Safety Planning When Substance Abuse is Present

SUBSTANCE ABUSE CONCERNS
IN CHILD PROTECTION
Presenters:
Melissa Kimball and Amy Kelly
LET’S DISCUSS THE DRUG CATEGORIES
• What are the categories?
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Opiates-Heroin, Morphine, Codeine, Opium, etc.
Depressants-Alcohol, Barbiturates, benzodiazepines, Marijuana etc.
Stimulants-Cocaine, Amphetamines, Nicotine, etc.
Hallucinogens-LSD, Mescaline, Marijuana, hashish, MDMA, etc.
Cannabinoids-Marijuana
Designer Drugs-Spice, K2 (anything manmade that mimic)
HAVE YOU
HEARD OF
NARCAN
PARTIES?
EMERGING
TRENDS…
FLAKKA (alpha-PVP)
KROKODIL
MOLLY
CAFFEINE POWDER
SYRUP, PURPLE DRANK, SIZZURP, LEAN
SALVIA
DABS
PUPPY CHOW
THE VERY NATURE OF HEROIN USE
IS THE INHERENT PROBABILITY
OF LETHALITY AT EACH USE…
WHAT DOES SUBSTANCE
ABUSE LOOK LIKE?
WHAT MAKES A PERSON
DEPENDENT?
WHAT ABOUT TREATMENT?
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Level of Use 1 - Experimentation
Level of Use 2 – Regular Use
Level of Use 3 – Heavy Use
Level of Use 4 – Chronic Use
Levels of Care
CHARTS TO SHOW ADDICTION…
PHASE 1: Experimentation
E
1 Way Street
N
P
Learning to use
E
PHASE 2: Social
N
Not willing to take
risk
P
PHASE 3: Abuse
E
N
P
2 Way Street
with Phase 2
1 Way Street
Has cons.
Willing to take risk
Not always problem
PHASE 4: Dependence
E
Not achieving same high
N
P
Has num. cons
Ate. Effects diff
Drinking to relieve pain
RESOURCES…
• Drugs.com - Identify pills, punch in “alcohol” for example and then the medication a client
is taking and it will tell you what interactions they may have which will help understand a
clients behaviors and you can learn about any medication you have ever heard of.
• Noslang.com – slang interpreter for sexting, drug use, you name it. Just put in what the slang
is and it will spit out the definition. Regularly updated.
• Telespoof.com – used by parents and youth to make it appear a phone call is coming from
one place (home for example) when it is really coming from their cell or another state even.
• www.cesar.umd.edu – The Center for Substance Abuse Research offers all kinds of
information on drug trends, drug information and free publications on a variety of topics
• www.familywatchdog.us – Family Watchdog will let you search for any registered sex
offender for free and will tell you the location they live as well as their crimes
• NH Alcohol and Drug Treatment Locator – (the link to this is http://nhtreatment.org)This
website allows you to put in a city you live by and then it will show you all of the treatment
options in that area for substance abuse. It also has links to on-line support services, twelve
step meetings and a variety of other information. It is relatively new and people are
encouraged to share the website.
• www.new –futures.org-website with resources specific to NH and surrounding areas/towns.
A CLOSER LOOK AT OPIOIDS…
• Opium, Morphine, Codeine
• Heroin, Oxycodone, Hydrocodone
• Buprenorphine (Subutex/Suboxonne)
• Methadone Fentanyl
HEROIN
Street Names:
H
Dope
Brown Sugar
Brown
Horse
China White
Thera Flu & Bud Ice
HEROIN
What does it look like:
White Brown or Tan Powder
Black Tar
Effects Depend on:
HOW IS IT USED?
Oral Use
Smoked
Inhaled
Injected
Plugged
Type of Substance
Route of Administration
How Long Used
How Much
Genetics
SIGNS OF ACTIVE USE
Drowsiness
Droopy eyelids /Nodding Off
Low Raspy Voice
Slurred Speech
Slowed body movements
Shallow Breathing
Constricted “pin point” pupils
Needle “Track” marks
BRAIN FUNCTIONING
Psychoactive Substances impact:
Thinking
Learning
Judgment
Emotions
Voluntary movements
Sensory inputs
NEUROTRANSMITTERS
DOPAMINE – regulates motivation & pleasure
ENDOGENOUS OPIODS – produces euphoria and is a
Naturally occurring pain reducer that is increased when
One feels pain OR experiences pleasure
NORADRENALINE – produces fight or flight response
Stimulates wakefulness, breathing, alertness
(From Misti Stori, NAADAC, New Innovations in Opiod Treatment: Buprenorphine)
PROCESS ONE…
PROCESS TWO…
CONSIDER THIS….
A person uses heroin/fentanyl , intravenously:
Time to get the drug
Time to inject the drug
Initial Euphoria/Nodding
Impairment
Start to get sick
30 Minutes
20 Minutes
20 Minutes
2 Hours
_________
Almost 3 Hours!!
If they do this 3x a day…… that (9) hours per day
WITHDRAWAL
Acute Withdrawal:
Nausea
Vomiting
Restless Legs
Diarrhea
Insomnia
Body Aches
TREATMENT OPTIONS
• Detox – Medically Assisted or “Cold Turkey”
• Residential Treatment
• Medically Assisted Treatment
• Outpatient Treatment – individual or intensive
BEFORE & AFTER…
ENJOY LUNCH!
OPIOID OVERDOSE
Extreme sleepiness - inability to awaken
Breathing problems (shallow or stopped)
Fingernails turn blue or purple
Extreme “pinpoint” pupils
Slow/Stopped hearbeat, low blood pressure
NARCAN
Can reverse or block the effects of other opioids
Restore normal respiration
Used by emergency personnel
Available without a prescription at Rite Aid
MEDICATION ASSISTED TREATMENT
(M.A.T.)
Methadone
Buprenorphine - Subutex / Suboxonne
Naltrexone - Vivitrol
(From Misti Stori, NAADAC, New Innovations in Opiod Treatment: Buprenorphine)
SUBSTANCE ABUSE WHILE PREGNANT
WHO IS TESTED
TESTING OPTIONS
History of Substance Abuse
Cord Blood (Last Trimester)
Positive pre-natal drug screen
Urine (Days)
Perinatal complications
Baby Urine
Delayed prenatal care & other
behavioral concerns
Meconium
FETAL ALCOHOL SPRECTRUM DISORDER
Abnormal facial features
Poor impulse control
Small Size
Difficulty with attention
Medical problems
Poor memory
Poor coordination
Hyperactive behavior
Learning disabilities
Poor reasoning & judgment skills
STIMULANTS
AT BIRTH…
LONGER TERM…
premature delivery
Low Cognitive Performance
Low Birth Weights
Problems w/Information Processing
Smaller head circumference
Shorter in length
Poor attention to tasks
M.A.T. DURING PREGNANCY
Prevent Miscarriage/Premature Birth
Reduce cravings for other opioids
Promotes increased health
Raises the quality of Life for Mother
will not cause birth defects
NEONATAL ABSTINENCE SYNDROME
High-pitched crying
Fever
Excessive Sucking
Problems sleeping
Sweating
Poor Feeding
Startle response
Yawning
Vomiting
Tremors
Sneezing
Increased Muscle tone
Problems breathing
Loose Stools
SCORING
Nurses evaluate with help of parents/caregiver
Score Symptoms 1-5 every couple of hours
Challenges with Scoring
Staring medication for the infants:
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2 scores 12 or more
3 scores 8 or more
Baby unable to eat or sleep
Hard time breathing
Losing weight or unable to gain weight
BREAST FEEDING
ENCOURAGED
Methadone
Buprenorphine
(Subutex/Suboxonne)
DISCOURAGED
Using illicit drugs
At high risk relapse
Marijuana *
THINGS THAT HELP …
PRE-NATAL
AFTER BIRTH
• Early Prenatal Care
• Low stimulation
• Stop/ Cut Back on
Cigarettes
• Skin to skin contact
• Eat Healthy
• Calming techniques
• Undisturbed sleep
• “Rooming In”
• Breast feeding
REFERENCES
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“New Innovations in Opioid Treatment: Buprenorphine”, 2008. Life-Long Learning Series
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“Overview of the Public Health Burden of Presciption Drug & Heroin Overdoses” , 2015. Baldwin, Grant, PhD, MPH, Center for Disease Control & Prevention.
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Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Prevention Toolkit. HHS Pulication No. (SMA) 14-4742. Rockville, MD: Substance
Abuse and Mental Health Services Administration, 2014.
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“The Ins & Outs of Medication-Assited Treatment & Recovery for Opioid Dependence”, 2015. Mistie Storie, MS, NCC. Director of Training, NAADAC. Information from
Training & Power point presentation.
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“Facts About FASDs”, 2015. Centers for Disease Control & Prevention. http://www.cdc.gov/ncbddd/fasd/facts.html
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“What are the effects of maternal cocaine use”, 2010. National Institute of Drug Abuse. http://www.drugabuse.gov/publications/research-reports/cocaine/what-areeffects-maternal-cocaine-use
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“Methadone Treatment for Pregnant Women”, 2009. US Department of Health & Human Services. Substance Abuse and Mental Health Services Administration.
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“Caring for Babies Exposed to Methadone or Buprenorphine (Subutex) During Pregnancy”, 2015. Bonny Whalen MD, Medical Director, CHaD/DHMC. Information from
training & power point presentation.
THANK YOU!!
Please don’t forget to fill out an evaluation for this training.
Thank you again for your time.