New Hampshire Opioid/Opiate Drug Education Classes

What are common prescription opiates?

• hydrocodone (Vicodin^®) oxycodone (OxyContin^®, Percocet^®)
  
  
• oxymorphone (Opana^®)
  
  
• morphine (Kadian^®, Avinza^®)
  
  
• codeine
  
  
• fentanyl
  
  

Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opiate use disorder, reversing opioid overdose, suppressing cough, and suppressing opioid induced constipation. Extremely potent opioids such as carfentanil are only approved for veterinary use.  Opiates are also frequently used non-medically for their euphoric effects or to prevent withdrawal.

Side effects of opioids may include itchiness, sedation, nausea, respiratory depression, constipation, and euphoria. Tolerance and dependence will develop with continuous use, requiring increasing doses and leading to a withdrawal syndrome upon abrupt discontinuation. The euphoria attracts recreational use, and frequent, escalating recreational use of opioids typically results in addiction. An overdose or concurrent use with other depressant drugs commonly results in death from respiratory depression.

Opioids act by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract. These receptors mediate both the psychoactive and the somatic effects of opioids. Opioid drugs include partial agonists, like the anti-diarrhea drug loperamide and antagonists like naloxegol for opioid-induced constipation, which do not cross the blood-brain barrier, but can displace other opioids from binding in those receptors.

Because of opioid drugs’ reputation for addiction and fatal overdose, most are controlled substances. In 2013, between 28 and 38 million people used opioids illicitly (0.6% to 0.8% of the global population between the ages of 15 and 65).  In 2011, an estimated 4 million people in the United States used opioids recreationally or were dependent on them.  As of 2015, increased rates of recreational use and addiction are attributed to over-prescription of opioid medications and inexpensive illicit heroin. Conversely, fears about over-prescribing, exaggerated side effects and addiction from opioids are similarly blamed for under-treatment of pain

The opioid crisis is worsening. Over 42,000 Americans died of opioid overdose in 2016, and government and public health officials are scrambling to find effective ways to reverse this frightening trend.

New Hampshire experts conducted an extensive review of current literature, state legislation and data to create a comprehensive report on the status of the opioid crisis. This white paper evaluates each state’s progress in fighting this epidemic, based on the number of these six key actions achieved:

• Mandating prescriber education
  
  
• Implementing opioid prescribing guidelines
  
  
• Integrating prescription drug monitoring programs into clinical settings
  
  
• Improving data collection and sharing
  
  
• Treating opioid overdose
  
  
• Increasing availability of opioid use disorder treatment
  
  

The New Hampshire Prescription Nation 2018 report gives you:

• • A state-by-state comparison of actions taken
    
    
  • Failing-lagging-improving grades for each state
    
    
  • Descriptions of key actions and how they make a difference
    
    
  • What’s working in states that have faced the crisis head on
    
    
  • Case studies, success stories and addiction experts’ insights
    
    

References:

Sullivan, C.J.; McKendrick, K.; Sacks, S.; and Banks, S.M. Modified therapeutic community for offenders with MICA disorders: Substance use outcomes. American Journal of Drug and Alcohol Abuse 33(6):823-832, 2007.

Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and Garfield, F. Four residential drug treatment programs: Project IMPACT. In: J.A. Inciardi, F.M. Tims, and B.W. Fletcher (eds.), Innovative Approaches in the Treatment of Drug Abuse, Westport, CT: Greenwood Press, pp. 45-60, 1993.

Sacks, S.; Banks, S.; McKendrick, K.; and Sacks, J.Y. Modified therapeutic community for co-occurring disorders: A summary of four studies. Journal of Substance Abuse Treatment34(1):112-122, 2008.

Sacks, S.; Sacks, J.; DeLeon, G.; Bernhardt, A.; and Staines, G. Modified therapeutic community for mentally ill chemical “abusers”: Background; influences; program description; preliminary findings. Substance Use and Misuse 32(9):1217-1259, 1997.

Stevens, S.J., and Glider, P.J. Therapeutic communities: Substance abuse treatment for women. In: F.M. Tims, G. DeLeon, and N. Jainchill (eds.), Therapeutic Community: Advances in Research and Application, National Institute on Drug Abuse Research Monograph 144, NIH Pub. No. 94-3633, U.S. Government Printing Office, pp. 162-180, 1994.