Harm Reduction for the Lost Generation.
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This document discusses harm reduction strategies for patients at high risk of opioid overdose during the current opioid epidemic. It identifies populations at risk, such as those prescribed methadone, at doses over 120mg of morphine equivalents daily, or those prescribed benzodiazepines or sedatives along with opioids. It recommends prescribing nasal naloxone to these at-risk patients and tapering opioid doses to safer levels. For patients requiring long-term opioid treatment, it suggests switching to buprenorphine which has a ceiling effect reducing risk of overdose. The goal is to reduce harm for the "Lost Generation" of patients dependent on opioids.
Harm Reduction for the Lost Generation.
- 1. Harm Reduction for the Lost Generation Paul C. Coelho, MD Board Certified PM&R Subspecialty Certified Pain Medicine
- 2. Table Of Contents 1. The Opioid Epidemic 2. The Lost Generation 3. Harm Reduction Strategies
- 4. Variation in Opioid Prescribing 1999-2008 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm
- 6. Opioid Prescribing Variation 2008 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509148/ Benton County
- 10. 14% Increase in ODD 2013 - 2014 policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf OR 13.3% Increase
- 12. Guns, MVA’s & ODD’s 2000-2015 http://www.realclearpolicy.com/blog/2015/12/21/guns_vs_cars_and_drugs_1500.html
- 13. Oregon Ranks #1 in the Nation in Prescription Opioid Abuse www.orpdmp.com/orpdmpfiles/PDF_Files/Reports/Statewide_10.01.11_to_03.31.12.pdf
- 14. Prescription Opioid Deaths In Oregon 2000-2011 http://www.orpdmp.com/orpdmpfiles/PDF_Files/Reports/NGA-overdose-presentation_Millet_12-05-2012.pdf
- 15. Top Oregon Counties for Opioid Prescriptions 160.0000 172.5000 185.0000 197.5000 210.0000 Josephine D ouglas Sherm an Lincoln C latsop Linn C rook C urry Jackson Jefferson County http://www.orpdmp.com/orpdmpfiles/PDF_Files/Reports/Statewide_10.01.11_to_03.31.12.pdf
- 16. Prescribed Opioid Addiction Tx By Age http://wwwdasis.samhsa.gov/teds09/TEDS2k9NChp2.htm
- 17. Age of Opioid ODD www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
- 18. Risk Factors for an ODD http://www.fda.gov/downloads/Drugs/NewsEvents/UCM300859.pdf
- 19. Dose as a Risk Factor For ODD https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/3.Practice_Management/2.Quality_Improvement/ 2.Patient_Safety/2.Patient_Safety_Education/C171%20-%20Franklin.pdf
- 20. Methadone as a Risk Factor for ODD https://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
- 21. Methadone as a Risk Factor for ODD https://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
- 22. Benzodiazepines & Opioids as a Risk Factor for ODD https://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Documents/oregon-drug-overdose-report.pdf
- 25. Pain Vs Fear of Withdrawal? http://www.ncbi.nlm.nih.gov/pubmed/24814051
- 26. Buprenorphine for the Lost Generation http://www.ncbi.nlm.nih.gov/pubmed/25220043
- 27. Buprenorphine for the Lost Generation http://www.ncbi.nlm.nih.gov/pubmed/23584313
- 28. Buprenorphine Is A Powerful Analgesic http://www.compoundchem.com/2014/09/25/painkillers/
- 29. Harm Reduction for the Lost Generation Identify the population at risk: a. Methadone b. Dose > 120MED c. Coprescribed benzo’s &/or sedatives
- 30. Prescribe Nasal Naloxone 1. SB 384 legalized for lay administration in 2013. 2. Stock in your pharmacies. 3. Some patients must pay out of pocket ($35.00.) 4. http://www.prescribetoprevent.org/ wp-content/uploads/2012/11/ naloxone-one-pager-in- nov-2012.pdf
- 31. Dose MTD < 30 or MED < 240 1. Offer an alternative analgesic to MTD: MS04, etc. 2. Offer an opioid taper with an end point below 120MED. 3. Offer a benzodiazepine taper. http://agencymeddirectors.wa.gov/mobile.html
- 32. Dose MTD > 30 or MED > 240 Hi Dose Patient Taper Buprenorphine VS
- 33. Buprenorphine 1. Schedule III drug, partial mu agonist 2. FDA approved for both pain - Butrans/Belbuca - and addiction - Suboxone/Subutex. 3. Ceiling effect for respiratory suppression (RS).
- 34. Buprenorphine’s Ceiling Effect for R.S.
- 37. Lost Generation