Opioid Misuse Prevention
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
AllCEUs Counselor Education
CEUs available at: https://www.allceus.com/member/cart/index/product/id/1348/c/
Objectives
– Identify the types of prevention
– Learn the steps in prevention
– Understand why people use opioids
– Explore the connection between pain and mood disorders
– Identify 5 prevention strategies
Prevention Types
– Primary—Prevent people from developing a problem in the first place
– Secondary—Prevent the problem from getting worse
– Tertiary—Prevent the development of additional issues (HIV, homelessness, stroke)
Steps in Prevention
– Raise awareness of an issue
– Change what people know, believe, and think about the promoted behavior
– Teach the skills needed to perform the behavior
– Build a person’s confidence in his or her ability to perform a specific behavior in a particular situation
– Provide support for sustaining a new behavior
Understand the Reasons People Use
– Acute pain management
– Chronic pain management (including autoimmune issues)
– Anxiety reduction
– Depression reduction
– Withdrawal (refractory pain)
Pain, Anxiety & Depression
– Anxiety activates the HPA-Axis which can increase inflammation and trigger autoimmune issues and depression
– Depression without anxiety is also associated with increased inflammation and pain.
– Ketamine (anesthetic) is used in pain relief and shown significant promise in treatment of acute suicidality
Pain, Anxiety & Depression
– Reducing Inflammation
– Emotional Regulation (HPA-Axis)
– Anti-inflammatories
– Improved nutrition
– Reduction of highly processed foods, increase raw fruits/veggies
– Vitamin D
– Vitamin C (immune system, inflammation, cartilage)
– Vitamin E (nuts and seeds)
– Omega 3
Prevention Strategies
– Improving Health Literacy (social media, schools, MSM)
– Physical (vulnerability prevention, pain management)
– Affective
– Cognitive: Teaching psychological flexibility and CBT skills
– Environmental
– Relational (Interpersonal skills)
Prevention Strategies
– Development of opioid alternatives
– Pain Reform extended release local anesthetic
– CBD Oil
– Gabapentin
– Muscle relaxants
– Antiepileptics (i.e. Lamictal)
– Acupuncture
– Chiropractics
Prevention Strategies
– Management of mood disorders and other SUDs
– Screening for and addressing mood and addictive disorders in all people at annual physical
– Improve access to MH and SUD treatment
– Addressing macrosystem issues contributing to opioid misuse
– Conservative Prescribing (and reducing expectation)
– Accessibility/availability (drug take back, parental control, injectables to reduce diversion)
– Improve drug screening protocols and drug free workplace policies at all organizations and in high school and collegiate athletics
– Make public assistance benefits dependent upon being drug free OR actively participating in a treatment program
– Enhancing community connectedness
Strategies
– Harm reduction (tertiary prevention)
– MAT
– Needle exchange programs
– Naloxone
– Provider education and guidelines
– Collaborative, multidisciplinary approaches required by insurance and taught in graduate school
Summary
– Opioids have a place for acute pain management
– Opioids have also been associated with reductions in anxiety and depression
– Dependence and tolerance develop quickly
– Currently opioids are very easily diverted
– Prevention needs to focus on all of the reasons people abuse opioids including stress and anxiety management, depression, and pain