linn

118,971
5
3.21
6.61
9.28

Malteur

30,551
6
0.00
0.00
9.14

Marion

323,259
21
3.25
6.84
4.41

Morrow

0.00

Multnomah

768,418
3
7.92
12.62
11.06

Polk

77,262
23
2.15
7.26
3.13

Sherman

0.00

Tillamook

25,430
1
6.51
4.77
14.20

Umatilla

76,738
24
0.00
5.91
2.86

Union

25,745
25
0.00
5.50
0.00

Wallowa

0.00

Wasco

0.00

Washington

556.210
20
2.83
4.15
4.54

Wheeler

0.00

Yamhill

101,119
15
2.71
5.74
6.55

Oregon

3,939,233

4.16
7.78
7.15

Source: www.oregonlive.com/trending/2017/07/oregon_opioid_overdose_deaths.html

 

Reducing Opioid Overdose and Misuse


Opioids
What You Should Know
Naloxone Rescue for Opioid Overdose
For Health Care Professionals and CCOs
Publications
Data Dashboard
Task Force
Contact OHA

Oregon has one of the highest rates of prescription opioid misuse in the nation


In Oregon, more drug poisoning deaths involve prescription opioids than any other type of drug, including alcohol, methamphetamines, heroin and cocaine. An average of 3 Oregonians die every week from prescription opioid overdose, and many more develop opioid use disorder.

Partners across Oregon are working to reduce this epidemic. We have made recent progress, but there is more work to be done.


Getting Help


Opioid use disorder can be treated

Talk to your health care provider or visit the links below for treatment resources.

Pain management resources

Publications

Partners

Addressing the opioid epidemic involves many local, state and national partners. In Oregon, our Opioid Initiative Partnership includes the following groups:

In Oregon

Source: www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SUBSTANCEUSE/OPIOIDS/Pages/index.aspx

©2015-2018, www.ZeroAttempts.org/opioids.html
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