Welcome. The theme of this lecture is opioid victims and treatment. How do individuals become victims of the opioid epidemic? One way is the same old story. They are chronic drug abusers interested in getting high. They are hooked on opioids, and they are prepared to work hard or even break the law to get them. Another route to being a victim of the epidemic is that they started taking opioids legitimately for pain under a doctor's direction. Eventually, after using the drugs for some time, perhaps more than the doctor recommended, they find themselves addicted and seeking more drug, in spite of a negative impact on their lives. However, they get there, they are taking drugs, they won't stop and they probably don't know for sure what drug they are taking, let alone its concentration or purity. They are in danger of overdosing. Now, let us examine how the situation could have been avoided. Preventive steps could have helped many as noted earlier in this course. Education in the dangers of drugs may have stopped them from getting involved in the first place or encouraged them to walk away from drugs as an unnecessary threat to their well-being. If they are already involved, entering into treatment could have them in various programs, whose goals are to control or end drug-taking, but society could have been more helpful also. Laws could have been more stringent or better enforced. This would reduce availability of drugs. Another approach would have been to improve medical care involving opioids so that the dangers of using opioid prescriptions for pain are more clear. Various groups have developed new guidelines for treating pain that are more cautious and aim to head off abuse problems while still adequately treating pain. There are millions of Americans being treated for pain. Some guidelines for this treatment address the following: when to use opioids for pain, which opioid drugs to us, how long they should be used, the use of the lowest dose as possible, the risks of using or employing additional medicines, the instructions that should be given to patients about the risks, and the following up and monitoring for problems or offering treatment for drug abuse if needed. A goal of the guidelines is to enhance communication between doctors and patients so that the risks of using opioids are clearly understood. The opioid and other drug problem is so great in this country that it has received attention at the presidential level. A commission, the Commission on Combating Drug addiction and the Opioid Crisis was established and it made broad recommendations to deal with this crisis. What about treatment? An effective treatment approach referred to as the whole patient approach or Medication-Assisted Treatment, MAT, has been developed. In this, medications are combined with behavioral counseling to treat subjects. One medicine is methadone, a longer acting agonist which is effective in reducing drug craving and seeking in highly addicted individuals. Buprenorphine, perhaps more useful for treating mild to moderately addicted individuals, is a partial agonist and has proven safer in terms of overdose. It would be helpful for you to review the reading on the differences between partial and full agonists. Naltrexone and naloxone are antagonists that block opioid receptors so that agonist drugs like heroin cannot cause a high or produce any effect. It is important to note that antagonists are critically needed and used in emergency rooms, for example, to reverse signs and symptoms of overdose. The introduction and availability of these and other medications has saved countless lives. There are also a number of other medications that are in development. Behavioral therapies can also be used in combination with medications and help patients in a number of ways. One, these therapies can change the patient's attitudes about drug-taking and reinforce healthy lifestyles. Two, they can help the patients stay in treatment and they can even offer rewards to remain drug-free. Three, these various therapies try to provide every opportunity to help the patients get and stay drug-free or to effectively manage medications. These behavioral therapies, along with the use of medications, offer a powerful helped to patients. Research shows that there are effective. Treatment costs money, but research shows that treatment saves money overall. In closing, there is a serious epidemic of opioid use. It is causing a misery of addiction and untimely deaths from overdose. Guidelines for physicians and patients have been developed that emphasize caution and communication about the risks of opioid drug use. Medications in counseling are effective in treating drug abusers. How can we help? We should promote prevention and education in our communities, bringing professionals to speak in schools and with other groups. Help your friends if they're using drugs, by getting help from treatment professionals. Support law enforcement to reduce the amount of drugs available. If you have any concerns at all about yourself or friends, go to a treatment specialist immediately. You can search the resources listed this week to learn much more about this problem. It's possible to reduce drug use problems in our society and to literally save many of our citizens.