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Congressman Tipton’s Opioid and Heroin Abuse Panel Discus Congressman Tipton’s Opioid and Heroin Abuse Panel Discus

Congressman Tipton’s Opioid and Heroin Abuse Panel Discus - PowerPoint Presentation

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Congressman Tipton’s Opioid and Heroin Abuse Panel Discus - PPT Presentation

Bob Sammons MD PhD Mesa Behavioral Medicine Clinic TMS Solutions Conflict of interest None      Dr Sammons received a bachelors and masters degree from Auburn University a PhD in clinical psychology from the University of North Carolina at Greensboro and a medical degree from t ID: 580508

abuse opioid treatment addiction opioid abuse addiction treatment drug medicine pain reward stimulation play dopamine circuit deterrent control university

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Presentation Transcript

Slide1

Congressman Tipton’s Opioid and Heroin Abuse Panel Discussion

Bob Sammons, M.D., Ph.D.

Mesa Behavioral Medicine Clinic

TMS SolutionsSlide2

Conflict of interest

None

     Dr. Sammons received a bachelors and master’s degree from Auburn University, a PhD in clinical psychology from the University of North Carolina at Greensboro, and a medical degree from the University of North Carolina at Chapel Hill.  He did a residency in psychiatry at the University of Virginia as well as a forensic fellowship.  While serving in the United States Air Force as a squad commander and captain, he was selected as one of 5 psychologist to establish the opiate treatment phase of the drug treatment program for the Department of Air Force in 1972.  For this he receive the  Meritorious Service Medal.  He has practiced adult psychiatry in Grand Junction for 28 years.  He is 1 of 2 physicians in town that have received specialist training and a special DEA number that allows him to prescribe Suboxone treatment for opiate dependency.

 Slide3

Goal

Fulfill requirements of H.R. 4969, John Thomas Decker Act of 2016

To educate and prevent addiction in teenagers and adolescents who are injured playing youth sports and are subsequently prescribed an opioid

Make this information available to teenagers who play sports as well as for their families, sports groups, and health care providers

Problem: Opioids are better educators than we are (Katie Sammons, M.A., Ph.D., Pend)Slide4

Impetus for the John Thomas Decker Act of 2016

John Thomas Decker died at age 30 from an opioid overdose

He was a talented young athlete, lettering in three different sports in high school before going on to play lacrosse at Cornell

He suffered an injury playing a pick up game of basketball

Undergone multiple surgical repairs on his or anterior cruciate ligament (ACL)Slide5

Eventually was place on an opioid medication

Became “hooked” on the opioid

Eventually sought out cheaper and more easily assessable heroin

Died of respiratory depression from an overdose of the opioidSlide6

Problem

You can play football or you can avoid being hurt. But you can’t play football and avoid being hurt.

Like the Deadliest Catch TV Show. There is a 100% injury rate.

If you are seriously hurt, you see a physician to relieve your pain and suffering.Slide7

You can be told the government does not want you to be given medicine that will take your pain away.

Or you can be given an opioid that will take your pain away but possibly put you on the path of a miserable and potentially life threating addiction.Slide8

Mechanism of Action of Addiction

At lower doses opiates causes analgesic pain relief

And at higher doses opiates produce a rush of euphoria or dream like state

opioids overstimulate the brain’s reward circuit and trigger a large release of dopamine

Dopamine is often called the pleasure moleculeSlide9

Repeated overstimulation of the brain’s reward circuit numbs the response in the brain’s pleasure center (nucleus accumbens)

To attempt to maintain homeostasis, the pleasure center releases dynorphin, which inhibits the stimulation of this area

By turning down the stimulation

the addict will feel less pleasure from the drug

the high won’t be as rewarding.

the addict will require more and more stimulation to get the same level of reward

Eventually, the addict needs to take the drug just to feel normal.Slide10

Cravings

Cravings occur through stimulation of an area called the ventral tegmental area (VTA)

Here the release of dopamine sensitizes the area of the VTA making it more sensitive and easier to activate

With repeated drug use the dopamine causes more cravings and over time the cravings become so strong they can no longer be resistedSlide11

Reduced self control

The prefrontal cortex plays a major role in inhibiting behavior suggested by the more primitive reward circuit

prefrontal cortex is the logical, rational circuit that understands consequences and that inhibits inappropriate behavior

With repeated drug use the prefrontal cortex is impaired and reduces the addict’s ability to exhibit self-control and override drug craving becomes weaker and weakerSlide12

Treatment

Recidivism of addicts who stop on their own is 93%

Lots of articles on opioid problem

New England Journal of Medicine, April 2016,

A Proactive Response to Prescription Opioid Abuse

“We will continue to support abuse-deterrent formulations and encourage development of more effective abuse-deterrent features”Slide13

Abuse-deterrent medications

I remove demons from people’s mind and never get a thank you. When I prescribe Suboxone, people hug my neck and thank me for giving them their life back.

Buprenorphine/Naloxone (Suboxone, Zubsolv)

I advocated for years for this medicine to be the first medicine used after the failure of a NSAID

Requires a special DEA number to prescribe of opioid dependency

Any physician can prescribe for pain controlSlide14

Abuse-deterrent medications

It is a partial agonist

You don’t develop tolerance

It has a ceiling effect

addicts can’t get high

once receptors are full, there is no place for opioids to bind

Can’t overdose - unless you are on a benzodiazepine or alcohol

Competes for the opiate receptor site

competitive agonistSlide15

Suboxone is an opiate

Short Acting VS Long Acting 24-36 hours

No roller coaster ride

Minimum of 3 days to tell what amount keeps you stableSlide16

rTMS in the treatment of addiction

The rationale to use rTMS as a treatment for substance addiction and craving is that the DLPFC, which plays a major role in top-down inhibitory control mechanisms and reward mechanisms, is dysfunctional in these disorders

Guidelines evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) Clinical Neurophysiology 125 (2014) 2150–2206Slide17

Acknowledgements

Mechanism of action in addiction heavily quoted from Thad Polk, Ph.D., The Addictive Brain Course Guide, The Great Courses

I have donated a CD and DVD copy of this course to the Mesa County Library as well as Mesa County Community Corrections