Lecture 14 Flashcards
(55 cards)
1
Q
Which of the following is not an opioid?
A) Heroin
B) Oxycodone
C) Codeine
D) Mescaline
A
D
2
Q
define psychoactive substances
A
- alter our consciousness perceptions and mood
3
Q
What are the categories of psychoactive substances?
A
- Depressants
- Stimulants
- Hallucinogens
- Opioids
4
Q
describe depressants
A
- Rx for anxiety, insomnia, seizures
- Decreases CNS and heart rate
- Decreases processing and coordination
- inhibitions (a feeling that makes one self-conscious and unable to act in a relaxed and natural way)
5
Q
describe stimulants
A
- energy
- alert
- jittery
- increase heart rate
6
Q
describe hallucinogens
A
- a psychedelic
- perceptual changes
7
Q
describe opioids
A
Rx pain
- decrease CNS
- breathing
8
Q
What are examples of depressants?
A
- barbiturates
- benzodiazepines
- alcohol
9
Q
What are examples of stimulants
A
- coffee/caffeine
- cigarettes/nicotine
- amphetamines/meth
- ecstasy/MDMA/Molly
10
Q
What are examples of hallucinogens?
A
- LSD
- psilocybin (magic mushrooms)
11
Q
What are examples of opioids?
A
- oxycodone
- hydromorphone
- morphine
- methadone
- heroin
- fentanyl
12
Q
Why do people use psychoactive substances (4 things and extras)?
A
- Cultural reasons/traditional ceremonies
- self-medicate to:
— feel better; treat anxiety, stress, depression, isolation, numb emotional/Psychol pain or trauma
— do better; improve performance, Rx ADHD
— feel good; feelings of pleasure
— survival - homeless, lack of $$ - curiosity/to fit in:
— experiment, build connections, peer pressure - avoid withdrawal
— developed a physical dependency
— physician over-prescribing
13
Q
Who introduced OxyContin? When was it introduced and what is it?
A
- Purdue Pharma
- in 2000
- a long-acting opioid and promoted it
— Pain was underrated
— OxyContin was safe and non-addictive
14
Q
What happened to OxyContin?
A
- Rx increased, diversion, crushed and snorted or injected
15
Q
In 2012, OxyContin patent ended. What did Purdue introduced?
A
- OxyNeo was introduced
- tamper proof version
- if crushed, became jelly-like, so can’t be snorted or injected
16
Q
explain the fall of OxyContin and emergence of fentanyl
A
2012: OxyContin was delisted in many jurisdictions
2014: fentanyl started appearing in unregulated street market
— powdered fentanyl mixed with or sold as heroin
— fake Oxy’s (green meanies) 2016
17
Q
Outcome is influenced by reasons for use, resiliency/support and social determinants of health like…?
A
- poverty
- unemployment
- homelessness
- adverse childhood experiences, physical/sexual abuse
- indigeneity - colonization and racism, etc.
- lack of belonging and connection - made worse by COVID
18
Q
What are the 4 guidelines to using non-stigmatizing language?
A
treat all people with the same respect
- use people-first language
— person who uses opioids // opioid user or addict - Use language that reflects the medical nature of substance use disorders
— person experiencing problems with substance use // abuser or junkie - use language that promotes recovery
— person experiencing barriers to accessing services // unmotivated or non-compliant - avoid slang and idioms
— positive test results or negative test results // dirty test results or clean test results
19
Q
What is the four pillars strategy?
A
- enforcement
- prevention
- treatment
- harm reduction
- all 4 need to work together
20
Q
When do pillars not work?
A
- pillars do not work in isolation. it’t not either one or another
- enforcement encourage people to use more safely (ex. at supervised consumption sites)
- enforcement may test substances and share information to enable accurate reduction/drug alert messages (Drug Overdose & Alert Partnership)
- Engagement in harm reduction can build trusting relationships and lead to treatment
21
Q
What is enforcement?
A
criminalizing drug use/prohibition
22
Q
What is the aim of prohibition?
A
- put people in prision
— who import, produce, sell (traffic), possess (use) drugs - reduce number of people who use drugs
— make drugs harder to get, increase cost of drugs, make people afraid to use drugs (scare tactic) - make communities safer
23
Q
How is drug laws based on racism?
A
- people of colour are overrepresented in US prisons, 2016
24
Q
Is Canada any better about racism?
A
- federal prison (2+ years) Indigenous people are 5-6% population, in 2019 - 30% overall corrections population
- BC Corrections Indigenous peoples 35% of those in custody
2022 Indigenous women in both federal and provincial corrections > 50%
25
In 1920-1933, Alcohol was...?
- widely available (speakeasies)
- stronger - spirits more available than beer or wine (easier to transport smaller volumes
- illicitly produced - contains toxins, no quality control/consistency of content and strength
- controlled by gangs and violent criminals
26
does prohibition work?
- the price of heroin and cocaine came down despite increased incarceration
- drugs are available in jail
- teens may find it easier to buy illegal drugs than regulated alcohol and tobacco. Don't need to show ID to buy drugs!
- It's easy and fast to have illegal drugs delivered to your home - Dial-a-dope
27
What is the goal of harm reduction?
- aims to keep people safe and minimize death, disease, and injury from high-risk behaviour by promoting safer practices
28
What are some examples of broader harm reduction?
- accepts risky behaviour will occur but resources/supports to make it safer
- if your drink, don't drive (safe ride home)
- teen sexual behaviour (birth control pills, condoms)
- driving (car seats, seat belts, airbags)
- working (hard hats, boots)
- sports (protective gear like padding or helmets or goggles, etc.)
29
What harms are due to illegal drug use?
- infections: (use in unsterile way)
--- HIV and HCV
--- bacterial from injecting: septicemia, abscess, endocarditis
- criminal activities
--- organized crime/violence
--- individual crimes to fund drug use, B&E, sex work
--- drug possession trafficking
--- incarceration
- overdose events and death
--- unregulated supply with unknown potency and constituents
30
Explain the substance use journey
- addiction is a chronic relapsing issue
- even with treatment it's not a straight line from dependency to abstinence
- abstinence is not the ultimate goal for many
- everyone has the right to the best possible health
31
A person who uses drugs ...?
- is a human being and deserves to be treated with respect
- is someone's sister, father, daughter, uncle
- has complex needs
- does not want to have a dependency on substances
- is aware how dangerous drug use is - they have seen their friends and family members die
32
What does harm reduction do?
- is a philosophy and human rights approach
- treats people with respect
- does not insist on abstinence
- works with prevention, treatment and enforcement - 4 pillars approach
- connects people to services
- meets people where they are
- engages with people who use drugs - nothing about us without us
33
What does harm reduction do?
- is a philosophy and human rights approach
- treats people with respect
- does not insist on abstinence
- works with prevention, treatment and enforcement - 4 pillars approach
- connects people to services
- meets people where they are
- engages with people who use drugs - nothing about us without us
34
define abstinence
the practice of restraining oneself from indulging in something, typically alcohol or sex:
35
What does harm reduction not do?
- mean legalizing drugs
- only provide services (ex. needles or supervised consumption sites)
- prevent people from entering treatment or stopping use
36
What does harm reduction not do?
- mean legalizing drugs
- only provide services (ex. needles or supervised consumption sites)
- prevent people from entering treatment or stopping use
37
Someone says "Giving out needles to those addicts promotes drug use and is a waste of tax payers dollars. We need to invest in police not harm reduction to stop the junkies from using it?
How would you respond?
- Language
- can keep people alive
- SUD/addiction not a choice, it's a health not a criminal issue
- HR does not promote drug use
- treats PWUD as humans
- helps develop relationships, ,by building trust connects people and may lead to treatment
38
Review one size doesn't fit all
How do we know what the issues are?
- different needs in different regions, substances used, age groups
- need a range of options
- people with lived and living experience of substance use are the experts in their reality
39
Review one size doesn't fit all
How do we know what the issues are?
- different needs in different regions, substances used, age groups
- need a range of options
- people with lived and living experience of substance use are the experts in their reality
40
- Explain the affect of the engagement of peers and peer workers
- is recognized as best practice in harm reduction
- can lead to nimble/effective OD response & prevention services
- can create "safe spaces" for PWUD & improve program access
- can build connections and trust with shared experiences
41
What is the HR services in Canada?
- opioid agonist treatment
- Rx alternatives to toxic drug supply (safer supply)
- drug checking services
- HR supplies
- observed consumption sites
- take-home naloxone
42
What are the drug checking services?
- currently available at SCS & OPS or in person or mail in "Get Your Drugs Tested"
- test strips
--- fentanyl fairly sensitive
--- Benzodiazepines/Etizolam not so good
- various technologies but most point of care give qualitative results (ex. +/-)
43
What are HR supplies for substance use used for?
- safer injection and safer smoking supplies
44
What is the observed consumption in BC?
In BC there are:
- 3 supervised consumption sites
- 44 overdose prevention services
--- episodic OPS
--- peer witnessing
45
What additional challenges did COVID bring?
- some sites closed, and restricted # visits to enable physical distancing
- people who use drugs may avoid crowds and hence use alone
- drugs initially became more expensive and are more toxic - high level fentanyl, added benzos, etc.
46
Explain the take-home naloxone
- PWUDs in BC asked why don't we have naloxone?
- program started August 31, 2012
- initially naloxone was prescription only
- naloxone now unscheduled, available at >2000 community sites at no charge and no identification needed
47
How does naloxone work?
1. Naloxone binds to opioid receptors in the brain
2. opioids are forced off
3. breathing is restored
48
- How long does it take for naloxone to work?
- works in 2-5 minutes
49
how long does naloxone last?
- lasts 20 to 90 minutes
50
Since August 31, 2012, how many THN kits were shipped?
1.8 million THN kits shipped
51
Why do we need a range of options in treatment?
Detox and abstinence based treatment
- not suitable for many
- risks if relapse (loss tolerance)
52
Treatment must be accessible to those who need it, therefore... (the 5 A's)
Appropriate
- diverse options
Accommodating
- hours of opening
Available
- Equity - rural geography
Acceptable
- no stigma from staff
Affordable
- Low or no cost
- can continue to work
53
list the prescribed opioid treatment
Methadone - oral
Buprenorphine/naloxone - oral (Suboxone)
Slow release - oral, morphine (Kadian)
Buprenorphine - oral
Hydromorphone (Dilaudid) tablets - oral
Hydromorphine - injection
Diacetylmorphine (heroin) - injection
54
What is the aim of BC Risk Mitigation Guidance?
- reduce COVID risks, enable people to isolate/quarantine
55
What were the actions of the BC Risk Mitigation Guidance?
- pharmacy home delivery
- BC nurse prescribing of OAT
- Expansion of treatment options
--- Hydromorph/Dilaudid - oral
--- Slow release oral morphine (Kadian)
--- Sustained release oral morphine (M-Eslon)
--- iOAT, TiOAT (Dilaudid)
