HLTHAGE 2L03 Lecture Notes - Lecture 8: Opioid Use Disorder, Methadone, Morphine
13 May 2018
School
Department
Course
Professor
Good$and$bad$drugs:$
Dichotomy$between$narratives$of$pharmaceuticals$and$narcotics
One$fixes,$one$destroys
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Drug$scheduling$(categorization)$
Different$categories$outlining$harms$of$certain$drugs
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What's$bad$and$what's$okay
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By$school$age,$children$recognize$that$some$drugs$are$good
And$that$some$drugs$are$bad$and$used$by$"bad$people"$
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"medicine"$=$good,$helpful
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"drugs"$=$bad,$scary$
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When$using$"good"$drugs$in$a$"bad"$way$
Users$might$justify$by$saying$"it’s$a$medicine$it$cant$be$that bad"$
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If$its$prescribed,$how$bad$can$it$be$
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The$division$is$not$solely$chemistry
Social$division$
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So$what$makes$a$drug$medical?$
In$industrial$societies,$drugs$that$weaken$productivity$are$viewed$negatively$
Drugs$that$boost$productivity$viewed$positively$
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This$dichotomy$is$too$simple$-many$exceptions$
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Dosage$continuum$-medicinal$/$narcotic$
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Social$and$individual$expectation$of$effects$
Is$it$going$to$get$you$high?$
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How$does$it$make$you$feel?$
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Is$there$a$supply?$Drug$dealers?$
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Who's$dealing?$Heroin$v$methadone$v$morphine$
Who's$using?$
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Who's$producing?$
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Prescription$addiction:$
Since$1990's$prescription$addiction$has$eclipsed$narcotics$in$terms$of$social$
harms$and$rates
Opioids,$benzos,$stimulants$most$common$
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Two$images$of$prescription$addiction
Those$who$are$"innocently"$addicted$to$a$drug$for$the$purpose$it$was$
prescribed$
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Those$who$use$the$drug$to$achieve$a$separate$effect$
Can$these$groups$be$dichotomized?
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What$is$the$line$between$these$2$types$of$addiction
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Prescriptions$and$black$market
How$have$these$drugs$become$so$widely$available$•
Diversion:
From$the$factory,$the$MD's$office,$the$pharmacy,$the$patient
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How$legit$drugs$get$onto$the$black$market$
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"doctor$shoppers"$
People$who$will$go$to$multiple$doctors$to$get$specific$drugs$
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"script$docs"$
Doctors$who$are$known$to$be$lax$in$writing$prescriptions$
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Internet$sales$(black$web)$
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RX$fraud$and$forgery$
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Some$may$purchase$from$"dealers"$
Bust$most$common$suppliers$are$fam,$friends,$physicians
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Addiction$is$not$simply$tied$to$"bad$users"$but$range$of$ppl$from$organized$
crime$to$medical$system$
Has$huge$implication$for$stemming$crisis$
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The$Opioid$Crisis:$
Deaths$from$prescription$opioids$surpass$heroin$and$cocaine$combined$•
Prescription$opioid$use$doubled$in$Canada$during$2000-2010$
In$US$900%$increase$in$treatment-seeking$for$opioid$addiction
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Oxycodone$at$centre$of$discussion$over$crisis
1990$oxy$was$a$"breakthrough"$pain$relief$
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Quickly$concerns$of$potential$addiction$
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Modifications$to$pills$also$found$incredible$high
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Sparks$large$increase$in$crime$across$regions$hardest$hit
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1890s$panic$over$opioids
Mothers$used$them$to$treat$children
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Soldiers$to$treat$injuries,$even$hangover$cure$
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"hillbilly$heroin"$
Ohio$valley$and$Appalachia$•
Prescription$rates$5x$national$average$
In$this$places,$individuals$have$jobs$that$cause$high$physical$pain$(mining,$
steel$producing,$farming)$
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Rural$ass$isolated$area,$nothing$really$ to$do
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Few$other$street$drugs$
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Boredom$+$pain$=$heroin$
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Economic$distress
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Not$connected$to$large$narcotics$distribution$
Could$get$oxy$through$prescriptions$
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Medicaid/Medicare$
Partially$or$fully$covered$prescriptions$
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Regional$histories$of$drug$distribution
Moonshine,$marijuana$
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Commercial$triumph:$
Van$Zee:$success$driven$by$marketization
Purdue:$company$making$OxyContin$
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Not$therapeutically$more$useful$than$other$drugs$
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1996$to$2000$-exponential$growth$
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Doctors$began$to$get$the$message$about$the$drug$
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Prescriber$database$used$to$identify$most$willing$to$prescribe$
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Major$message?$OxyContin$has$"miniscule$risk$of$addiction"$
Claim$that$"legitimate$ pain$patients"$could$not$get$addicted$
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Found$guilty$of$criminal$charges$relating$to$false$advertising$
Misleading$public$and$MDs$about$addictiveness
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Case$study:$U$of$T
Navindra$Persaud:$2000-2010,$1400$med$students$took$mandatory$course$on$
pain$management
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They$were$told$OxyContin$was$best$medicine$to$treat$pain$because$it$was$not$
addictive$$
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Given$free$textbooks$written$by$Purdue$-company$who$makes$oxy$•
Professor$of$the$course$was$paid$by$Purdue$to$lecture$these$students$•
Students$were$contacted$later$on,$told$to$disregard$everything$they$learned$in$
the$course$
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Beyond$OxyContin:
Eventually,$OxyContin$was$removed$from$Canadian$market$in$2012•
Many$turned$to$other$substances$
Fentanyl$(often$used$in$fake$oxy)$
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May$be$100x$more$powerful$than$morphine$and$heroin$
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Naloxone$debate:$should$kits$and$training$be$funded?$
Should$non-healthcare$professionals$be$able$to$use$them?$
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Lecture'8:'Prescription'Drugs
Tuesday,$ March$ 13,$2018
2:31$PM
