pharmaceutical risk and response seminar...• half life • memory loss • withdrawal 17...
TRANSCRIPT
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Pharmaceutical Risk and Response Seminar
Keith Bhebhe Penington Institute
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Commonly used pharmaceutical drugs
Problematic use of prescription and over-the-counter medicines
Opioid use including pharmaceutical drugs, heroin and illicit synthetic opioids
Overdose risk factors
Treatment options
Recognising overdose (signs of overdose of different drugs including alcohol)
Opioid overdose prevention and response including naloxone
Overview
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Commonly misused prescribed medications
Opioids – oxycodone, morphine, methadone, fentanyl, tramadol, codeine
Benzodiazepams – diazepam (valium), temazepam, alprazolam (xanax)
Antipsychotics – seroquel (quetiapine)
Hypnotics – zopiclone, zolpidem and zaleplon
Just because it’s prescribed, it’s not always safe
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Accidental drug related deaths, Vic
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Fatal overdoses: A coroner`s perspective 2015
www.coronerscourt.vic.gov.au March 2015
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Heroin and pharmaceutical opioid overdose deaths
Roxburgh, et al (2017) Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug and Alcohol Dependence. Volume 179, 291-298a, doi.org/10.1016/j.drugalcdep.2017.07.018
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Overdose deaths Victoria 2016
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Who is at risk of prescription opioid harm?
477 Victorians died of drug overdose in 2016
40-49 are the most at-risk age group for drug overdose
Economically disadvantaged
Rural populations
Psychiatric illness
A past history of substance abuse
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Half life and duration
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Oxycodone
One of the most abused prescription drugs around the world.
Brand names include:
• Proladone
• Endone
• OxyNorm
• OxyContin
• Targin (oxycodone + naloxone)
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Fentanyl
Approximately 80 - 100 times more potent than morphine
Management of persistent, moderate to severe chronic pain
For opioid tolerant patients who require continuous, around-the-clock opioid administration for an extended period of time
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Fentanyl
New Hampshire State Police Forensic Lab
On the left, a lethal dose of heroin; on the right, a lethal dose of fentanyl
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Over the counter medication - Codeine
Mostly widely-used opioid analgesic
Short half life
Recommended short lasting and infrequent pain
Usual single dose is 15-60mg
Can cause constipation, nausea and confusion
Changes to legislation Feb 2018
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Physical impact
differencebetween.net
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Opioids withdrawal
Drug and Alcohol Clinical Advisory Service (DACAS) SA Health
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Benzodiazepines
Considerations: • Drug interaction - overdoses • Half life • Memory loss • Withdrawal
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Multi-drug overdoses - Benzodiazepines
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Benzodiazepines – alprazolam (Xanax)
Treatment of anxiety and panic disorders
Should be short term use only
Reports of severe withdrawal symptoms
Intense rebound of anxiety
Interaction with SSRIs (delayed clearance)
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Associated with an increased risk of: • Amnesia • Sedation, reduced alertness • Ataxia, reduced mobility, falls, fractures • Night wandering • Incontinence • Pseudodementia
Benzodiazepines – elderly
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Harm reduction
Avoid injecting above your shoulder
Avoid injecting below your waist
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Treatment options and harm reduction strategies
Opioids replacement/substitute/maintenance therapy (ORT/OST/OMT)
Daily dispensing for individuals undergoing ORT/OST
Prescription monitoring programs
Changes to scheduling of medications – codeine
Needle syringe programs
Naltrexone – implant options
Education – to prescribers, frontline staff and patients
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Treatment options and harm reduction strategies
Prescription monitoring programs
Prescription drug take back
Improved opioid prescribing education
Improved consumer opioid education
Improved pain management practice
Improved mental health management
Increased accountability, responsible marketing, research and related funding initiatives from pharmaceutical companies
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Harm reduction strategies
OxyContin OC versus OP
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Harm reduction strategies
medicine-online.org/img/cms/targin.jpg
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Treatment options - Non-pharmacology strategies for CNCP
Planned daily walks or exercise
Physiotherapy/hydrotherapy
Counselling (may be available online or via telephone)
Relaxation therapy/mindfulness/yoga
Nutritional change with support from a dietitian
Attending a group pain management program
Social connection
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Direct Line 1800 888 236 www.directline.org.au
www.scriptwise.org.au 03 9909 2807
Medication support and recovery services (MSRS) 1800 931 101
Family Drug Helpline 1300 660 068
Healthdirect Australia - Free health advice 24 hours, 7 days a week on 1800 022 222
Disposal Helpline 1800 552 355
Reconnexion: Anxiety, panic, depression, benzodiazepine dependency. www.reconnexion.org.au 1300 273 266 or 03 9809 8200
Australian Pain Society – Facility Directory: www.apsoc.org.au/facility-directory
Confidential and free information, counselling and referral helpline resources
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Reference list
Cayoun B, Simmons A and Shires A (2017) Immediate and lasting chronic pain reduction following brief self implemented mindfulness based interoceptive exposure task: A pilot study. Mindfulness. doi 10.1007/s/2671-017-0823x
Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Cognitive behavioural therapy for treatment of chronic primary insomnia a randomized controlled trial. JAMA 2001;285:1856-64.
Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioural and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA 1999;281:991-9.
Nielsen S, Bruno R, Lintzeris N, Fischer J, Carruthers S, Stoové M. Pharmaceutical opioid analgesic and heroin dependence: How do treatment-seeking clients differ in Australia? Drug Alcohol Rev 2011;30:291-9
Nielsen S, Bruno R, Degenhardt L, Stoove MA, Fischer JA, Carruthers SJ, et al. The sources of pharmaceuticals for problematic users of benzodiazepines and prescription opioids. Med J Aust 2013;199:696-9.
Office of National Drug Control Policy (ONDCP). Epidemic: Responding to America's Prescription Drug Abuse Crisis. Washington DC, USA: Executive office of the President of the United States; 2011.
Roxburgh, et al (2017) Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug and Alcohol Dependence. Volume 179, 291-298a, doi.org/10.1016/j.drugalcdep.2017.07.018
Tiller JWG. Cognitive behaviour therapy in medical practice. Aust Prescr 2001;24:33-7.
Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J. Zolpidem use and hip fractures in older people. J Am Geriatr Soc 2001;49:1685-90.
Wilson C, Lack L. Sleeping habits of people living in the Adelaide metropolitan area - a telephone survey. Aust Psychol 1983;18:369-76.
www.nps.org.au/australian-prescriber/articles/the-management-of-insomnia-an-update
www.msrs.org.au
www.tga.gov.au/codeine-info-hub
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