Class2_Addiction_StudentCopy_2 (1).pptx

Health & Illness II CL ASS 2 NRSG3301 CRYSTAL TREIG E BS C N RN M N NP Concept(s) & Exemplar(s) Concept(s): Addiction Exemplar(s): Opiate addiction, prescription drug dependency & abuse Key Terms A) The need for increasingly more of the sti...

Health & Illness II CL ASS 2 NRSG3301 CRYSTAL TREIG E BS C N RN M N NP Concept(s) & Exemplar(s) Concept(s): Addiction Exemplar(s): Opiate addiction, prescription drug dependency & abuse Key Terms A) The need for increasingly more of the stimulus (e.g., alcohol, drug, behavior) to 1) Substance abuse get the effect, which is the result of habituation and adaptation. B) A maladaptive pattern of substance use 2) Substance dependence leading to clinically significant impairment or distress. C) The occurrence of symptoms when 3) Tolerance sufficient quantities of a stimulus are not obtained to achieve the effect as a result of tolerance or reduced consumption. D) A maladaptive pattern of substance use 4) Withdrawal leading to clinically significant impairment or distress accompanied by tolerance and withdrawal. Continuum of Use Perspective Distinguishing Between an Addiction and Compulsive Behavior Addiction must include three elements: biological, psychological, and social Compulsive behaviors do not have the biological element, only the psychological and the social. Without the biological risk different concerns for policy and practice are present Epidemiology Substance use is common in Canada Prevalence of alcohol use for Canadians over age 15 years is 78% Drug use by youth 15 to 24 years of age is higher than for adults 25 years and over Binge drinking among Canadian men is ranked as the highest in the world 6 Epidemiology/Comorbidity The combination of a psychiatric comorbidity and substance use disorder is called a concurrent disorder People with a mental illness are twice as likely to have a substance use disorder compared to the general population. At least 20% of people with a mental illness have a co-occurring substance use disorder. For people with schizophrenia, the number may be as high as 50% (CAMH, 2023). Concurrent disorders require longer treatment, more severe symptoms, experience more crisis, and require more extensive assessment for both disorders in order to create individualized interventions. 7 Our Brain on Opioids Please be mindful of this video when caring for those dealing with addiction. https://www.youtube.com/watch?v=NDVV_M__CSI Opioid Crisis in Canada The current opioid crisis is a result of multiple, complex factors that include: A misunderstanding of the addictive risk of prescription opioids Psychological, social and biological risk factors like genetics, mental health, early life experiences, trauma, poverty, lack of secure housing and other social determinants of health Stigma towards substance use disorders Frequent opioid prescribing and high amounts being prescribed for pain relief Lack of awareness or access to alternative treatments for pain Use of prescription opioids by individuals to whom they are not prescribed, such as friends and family members Lack of access to prescription opioids leading to illicit opioid use Illegal drugs that are laced with fentanyl and its analogues A lack of comprehensive care to respond to all the mental and physical health needs of an individual Opioid Deaths in Canada (2020) Government of Canada, “Maps: Number and rates (per 100,000 population) of total apparent opioid toxicity deaths by province and territory in 2020,” Opioid‑ and Stimulant‑related Harms in Canada (December 2021), Public Health Infobase, Database, accessed 1 December 2021 Addiction- Risk Factors Substance Use Disorder Characterized by use, abuse, and physical and psychological dependence, and also by certain behaviors:  Loss of control of substance consumption  Continued substance use despite associated problems  Cravings and a tendency to relapse after efforts to change behaviour COPYRIGHT © 2019 ELSEVIER CANADA, A DIVISION OF REED ELSEVIER CANADA, LTD. 12 Opioid Use Disorder DSM-5.pdf (bccsu.c  Trauma Informed Care Trauma Informed Care | Alberta Health Services Trauma Informed Care: Using a Non- Judgmental Approach Harm Reduction Model of Care (CAMH, 2023) Harm reduction Harm Reduction: Canadian Nurses Association Recognizes that individuals who use substances must be involved in decisions related to their care and larger discussions about policy and harm reduction programs Harm reduction emphasizes human rights of dignity, respect, and compassion regardless of substance use Is a non-judgmental approach that accepts individuals as they are as well as their right to make choices about their health and lives Focuses on promoting safety and does not require the substance use to be discontinued Aims to prevent death or disability by supporting safer substance use for the health and safety of all individuals, families, and communities Emphasizes the importance of providing safe, and competent care that is based on evidence instead of personal beliefs, ideology, or misconceptions (Canadian Nurses Association, 2023) Opioid Overdose in Canada A total of 5,360 apparent opioid toxicity deaths occurred in 2022. This is approximately 20 deaths per day. For the same period in 2019 prior to the COVID-19 pandemic, the number of deaths per day was 10, which increased to a peak of 21 in 2021. Most (87%) of all accidental apparent opioid toxicity deaths in Canada occurred in British Columbia, Alberta, or Ontario Of the accidental apparent stimulant toxicity deaths in 2022 78% involved an opioid, *81% involved fentanyl (Government of Canada, 2023) Opioid Overdose: Naloxone A person may have overdosed if: they can’t be woken and/or don’t respond to pain (e.g., pinching) they are not breathing at all or are breathing very slowly their lips and fingertips are turning blue or purple (in people with darker skin, their gums may be blue or purple) they are making an unusual gurgling or loud snoring sound their pupils are very tiny (CAMH, 2023) *Naloxone is a medication that can temporarily reverse the effects of an opioid overdose and allow time for medical help to arrive Other Therapies Psychotherapy Social work Clinical Therapist Housing First Social Assistance Worker Psychiatrist Prescription Drug Misuse Canada leading public health concern Canada is the second largest consumer of opioids Declared a community crisis in some First Nations' communities (International Narcotics Control Board 2013) Prescription Drug abuse Intoxication and Withdrawal (Opiates, Heroin, Oxycodone, Hydromorphone, & Fentanyl) Constricted pupils, drowsiness, Dec Resp, Dec BP, Slurred speech, euphoria, dysphoria, Intoxicati on impaired judgement and memory Possible dilated pupils (BC anoxia), Resp depression, or arrest, CV arrest,, coma, convulsions, death Overdose Tx: Narcan, Resp support, CV support Yawning, insomnia, runny nose, panic, diaphoresis, cramps, N&V, aches, Fever, chills, diarrhea Withdraw al TX: Suboxone (buprenorphine), methadone, Clonidine Intoxication and Withdrawal of Depressants (Benzodiazepines, Alcohol) Slurred speech, intoxication, gait, drowsy, decreased BP Intoxicati Sexual disinhibition, aggression, impaired on judgement and memory, CV or Resp depression, coma, shock, convulsions, death Treat: Induce vomiting, IV fld, charcoal, seizure Overdose precautions, Et tube, EKG, labs N&V, tachycardia, diaphoresis, irritability, anxiety, tremors, insomnia, Grand Mal Seizure, delirium Withdraw al Treat: Antabuse (Disulfiram), Librium, Thiamine Intoxication and Withdrawal of Stimulants (Cocaine, Crack, & Meth) Tachycardia, dilated pupils, Elevated BP, N&V, Insomnia, Abusive, Grandiosity, impaired judgment, Intoxicati euphoria, energy, wakefulness, paranoid, delusions, on hallucinations Resp distress, Ataxia, Hyperpyrexia, Convulsions, Coma, Stroke, MI, Death TX: antipsychotics, cooling, Diazepam, Resp Overdose support, CV support Fatigue, depression, agitation, apathy, anxiety, sleepiness, disorientation, lethargy, cravings Withdraw TX: antidepressants, dopamine agonist al Canadian Center on Substance Abuse Report (2018) The report contains a 10-year pan-Canadian strategy lays out 58 recommendations across five areas: Prevention Education Treatment Monitoring and Surveillance Enforcement Levels of Prevention Primary – those efforts focused on reducing the demand for a substance or behavior, as well as stopping the occurrence of alcohol or drug use or abuse (e.g., prescription drug monitoring programs, safe storage and disposal, pt. education, pharmacological changes in medications, media campaigns, improved MH services) Secondary – seeks to limit further health deterioration and social harm from the use of, abuse of, dependence on, and addiction to substances and behaviors (e.g., harm reduction practices, supervised injection sites, relapse prevention support, good Samaritan act) Tertiary – mitigate the impact of the addiction (e.g., detox and recovery/rehabilitation programs, naloxone program, methadone and buprenorphine program) 28 Practice Questions A patient that abuses heroin tells the nurse ‘I’ve been using more heroin lately to feel the effect I want.‘ Which of the following does this describe A) Intoxication B) Withdrawal C) Tolerance D) Addiction Practice Questions A patient is admitted to hospital for observation after describing suicidal ideation. This patient also has been using cocaine and alcohol heavily for 5 months. What would be the nurse’s priority outcome for this patient while in hospital? A. The patient will return to a pre-drug level of functioning within 1 week B. The patient will be medically stabilized while in hospital C. The patient will totally abstain from drugs and alcohol D. The patient will engage in strategies to alleviate stress Debate Groups Question A/B Take 20 mins to prepare 3 talking points Affirm 2 min to begin Should health care dollars be used for Oppose 2 min to respond methadone treatment? Affirm 2 min to respond ½ Group agree Opposed 2 min ½ Group opposed Group Discussion B. Should the government fund safe injection sites? Share with class ½ Group agree ½ Group opposed Resources CCSA: http://www.ccdus.ca/Eng/topics/Prescription-Drugs/Pages/default.aspx Stats on opioid deaths: https://www.canada.ca/en/health-canada/services/substance-use/problematic -prescription-drug-use/opioids/data-surveillance-research/harms-deaths.html Management of opioid use disorder: http://www.cmaj.ca/content/190/9/E247