Substance Abuse//Exam 3?

Three Purdue Marketing Claims

Opioids are not as addictive as people say they are; all pain, even acute, should be addressed in ethical practices; and all patients should be assessed for pain.

50 Million

How much Purdue Pharma made in Oxycontin sales in 1996

1.1 Billion

How much Purdue Pharma made in Oxycontin sales in 2000

Arthur Sackler

The oldest Sackler brother (1913-1987) who predominately gave rise to the Purdue Pharma’s company success, mostly due to his bold, ethically questionable marketing strategies. Not tied to the Oxycontin scandal.

Detail Men

Salesmen type pushed by Arthur Sackler, which is physicians trained to promote/pitch pharmaceuticals to other physicians.

MS Contin

Drug sold by Purdue Pharma meant for serious cases of cancer pain, which was repackaged into a falsely advertised “slow-release” pill called Oxycontin to avoid its patent deadline.

Dr. Russell Portenoy

Former director of many NYC hospitals in their hospice and pallitave care. Did a ton of promotion for Oxycontin in the form of conferences and talks.

Pseudoaddiction

Term coined by physicians-turned-Purdue Pharma workers that all drug-seeking behavior is a pain management issue rather than an addiction issue.

Dr. Curtis Wright

Former FDA Reviewer who helped Oxycontin get passed by the FDA, then soon quit the FDA for a more lucrative job in Purdue Pharma.

2012

Year where opioid prescriptions peaked in the US (more than 255 million). Prescriptions have been decreasing ever since.

2006

Year where opioid prescriptions began to increase.

2011

Year where heroin use began trending.

2013

Year where synthetic opioid use (predominantly fentanyl) began to increase

Timothy Leary

Clinical psychologist who became a counter-culture icon. He oversaw Harvard’s Psilocybin Lab, where he pushed mushroom use onto peers and students until he was fired. Coined many psychedelic-related phrases.

Leo Zeff

Psychologist and Lieutenant Colonel in the US Army. Early innovator of ‘psychedelic-assisted therapy’ treating patients with LSD and training other psychologists to do so also. Took his therapy underground after LSD was outlawed in 1965.

Albert Hoffman

Swiss chemist who was the first man to synthesize (1938) and accidentally ingest (1943) LSD while trying to create a respiratory and circulatory stimulant. Later, he intentionally takes a crazy high dose of LSD and trips balls. Very outspoken against Leary.

LSD

A highly potent odorless and tasteless synthetic chemical made from a substance in ergot, a fungus that targets rye. It changes mood, perception, and thought, and is associated with hallucinations. Normally put on gelatin or sugar for consumption.

LSD Trip Symptoms

Euphoria, dilated pupils, hallucinations, confusion, nausea, sweating, chills, as well as increased body temperature, heart rate, and breathing

Flashbacks

Rare episodes where LSD effects pop up weeks or months after taking it.

Psilocybin

AKA magic mushrooms, a group of multiple species of fungi, many of which with very toxic lookalikes. Taken as dried material or as tablets or pills.

Mescalin

AKA buttons or peyote, hallucinogen from the Mexican peyote cactus

Ayahuasca

AKA the Tea, a very bitter plant normally ingested as a tea, which is taken spiritually.

Ketamine

Dissociative made in the 1960s as a dissociative anesthetic, and now is a Schedule III drug, Causes a trance-like state with sedation and pain relief. Used as an alternative sedative rather than the first choice due to its ability to dramatically reduce respiration

Problems Associated with Ketamine Use

Bladder and kidney problems as well as impaired memory and focus.

PCP

AKA “angel dust”, a dissociative anesthetic that targets the neurotransmitter glutamate developed for medical use, which was dropped for its serious, unpredictable side effects. Can cause hallucinations, distortions, decreased pain sensitivity, and aggression. Serious cases cause catatonia.

Long Term PCP Effects

Memory loss, difficulty with speech and thinking, decreased cognitive function, seizures, comas, respiratory depression, and ego inflation.

3,4-methylenedioxymethamphetamine (MDMA)

Empathogen that behaves like a hallucinogen and stimulant (targeting the same receptors as cocaine and meth, while being more serotonin-like)

Anton Kollisch

Chemist who synthesized MDMA in 1912 in an attempt to make a blood clotting drug. He shelved the drug and it only be uncovered in 1953 for MK Ultra.

1970

Year where the first documented case of recreational MDMA use occurred, in suburban Chicago.

Alexander "Sasha” Shulgin

The “godfather of psychedelics”, who got a DEA schedule I licence to study psychoactive chemicals in “the farm”, a lab behind his house. Got into taking MDMA with his students.

Micheal Clagg

Man who nicknamed MDMA ‘ectasy’, a former seminary student dropout who got into MDMA in Cali, then in Dallas, TX, where he allegedly made the most MDMA in one spot in history ever. Runs from the DEA in Brasil, where he channels pills to Europe, where rave culture was on the rise.

1978

Year where the first scholarly publication of MDMA got published

1985

Year where MDMA is labelled a schedule I drug permanently, despite having evidence supporting that it was not distinctly addictive and having therapeutic uses.

Multidisciplinary Association for Psychedelic Substances

FDA-approved organization starting in 1995 that studies the safety and use of MDMA. Had a famous incident with a study indicating MDMA causes brain damage, where it was then found the study actually was using meth.

2010

Year where the 1st controlled study demonstrating MDMA therapy for PTSD was published

GI Tract

Where MDMA pills are absorbed

MDMA Effects

Increased trustingness, openness, and empathy. Bronchiole and pupil dilation, exaggerated/enhanced perception of sensory stimuli, and a sense of time shrinking. Jaw clenching and teeth grinding.

Four Types of Enabling

Avoiding and shielding, attempting to control, taking over responsibility, and rationalizing and accepting.

Stage 1 (Active Addiction)

Stage of family addiction characterized by denial and a creation of a story to defend the addict.

Stage 2A (Transition)

Stage of family addiction characterized by ‘laying down the law’, normally after a crisis.

Stage 2B (Giving Up)

Stage of family addiction characterized by being the ‘rock bottom’

Stage 3 (Early Recovery)

Stage of family addiction characterized as a time of stabilization, new behavior, and knowledge.

Stage 4 (Ongoing Recovery)

Stage of family addiction characterized by internalizing cognitive and behavioral changes, taking responsibility, and setting boundaries. Considered a 2nd rock bottom as prior habits need to be cut entirely, relationships often need to ‘start over’, and resentment can build easily

Question-Answer Trap

Conversational trap to avoid for practitioners, where the practitioner asks the client only Yes/No questions, which forces a power differential of expert/patient rather than building rapport or engagement.

Taking Sides Trap

Conversational trap to avoid for practitioners, where the practitioner detects some information that indicates the presence of a specific problem, hones in on it as something to address, and reluctance from the client only eggs them on.

Labeling Trap

Conversational trap to avoid for practitioners, where the practitioner gets caught up in diagnostic labels, which can be construed negatively as a power struggle.

Premature Focus Trap

Conversational trap to avoid for practitioners, where the practitioner and client focus on different topics entirely

5 Early Methods to Build Motivation

Open-ended questions, affirmations, reflective listening, summarizing, and eliciting change talk

Stage 1 Reflective Listening

Reassuring, denying, or offering advice in response to a client statement, which often feels dismissive

Stage 2 Reflective Listening

Responding to the content of what’s said, but not its feelings.

Stage 3 Reflective Listening

Understanding feeling and content of what’s said with no direction or interpretation. Actually where most therapeutic/motivational focus should be.

Stage 4 Reflective Listening

Understanding feeling and content of what’s said as well as direction or interpretation. Requires prior rapport and appropriate context.

Brief Encounter Strategy for Motivational Interviewing

AKAa FRAMES; Feedback, Rolling with resistance, Advice about change, Menu of options, Empathy, and Support of self-efficacy.

Naturally Occurring Opioids

Codeine and morphine

Semi-Synthetic Opioids

Hydrocodone (Vidocin and Lortab), hydromorphone (Dilaudid), oxycodone (Percocet and Oxycontin), and heroin.

Synthetic Opioids

Methadone and fentanyl (Ctiq and Sublimaze)

Things Opioids Treat

Pain, cough, and intestinal discomfort.

Opioid Effects

Extreme Relaxation, drowsiness, confusion, memory loss, constricted pupils, slurred speech, slowed heartbeat and breathing, nausea and vomiting, and constipation

Early Opioid Withdrawl Effects

Fever, trouble falling asleep, agitation, runny nose, sweating, racing heart, and muscle aches.

Late Opioid Withdrawl Effects

Depression, dilated pupils, stomach cramps, nausea and vomiting, and diarrhea.

Heroin

AKA junk or smack, a potent opioid with high potential for addiction. Varies in appearance from powders to gels. Often paired with dangerous additives as a street drug

Heroin High Effect

Intense feeling of well-being with contentment, reduced anxiety, relieved tension, drowsiness, and apathy.

Subacute Pain

Pain that’s been present for at least 6 weeks, but less than 3 months.

Full Agonist

A compound that mimics a drug entirely, both binding to the drug receptor and causing the same effects. A main example is methadone.

Partial Agonist

A compound that mimics a drug, binding to the drug receptor but causing a more mild effect. A main example is buprenorphine.

Antagonist

A compound that mimics a drug, binding to the drug receptor but causing no . A main example is naloxone.

Naltrexone

Non-addictive antagonist prescribed for opioid addictions, as they prevent to ability to get high and often lowers cravings.