The Opioid Epidemic: What Everyone Needs to KnowR

Cover
Advance Praise
The Opioid Epidemic
Copyright
Dedication
Contents
Preface
Acknowledgments
Section 1: The Basics
	1 The Basics of Opioids and Opioid Addiction
		What are opioids?
		How are opioids made?
		How do opioids affect the brain?
		How do opioids affect the body?
		What forms do opioids take?
		How do opioids differ from one another?
		What is tolerance to opioids?
		What is opioid withdrawal?
		What is physical dependence on opioids?
		What is opioid addiction?
		What is the stigma of addiction?
		Is there a cure for opioid addiction?
		Can the symptoms of opioid addiction improve without treatment?
		Is there effective treatment for opioid addiction?
		Is taking methadone or buprenorphine just “replacing one addiction for another”?
		How do opioids cause overdose?
		What is naloxone?
		What are remission and recovery?
		What is relapse?
		What is the opioid epidemic?
		What can be done to respond effectively to the opioid epidemic?
Section 2: Individuals and Families
	2 Use of Opioid Medications for Pain
		When is it appropriate for someone to receive opioids for pain?
		Should opioids be used for chronic, non-​cancer pain?
		In what forms are opioid medications used for pain?
		Should people with a family history of addiction worry about taking opioids for pain?
		What should I discuss with my doctor before taking opioids for pain?
		Should I take an opioid medication if I am pregnant?
		What are the side effects of opioid medications for pain?
		Do all people who take opioids for pain develop an addiction?
		What are the signs of developing an addiction to opioid medications?
		How should my doctor monitor my use of opioids for pain?
		If I would like to reduce my use of opioid pain medications, what should I do?
		What are signs and symptoms of an overdose from opioid medications?
		Should I have naloxone on hand if I am taking an opioid medication for pain?
		Where should I store opioid medications at home?
		What should I do if I have opioid pills left over?
		Why do people keep unused opioids at home?
	3 Misuse of Opioids
		What is misuse of opioids?
		What are the different ways people misuse opioids?
		What is fentanyl?
		How do people start misusing opioids?
		Why is opioid misuse linked to risky sexual behavior?
		Why do people misuse opioids with other substances?
		What can people who misuse opioids do to reduce their risks?
	4 Opioid Addiction
		What causes opioid addiction?
		What is happening in the brain of someone with an opioid addiction?
		What are triggers?
		What are drug dreams?
		Is opioid addiction a disease?
		How do doctors diagnose opioid addiction?
		What are the consequences of opioid addiction?
		How long does opioid addiction last?
		Do people with addiction want to stop using opioids?
	5 Opioid Overdose
		What affects the risk of opioid overdose?
		How can I tell if someone is experiencing an opioid overdose?
		What should I do if I suspect someone is experiencing an opioid overdose?
		What are the different forms of naloxone and how are they used?
		What happens after someone suffering an opioid overdose gets naloxone?
		Do I still need to call 911 if I have rescued someone with naloxone?
		How can I get naloxone?
	6 Treatment for Opioid Addiction
		What are the goals of treatment for opioid addiction?
		What are effective ways to engage people with opioid addiction in treatment?
		What is remission?
		What is effective treatment for opioid addiction?
		When is the right time to start treatment for opioid addiction?
		How are the needs of someone with opioid addiction assessed?
		What is methadone?
		Does methadone make people sleepy?
		Can I take other medications with methadone?
		What are opioid treatment programs?
		What is buprenorphine?
		Why does buprenorphine come in a formulation mixed with naloxone?
		What is naltrexone?
		Which is the best medication to take for opioid addiction?
		How long should I take a medication for opioid addiction?
		Does evidence support the use of marijuana as an effective treatment for opioid addiction?
		Does evidence support the use of the botanical kratom as an effective treatment for opioid addiction?
		Does evidence support ibogaine as an effective treatment for opioid addiction?
		How is pain managed in someone being treated for opioid addiction?
		What is “detox”?
		What is the role of counseling and other mental health care in the treatment of opioid addiction?
		What is the role of peers in the treatment of opioid addiction?
		What is the role of a residential (inpatient) setting in the treatment of opioid addiction?
		What is the role of drug testing in the treatment of opioid addiction?
		What is the role of my primary care provider in the treatment of opioid addiction?
		What should I expect from my specialty addiction treatment provider?
		What should I expect from other clinicians in the healthcare system?
		What confidentiality protections exist for treatment for opioid addiction?
	7 Opioids and Pregnancy
		What are the risks of opioid exposure during pregnancy?
		How is opioid addiction treated during pregnancy?
		Which medication is most effective for pregnant women with opioid addiction?
		What is neonatal abstinence syndrome?
		How is neonatal abstinence syndrome treated?
		Is a baby with neonatal abstinence syndrome “born addicted”?
		What are the long-​term effects of opioid use during pregnancy?
		Should women who use opioids breastfeed?
	8 Opioids and Teenagers
		How has the opioid epidemic in the United States affected teenagers?
		What are the characteristics of opioid addiction among teenagers?
		Is treatment effective for teenagers with opioid addiction?
		Should parents of teenagers who use opioids keep naloxone in the home?
		What should parents do in a crisis?
		Are there scams targeting parents of teenagers with addiction?
	9 Opioids and Families
		What do I do if I suspect my family member is misusing opioids?
		How can I help connect my family member with opioid addiction to effective treatment?
		How can I tell if a treatment program is high quality?
		How can my family avoid residential treatment program scams?
		What is “enabling”?
		Does my family member first need to “hit rock bottom” before getting better?
		How can I cope with the stress of having a family member with opioid addiction?
		What is the role of home drug testing?
		How can I help a family member who is in recovery from opioid addiction?
	10 Recovery from Opioid Addiction
		What is recovery from opioid addiction?
		What are 12-​step programs?
		How can peers assist with recovery?
		What kinds of supports do people in recovery need?
		What is recovery housing?
		What are threats to recovery?
		How can addiction treatment providers support recovery?
Section 3: Communities and Policy
	11 A Historical Perspective on the Opioid Epidemic
		When did the opioid epidemic start?
		Why have historians called the opioid problem “The American Disease”?
		What led to the increase in prescriptions of opioids for pain from 1990 to 2010?
		What was the response to the overprescription of opioids?
		Have tighter regulations on opioid prescriptions contributed to a rise in use of heroin?
		What is the fentanyl crisis?
		What role has race played in the opioid epidemic?
	12 Prevention Policy for the Opioid Epidemic
		How can communities prevent opioid addiction?
		Does reducing the excessive prescribing of opioids prevent opioid addiction?
		What are prescription drug monitoring programs?
		What are take-​back days?
		What can the US Food and Drug Administration do to prevent opioid addiction?
		Do “abuse-​deterrent” formulation of opioids work?
		What other technologies are under development to prevent misuse of opioid pain medications?
		What is the role of marijuana in preventing opioid addiction?
		Can policies go too far in restricting opioid prescribing?
		How can communities support resilience and create a healthy environment to prevent opioid addiction?
	13 Treatment and Recovery Policy for the  Opioid Epidemic
		How important is broad access to effective treatment for opioid addiction?
		What are the elements of a robust treatment system?
		Should hospital emergency departments start treatment for opioid addiction?
		Where else should people with opioid addiction be able to start treatment?
		Do gaps in payment and insurance coverage limit access to opioid addiction treatment?
		What happens when the treatment system falls short in providing access to effective care?
		Why are there so few robust treatment systems for opioid addiction in the United States?
		What is “not in my backyard” syndrome?
		Why is there resistance in some minority communities to addiction treatment programs?
		Can treatment expansions backfire?
		How can a robust treatment system support pregnant women with opioid addiction?
		What is the controversy over forcing people with opioid addiction into treatment?
		What is the role of communities in supporting people in treatment and recovery?
	14 Harm Reduction Policy for the Opioid Epidemic
		What is harm reduction?
		What are naloxone distribution programs?
		What is the case for making naloxone available without a prescription?
		What are good samaritan laws?
		What are syringe services programs?
		What are the controversies over how syringe services programs are managed?
		What is drug checking?
		What are overdose prevention sites?
		What is the medical use of heroin?
		What limits the expansion of harm reduction programs in the United States?
	15 Criminal Justice Policy and the Opioid Epidemic
		What is the war on drugs?
		Has the war on drugs failed?
		What is the role of race in the war on drugs?
		Is the war on drugs over?
		How can police departments address the opioid epidemic?
		How can jails and prisons address the opioid epidemic?
		Why don’t more jails and prisons offer access to opioid addiction treatment?
		What are drug courts?
		What can the United States learn from other countries’ approaches to criminal justice policy?
	16 Surveillance, Evaluation, and Research and the Opioid Epidemic
		How well is the United States tracking the opioid epidemic?
		What trends related to the opioid epidemic are most useful to monitor?
		What other trends make sense to track?
		What is the role of evaluation in assessing the response to the opioid epidemic?
		What are some of the most promising areas of current research related to opioids and opioid addiction?
		What are the challenges to moving research discoveries quickly into practice?
	17 What To Do for the Opioid Epidemic
		What can the addiction field do to address the opioid epidemic?
		What can others in the healthcare system do?
		What can the criminal justice system do?
		What can litigation do?
		What can local communities do?
		What can cities and counties do?
		What can states do?
		What can the federal government do?
		What can individuals and families do?
Appendix 1: Definitions of Addiction
Appendix 2: Non-​Stigmatizing Preferred Language
Appendix 3: Definitions of Recovery
Appendix 4: Examples of Pharmaceutical Opioids Available in the United States, December 2018
Appendix 5: Diagnostic Criteria for Opioid Use Disorder
Appendix 6: Recovery Organizations (Listed in Alphabetical Order)
Notes
Index