The influences the availability and the impacts Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings non is so universal and so efficacious as opium ID: 273943
Download Presentation The PPT/PDF document "Emergent opioid trends" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Emergent opioid trends
The influences, the availability and the impacts
Slide2
“Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, non is so universal and so efficacious as opium”
Sir
Thomas Sydenham, 1680Slide3
Inspired by
Historical use of opioids
Supply sources
Communication channels
Adjunctive use
-over and above maintenance doses
Desire to ‘have some control’ over use
Users
resourfulness
Desire to ‘not do harm’Slide4
NZ context
Dominated by use of pharmaceuticals:
Morphine and methadone as the ‘mainstays’
(Robinson et al, 2011
)
Cough syrups
(Griffiths et al, 1982)
Homebake
(Bedford et al, 1987)Opium poppy heads (Dore et al, 1997)Poppy seed tea (Braye et al, 2007)Over the counter codeine analgesics (Robinson et al 2010)Oxycodone (BPJ, 2011)Slide5
Objectives
To
explore service users and service providers understandings
of:
patterns
of new and emerging opioid drug use (trends)
the mechanisms that influence these trends (availability)
the impacts of these on opioid users (impacts)Slide6
Mindful that:
‘each kind of analysis and way of presenting the data, both simultaneously reveals and
conceals…however rich one analysis is, it is
inevitably incomplete, partial, tentative,
emergent, open and uncertain’ (Finlay, 2008)Slide7
Methodology
Qualitative
Husserlian phenomenologyUnderstanding of participants perspective
Role of the researcherSlide8
Method
Self reflection- bracketing
Ethical challenges
Purposeful sampling
In depth interviews
Reflection
Analysis-
(Giorgi; N-vivo)
Iterative processSlide9
Participants
Service Users
n=9
CADS, OST, DHDP
Age 35-56;
10-30+
years use
7 male; 2 femaleNZ Euro, Māori, British, Aus, JewishService Providersn=510-35 years working in addictionRange of services, roles, ethnicity, genderSlide10
Findings
Emergent trends
Availability and accessibilityImpactsSlide11
Emergent trends
“what
is reported is that morphine and methadone is used predominantly, but then that’s because they ask about morphine and methadone. They don’t actually ask about the more OTCs or...” (SP
)
TrendsSlide12
Localised
trends, susceptible to change
“There is always something that will replace something that goes” (SU)
“…
it’s a comparatively small market and, you know, it only needs one dealer to get put in jail and you know, the whole thing changes, and one big bust and there will be a recalibration of what people use and what is
available”
(SP)Slide13
Availability and Accessibility
The business of
p
harmaceutical companies
“They keep
supplying and supplying, and keep the opiate users going
...”(SU)
“Growing market share is what they do” (SP)“You
know, these drug companies are quite cunning, you know. They put a hell of a lot of, a lot of thought, they know that’s addictive...and
there is a lot of money involved. You know, they don’t put silly people in charge of getting these things out there and I think people have to be aware of that” (SU)“marketing programmes…including direct to the public marketing” (SP)Slide14
Prescribed opioids-a primary supply
source
‘aroha’, ‘
ignorance’ or ‘arrogance’
“Yeah. Well, I have always been really lucky, I have always found drug doctors…”(SU
)
“A
lot of the discharge prescribing, discharge scripts, discharge summaries etc. are done by junior doctors, who aren’t sufficiently aware of these sorts of issues. So I think there is a problem with hospitals in particular… “(SP)
“The surgeons, you could just get anything you want off them really, and I used to think, can I get anything off these guys…”(SU)Slide15
Users as creative, flexible people
‘The art of lying, cheating and manipulation’
“you’ve got to think about what they’re going to come back at you with to turn you down so you’ve got to work it out, so you’ve closed up all the loopholes so they can’t say no
” (SU)
‘Deterrents, potentiators and precursors’
“they are not deterrents, yeah. To an addict there is always a way, there is always a way...” (SU)
“...they’ll say we’ll put that in, that will stop them. But if they knew the client that wouldn’t bloody stop them” (SP)Slide16
Information sharing
“
I guess when you look way back at opiate use, it was very much like an apprenticeship in a way, you know, the elders taught the younger ones, and it came through. I don’t get a sense that that is happening so much anymore. There’s not those tight communities of drug users”
(SP)
“I don’t know if that is because there is more availability of other stuff or maybe the new generation just doesn’t have that kind of chemistry knowledge” (SU)Slide17
Systemic considerations
“Guidelines exist- but are not necessarily adhered to”
(SP)The role of PHARMAC and MoH Pharmacists role-
the friendly pharmacists
the regulated pharmacist
The supportive/accessible pharmacistSlide18
Border controls
“Small
country. Small market. Island. Good border control. Lots of sea, no warring countries on our borders”Legislation enforcement
Fairly lax re opioids
‘Focus on methamphetamines as part of
govt
policy’
Precursor restrictions used in baking processesUnsanctioned controlsOST-restricting availability, ‘labeling’, stigmaRetail restrictionsSlide19
Impacts
Associated harms
h
arms of opioids generally
s
ome emergent trends more harmful-particularly
to the uninitiated
userabuse deterrent formulations (ADFs)dependence cycled
isplacementCriminalisation
“Or they would get it off the black market, which is actually going to be worse, …Then they would be involved in crime and things like that” (SU)Slide20
Considered approaches to
minimising
harm‘Carefully considered and executed exercise to maximise effect and
minimise
harm’
Stabilising
effect of some opioids
“I don’t know. On one hand I want to get my drugs and on the other hand I know that it’s not good for too many people to have those drugs. Some people are just going to do what they are going to do. No matter how much you educate them or lecture them and that. It’s probably better that they don’t restrict the access but don’t make it so liberal that anyone can just go in and get it as well” (SU)Slide21
Considerations-opioid dependant population
Unintended consequences:
l
ifestyle and wellbeing
a
ccessibility (price, dosing, formulations)
criminalisationstigma and discriminationdisplacement (substance, geographical)‘Metered’ doses/low harm options
Abuse deterrent formulationsAccess to harm reduction info and interventionsTreatment delivery to be ‘recovery’ focused
RecommendationsSlide22
Considerations-wider population
Abuse, misuse and dependence potential
Impact on uninitiated users
Training AND monitoring for ALL prescribers
Networking opportunities
‘Atypical’ or hidden populations
Roles across agencies: prescribers pharmacists, DHDP/NEP
National prescribing and monitoring platformDirect to public advertising (DTPA)Slide23
Shared responsibility
prescribers
userstreatment providerspharmaceutical industryMinistry/Government
legislation
Consideration of
“
the public good”
The effect of drug policy options on the public good and individuals, (
Strang et al., 2012, p79)Slide24
Closing thoughts
“There has never been a time,
place
or culture where some psychoactive drug
has
not been
used
, and it’s highly unlikely that there ever will be” (Ryder, Salmon & Walker, 2006)