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The Pale Horse
Opioid use in Minnesota, 2014
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• Presented by Rick Moldenhauer, MS,
LADC, ICADC, LPCC
Treatment Services Consultant/State Opioid
Treatment Authority
P: (651) 431 2474
F: (651) 431 7449
Alcohol and Drug Abuse Division, DHS
PO Box 64977
St Paul, Minnesota 55164-0977
[email protected]
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3
MARRCH Fall Conference
2013…..
Step 4: Made a searching and
fearless moral inventory of
ourselves.
message
messenge
r
Separated at birth?
I’m with the government, I’m here
to help……
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Half Life
• Abbreviated as: t ½
• The time it takes for a
substance to lose half
of its pharmacologic
activity
• Generally, 9 x t1/2 it’s
gone
• Does NOT equal
elimination half-life
•
•
•
•
•
•
•
•
•
0
1
2
3
4
5
6
7
n
1/1 100%
½
50%
¼
25%
1/8
12.5%
1/16 6.25%
1/32 3.125%
1/64 1.563
1/128 0.781
1/2n 100(1/2n)
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Potency
• A measure of drug activity
expressed in terms of the
amount required to produce an
effect of given intensity. A
highly potent drug evokes a
larger response at low
concentrations. It is
proportional to Affinity and
Efficacy
• For our purposes, how strong
the stuff is……don’t forget
synergistic effect and
contaminants
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Effective Dose
• Abbreviated as: ED50
• An effective dose in
pharmacology is the
amount of drug that
produces a
therapeutic response
in 50% of the people
taking it, sometimes
also called ED-50.
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Intoxication & withdrawal
How much/
how potent
What they took
How long ago
Intoxication & withdrawal
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Intoxication/Withdrawal
0
2
4
6
8
10
12
14
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Tolerance=Adaptation
• Person’s response is
decreased to same
dose, requiring
greater volume or
frequency of
application
(tachyphylaxis end
result, as with
amphetamines
“amped out”)
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Drugs make you feel something
you normally don’t
• T½
• Effective Dose: ED 50
• Lethal Dose: LD 50
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Opioids
• Water soluble,
detectible by UDS
• Contains morphine
(natural) heroin (semi- • Agonist and
synthetic), diverted
antagonist properties
methadone
at mu and kappa(synthetic), other
opioid receptor sites
prescription opioid
• Used an analgesics,
drugs
anesthetics, antidiarrheal, cough
suppressants
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19
SOURCE; DAWN, 2013
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Heroin vs. other opiate admission 19982013
Source: DAANES, PMQI, MN DHS 2014
Heroin vs. other opiate admission 19982013 by gender
Source: DAANES, PMQI, MN DHS 2014
Heroin vs. other opiate admission for
pregnant women, 1998-2013
Source: DAANES, PMQI, MN DHS 2014
2010 US Census data, MN race by %
%
Source: MN State Demographic Center
Other opiate admission by race 1998-2013
Source: DAANES, PMQI, MN DHS 2014
Other opiate admission by race, not
counting white, 1998-2013
Source: DAANES, PMQI, MN DHS 2014
Other opiate admission by age 1998-2013
Source: DAANES, PMQI, MN DHS 2014
Heroin admission by race 1998-2013
Source: DAANES, PMQI, MN DHS 2014
Heroin admission by race, not counting
white, 1998-2013
Source: DAANES, PMQI, MN DHS 2014
Heroin admission by age 1998-2013
Source: DAANES, PMQI, MN DHS 2014
Number of Deaths From Poisoning, Drug Poisoning, and
Drug Poisoning Involving Opioid Analgesics—United
States, 1999–2010
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6212a7.htm?s_cid=mm6212a7_e
MMWR, March 29, 2013
Prescription Related Deaths in the US, 1999-2010
Source: CDC Wonder, 2014
Sold vs. used…..
Source: CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 19992008. MMWR 2011; 60: 1-6
Sold vs. used…..
Source: CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 19992008. MMWR 2011; 60: 1-6
Total opiate related deaths in MN,
2000-2010 by four largest race
categories
R
a
w
n
u
m
b
e
r
s
Sources: DAANES, PMQI 2012
and MDH VItal Stats, 2011
Total opiate related deaths in MN,
2000-2010 by select age categories
R
a
w
n
u
m
b
e
r
s
41.9 avg.
age of
death of
opiates
Sources: DAANES, PMQI 2012
and MDH VItal Stats, 2011
Compared to other substances in MN….
Substance Abuse Treatment Admissions for Minnesota Residents Primary Substance of Abuse by Admission Year
Source: Minnesota Department of Human Services, ADAD, DAANES (10/6/2014)
CY2009
CY2010
CY2011
CY2012
CY2013
Change Between
Primary Substance of Abuse Count Col % Count Col % Count Col % Count Col % Count Col % CY2009 and CY2013
Alcohol
27,633 55.4 26,134 53.2 25,109 50.6 24,248 47.7 22,748 44.4
-17.7
Methamphetamine
3,440
6.9 3,934
8.0 4,249
8.6 5,299 10.4 7,095 13.9
106.3
Cocaine
633
1.3
551
1.1
615
1.2
496
1.0
443
0.9
-30.0
Crack
1,890
3.8 1,581
3.2 1,474
3.0 1,362
2.7 1,167
2.3
-38.3
Marijuana
9,496 19.0 9,431 19.2 9,058 18.3 9,137 18.0 8,788 17.2
-7.5
Heroin
2,181
4.4 2,282
4.6 3,336
6.7 4,527
8.9 5,128 10.0
135.1
Other Opiates
3,585
7.2 4,222
8.6 4,571
9.2 4,479
8.8 4,379
8.6
22.1
Other
732
1.5
827
1.7
953
1.9 1,076
2.1 1,092
2.1
49.2
Unknown
262
0.5
160
0.3
223
0.4
243
0.5
363
0.7
38.5
Total
49,852
49,122
49,588
50,867
51,203
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Opiate intoxication
• Directly related to
volume and strength
consumed
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miosis
• Constricting of the
pupil, 2-3mm
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Slurred speech
• Inability to enunciate
words, broken
sentence structure
and vocabulary
choice
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fatigue
• That state, following a
period of mental or bodily
activity, characterized by
a lessened capacity for
work and reduced
efficiency of
accomplishment, usually
accompanied by a feeling
of weariness, sleepiness,
or irritability.
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Stupor or coma
• The partial or nearly
complete
unconsciousness,
manifested by the
subject's responding
only to vigorous
stimulation
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Impairment in attention
• Inability to focus on
objections or
discussions, e.g. can’t
“track”
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Impairment in memory
• Inability to recall short
or long term memory,
may also have
difficulty with
recognition
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Opioid withdrawal
Rarely life threatening
• Looks like bad case
of the flu
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mydriasis
• Widening of the pupil,
7-8mm, slow and
sluggish to respond
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lacrimation
• Watering of the eyes,
shedding tears
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rhinorrhea
• Flowing, nasal
discharge
50
diaphoresis
• Perspiration,
especially profuse
perspiration, e.g.
“sweating”
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Nausea/emesis
• Upset stomach and
vomiting
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diarrhea
• A morbidly frequent
and profuse
discharge of loose or
fluid evacuations from
the intestines e.g. “the
shits, the hershey
squirts, the green
apple two-step”
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Muscle aches
• Burning pain in the
muscle body
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fever
• A rise in body
temperature above
normal usually as a
natural response to
infection. Typically an
oral temperature
greater than 100.4
degrees Fahrenheit
constitutes a fever.
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piloerection
• Erection of the hair,
e.g. “hair standing on
end”
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Social confusion
Normal (Merriam-Webster)
Average (Merriam-Webster)
• according with,
constituting, or not
deviating from a norm,
rule, or principle
• a number that is
calculated by adding
quantities together and
then dividing the total by
the number of quantities
• a level that is typical of a
group, class, or series : a
middle point between
extremes
• conforming to a type,
standard, or regular
pattern
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normal
average
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normal
average
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normal
average
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normal
average
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