Part 1- Background

Watch the brief video “Susan’s Brain: The Science of Addiction” at

https://www.youtube.com/watch?v=pe5loX720Rk

 

Part 1 Questions

Answer the questions in the table below by typing your answer in the column labeled your answer. (note:  the box where you type your answer will enlarge as you type so you can type a complete answer.  In other words, don’t let the current size of the box stop you from typing all of the thoughts you have to answer the question!)

Question	Your Answer
1a) Explain how opioids like oxycodone work in thebody. (6 points)
1b) Explain how tolerancedevelops.(6 points)

 

Part 2 – Abuse

“No doc! I don’t think you’ve been listening to me!” James barked. “I have been taking Tylenol and Advil, and they arenot working for me.”

 

“Sorry, James. For now, I can prescribe some stronger painkillers, but please be careful with those. You need to…” Dr. Chang continued explaining, but James started to zone out. His pains were coming back again, and they hurt so much. He couldn’t concentrate on a word the doctor said.

 

“Got it?”

 

“Yes, thank you Doc.” James was sent home with 30 tablets of 5mg oxycodone (also known as Oxy), to be taken twice a day. As soon as he got home, he popped two pills into his mouth and chewed them. For the first time in his life, he did not feel limited by his pains. He felt a bit nauseous, and quickly fell asleep.

 

One week passed and he notices that he had run out of tablets. He called the pharmacy. “If you are taking two a day, you should have at least 16 tablets left,” said the pharmacist.

 

“Maybe you didn’t give me the right amount of tablets? Said Jason.

 

“We double count all narcotics, like the oxycodone that you are taking. That’s because narcotics, which are addictive medications, are closely monitored by the government. Remember how you have to show us your ID and sign when receiving the Oxy? That’s just another way of ensuring the medications are delivered to the person that needs them,” explained the pharmacist.

 

“Ok, Ok, I’ve been taking it whenever I’m in pain. It’s just so soothing every time I chew on the meds, you know? It’s… it’s just… I constantly have these excruciating pains since the car accident.”

 

“You can’t chew the meds!” the pharmacist exclaimed, slowly regaining control of her anger. “These tablets are designed to release their contents gradually. When you chew it, the full dose gets released at once. You are very lucky that you didn’t overdose from doing that.”

 

“I’m sorry…”

 

“Schedule an appointment with your doctor. It’s too early for a refill.” The pharmacist hung up.

Weeks passed and Dr. Chang approved a refill for James, of course not without a warning. However, James could not fully stand up with his back pain and often had to crouch down in agony. He distinctly remembered that the doctor refused to increase his dosage, so he decided to take matters into his own hands and doubled his dose. He soon ran out of pills again.

 

James calls the pharmacy; he says, “Hi, my name is James Chen and I want to request a refill please”

“Oh,” said James, sensing the pharmacist’s change of tone over the phone. “You umm… it’s too early for a refill? But my original dose is not working anymore, and I need to take more to suppress the pain.”

 

“Sorry, I can’t do anything about it without a prescription. It seems like you are developing a tolerance for oxy. You should really see your doctor, James.” The pharmacist hangs up.

 

James was scared to see the doctor. He was guilty of not following his doctor’s directions, and he blamed himself for everything that had happened. He decided to try to stop himself from taking so many pills. However, he could feel his heart racing, and he couldn’t sleep at night because of the tremors and muscle twitches. At work, he had difficultyconcentrating. At this point, he had no one to seek help from, although he knew that he needed the medication. With the help of a friend’s friend, he found a temporary solution.

 

Part 2 Questions

Answer the questions in the table below by typing your answer in the column labeled your answer.

Question	Your Answer
2a) Visit the CDC website How are narcotics monitored by the government?  Name the program and in your own words state the program requirements for health care providers. (12 points)
2b) List two things that James did that led to him becoming addicted tooxycodone?  (10 points)	1)     2)
2c) Identify three symptoms of withdrawal that Jamesexperienced. (9 points)	1)   2)   3)

 

Part 3 – More?

ThenextthingJamesknew,hewasinahospitalbed;hewokeup,fellbackasleep,andwokeupagain.Thelastthing hewasabletorememberwastakingsome“borrowed”oxyonastreetcorner.Hewassurprisednottofindhandcuffs around hiswrists.

“What happened?”

“You overdosed,” said a main in a white coat.

“How much trouble am I in?”

“You are legally protected under the Good Samaritan Drug Overdose Act. The government wants to encourage people to stick around and save those who overdose on drugs.” Dr. Rendall pointed at a kit on the bedside table. “You’ll probably need this from now on.”

James sat up and opened up the small package. Included was a printed card that read “Five Steps to Respond to an Opioid Overdose.”

“What is this? Some kind of care kit?”

“Those are naloxone nasal sprays. Naloxone basically replaces oxy on the opioid receptors in the brain, and prevents the good feeling of dopamine from flooding your brain,” Dr. Rendall explained.

“What’s that in English?” James asked.

“It’s basically an antidote that restores your breathing during an overdose and gives you enough time to seek emergency care.” Dr. Rendall continued, “The kit comes from the hospital pharmacy. If you use opioid painkillers in an unhealthy way, if you are a family member or friend of an addict, or if you are being released from a correctional facility, you can get one of these for no charge.”

“What now, Doc? I think I’m slowly losing control over my life.”

“Well, first of all, you need some help.” Dr. Rendall handed James some pamphlets. “There are multiple approaches to treating an addiction, like opioid agonist therapy, where you take medications to reduce withdrawal symptoms. I would also recommend you look at some of the support programs mentioned in the pamphlets.”

“But what can I do about my back pain without oxy?”

“Some of the drugs used in the medication therapy can help with your pain, like methadone. You can also consider acupuncture, physical therapy, surgery, or massage therapy to treat your pain.”

 

Part 3 Questions

Answer the questions in the table below by typing your answer in the column labeled your answer. Visit the National Institute on Drug Abuse to help you answer the questions for Part 3.

 

Question	Your Answer
3a) Which of following drug(s)(A, B, and/or C) is/areused to assist an individual to recover from a heroin overdose. A.   Nalaxone B.   Methadone C.   Buprenorphine (4 points)
3b) Explain how the drug(s) mentioned in the answer to 3a works? (8 points)
3c) Which of following drug(s)(A, B, and/or C) is/areused to treat opioid addiction? A.   Nalaxone B.   Methadone C.   Buprenorphine (4 points)
3d) Explain how the drug(s) mentioned in the answer to 3c works? (8 points)

 

 

 

Part 4 – Others Like Me

While James was waiting for discharge, he read up on the opioid crisis in Canada.

“I can’t believe people think that decriminalizing these dangerous drugs can help with the opioid crisis,” James muttered to himself.

 

“Well, they’re already doing it on a small scale,” a nurse responded to his comment.

 

“How?”

 

“There are places called safe consumption sites, where people can take illegal drugs as legally as possible.”

 

“Why would people go to these sites and take their drugs?” said James.

 

The nurse responded, “First, they are staffed with professionals who can respond to emergencies and provide addiction support. Second, they provide sterile equipment and tests for diseases like HIV and STIs, which can be transmitted through sharing needles.” The nurse caught herself, realizing she was sounding like she was reading off a script. She then simply said, “It’s just a safer place to take drugs.”

 

“How does it help with the crisis though? Aren’t they just giving them a place to overdose on drugs?”

 

“That’s what I thought too,” the nurse continued. “Apparently, since the first safe consumption site opened in Vancouver, it has reduced incidences of overdoses, and none of the overdoses at the site have resulted indeaths.”

 

“That still doesn’t really make sense to me.”

 

“I don’t think the government is really trying to prevent people from getting addicted with this program, but rather to minimize the harm that may come with addiction,” the nurse explained.

 

“The government has also allowed doctors to prescribe methadone and heroin more easily, but that comes with problems aswell.”

 

“Methadone? Like the drug to treat opioid addiction?”

 

“Yes, there are two extremes to this problem. Some methadone clinics are accused of making big money out of selling methadone but providing insufficient follow up counselling,” said the nurse. “Meanwhile, a large majority of doctors in Saskatchewan don’t prescribe any methadone to treat addiction.”

 

“It seems to be a really complicated issue.”

 

“Yes… and done!” The nurse pulled out the IV needle and applied some gauze on the wound.

 

“Apply some pressure on it and count down from 30. And then you are good to go!”

 

“Thank you so much!”

“No problem. Just remember to stay out of trouble.”

 

James left the hospital. He had a lot to think about and even more things to do. His addiction was not over yet, but he was confident that he would overcome it.

Part 4 Questions

Question	Your Answer
4a) Watch the following two videos about needle exchange programs: Needle exchange programs help curb disease but legislators don’t like them. And Do needle exchange programs do more harm than good? Name two diseases needle exchange programs are thought to prevent? (4 points)	1)   2)
4b) Based on the videos, state one reason why needle exchange programs should not exist.  (6 points)
4c) Visit the Drug Policy Alliance’s Safe Consumption Services site Define the term:  safe consumption site. (6 points)
4d) Based on the readings and videos you’ve watched throughout this case study, do you think the United States should have safe consumptions sites? Answer yes or no and explain your answer. (10 points)
4e) Visit the CDC’s state prescribing rate map. Based on the data you viewed on the map, what state would you select to develop a safe consumption site.  Explain your answer.  (7 points)