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TRANSCRIPT
ADDICTION
LORNE R. CAMPBELL SR. M.D.
UBMD Family Medicine UBMD Addiction Medicine
OPIOIDADDICTION
LORNE R. CAMPBELL SR. M.D.
UBMD Family Medicine UBMD Addiction Medicine
Pain
The 5th Vital Sign
1996
American Pain Society
1977
Pain needs to be treated
Pain ManagementNot relatedto Addiction
2008
Add
iction
Prescription Opioids
Med
icat
ion
Prescription Opioid Sales
2000 2002 2004 2006 2008 2010 2011150
200
250
300
Opioid Prescriptions (In millions)
Pre
scri
pti
on
s in
million
s
Prescription Opioid Problems
2004 2006 2008 20100
50,000
100,000
150,000
200,000
250,000
300,000
350,000
DRUG USE IN 12 – 15 YEAR OLDS
Marijuana
Nicotine
Opiates
1996
2012
Buffalo
Prescriptions for Opiate Pain Medications
Deaths Due to Pre-scription opiates
AgonistOpiatesOpioids
MorphineCodeineOpiumHeroin
OxycodoneFentanylHydrocodoneMethadone
NaloxoneNaltrexoneAntagonist
OralDepo
They can change if they wantLazyCraz
yStupi
dThey lack will
powerThey made the
choice
Disease
Disease
80% of alladdiction problemshave a genetic root
Disease
Limbic system
Fro
nta
l Lob
e
Neuron
SynapseSynaptic cleft
Nerve Cell Dendrite
Dopamine Neurotransmitter
Synapse
Down Regulation
Synapse
AgonistAntagonistPartial Agonist
What Can You Do?
Screening
Brief Intervention
Referral to Treatment
ASKADVISEASSIST
ASK
ASK?
ASKDISCUSS USE
ASKON A REGULAR BASIS
When Should You Screen
Before You Write
ASK
Hypertension DiabetesAnemiaLiver diseaseHepatitisHepatitis CHepatitis BCirrhosisVitamin Deficiencies TraumaMalnutritionStrokesSevere Weight Loss CancerSexual Abuse ObesityDementia Accelerated AgingWerincke – Korsakoff GoutElectrolyte AbnormalitiesLipid AbnormalitiesInterference with HealingGastric Ulcers InjuriesBirth Defects
Heart disease Lung Disease
Digestive disordersImpotence
DepressionSexual Dysfunction
Urinary Tract DisordersRelationship problemsEarly Menopause
SeizuresGynecomastia
PsychosisTremors
HeadachesNausea
PancreatitisInfertility
MigrainesBleeding Disorders
ArthritisPoverty
Insomnia
Family Dysfunction Crime
Accidents
Problems Related to Addiction
When Should You Screen
ASK
Opioid Risk Tool
Provides 5-item initial risk assessment
Stratifies risk groups into low (6%), moderate (28%) and high (91%)
Family HistoryPersonal HistoryAgePreadolescent sexual abusePast or current psychological disease
Lost scriptsIncreased demand
Not using as prescribedStrange urine tox screens
Warning Signs
ADVISE
ADVISE
ASSIST
Most addicted patients don’t know they are.
Consider the consequences of
use as the problem.
Do not blame the patient.
Monitor yourself
Think Patient Has a Problem
Do NothingGet Angry
Brief Intervention
Reschedule for reassessment
Brief Assessment
Refer for Treatment
Where to Refer
UBMBADDICTION MEDICINE
1408 Sweethome RoadAmherst NY, 14228
247 5281