Opioid Prevention Toolkit

OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Drug Free Communities of Fond du Lac County (DFC) is a coalition of over 35 community stakeholder organizations and agencies who come together in collaboration to address the growing problem of substance abuse in our county. Comprised of individuals from multiple sectors, DFC members are all willing to work together toward common goals.

THE GOALS ARE TO PREVENT AND REDUCE: ● Underage and adult binge drinking ● Misuse and abuse of prescription medication ● Opioid/Heroin abuse

Vision : "Healthier Children Today, Healthier Community Tomorrow" Mission : To decrease substance abuse among youth and adults in our community.

Contact us at: 920.906.6573, or www.csifdl.org/dfc

OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Table of Contents Local Story

1

Prevention

Steps We Can Take to Prevent Prescription Drug Abuse Commonly Abused Prescription Medications

4 5 6 7 8 9

Access to Medication Student Concerns

Factors That Can Increase the Chance of Addiction

Why Would My Child Use Drugs?

Signs to Look For Things to Know

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If You Suspect Your Loved One May Be Using

12 13

Drugs in the Workplace

Harm Reduction

What is Harm Reduction

& Health Consequences of Opioid Use

14 15 16 17

Effects During Pregnancy If You Suspect an Overdose

Good Samaritans

Drug Endangered Children: What Caregivers and Educators Should Know

18

Law Enforcement

Wisconsin Statutes

19

Legal Consequences of Prescription Drug Abuse What Happens When You are a Convicted Felon and the Len Bias Law

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Treatment

Addiction is a Medical Condition When Someone You Love is Addicted

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22 23

Treatment Options

Local Treatment & Recovery Resources

24

Local Stories

25, 27, 28

Additional Resources

County-wide Medication Disposal Locations

29 30 30

Military Veteran Resources

211

Notes

31, 32

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

A Local Story M y name is Eddie and I am 27 years old. I’m currently working toward my Bachelor’s degree in Music Composition. My primary instrument is guitar, but I also play piano and give private lessons for both. Beside my academic life I have a wonderful family life. My girlfriend and I are raising our 4-year-old son who keeps us constantly on our toes. We live in a beautiful home and have much to be grateful for. A little over four years ago I was hiding out in a hotel smoking crack and shooting heroin after being awake for three days straight. I started to hallucinate and smashed the glass of the hotel window and began to run. I was arrested on charges of burglary/dwelling, theft, receiving stolen property, joyriding, and bail jumping. This sparked the beginning of my life in recovery. My name is Eddie, and I am an addict. By September 2013 I had reached the peak of my addiction to opioids and cocaine. This hell of a life was on a steady increase for a span of about 10 years. By this time, I had sold almost all my belongings including every bit of music equipment I owned. I started to steal from friends and family, and I deemed myself hopeless. In my eyes I was unlovable because I didn’t love myself and after I had taken everything from my family, I knew that I had become an empty shell. I was dope sick every day. All I could think about was the ways and means to get more of whatever drug I could get my hands on. I knew that I was a disappointment to my family, but most of all I was a disappointment to myself. A year prior to September 2013 I had it all. I was in a band that was rapidly gaining popularity. I had a good job and a great relationship with my family. I was one semester away from receiving my Associate’s degree. But everything was gone in what seemed to be in a blink of an eye. After I was arrested, I spent the next 10 days in an isolated cell detoxing. On day three I tried to hang myself with my pants. On day four I began to mutilate myself by ripping out stitches I had just received (from the hotel window) and banging my head against a sharp corner of my bed frame. A couple days later I received a visit from some of my family, and I broke down in tears. They expressed their love for me and I reciprocated. After this visit, things began to change with my behavior and on my tenth day I was bailed out. My bail was set at $1,500, which my grandpa generously posted. This was after I had already stolen $16,000 from him. The addiction made me lose sight of how much these people really cared for me and for them I am forever grateful. Once I was out of jail, I was awaiting sentencing. I began to attend local NA meetings and hated it. I thought to myself, “how can these people be smiling?” In my eyes there was nothing to be happy a bout, but I was warmly welcomed. I was now employed and attending support group meetings regularly, but things slowly started to slip.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

A Local Story, continued When I began recovery, I didn’t know the extent of my addiction. I figured that my addiction was simply my physical dependence to opioids. I remember hearing early on in NA meetings that alcohol is a drug, and I thought to myself then “no it’s not.” I started to occasionally drink, and this led to smoking marijuana, which led to buying a couple pain pills, which led to smoking crack, which led to heavily abusing suboxone up until the week I was being sentenced. During this time, which was almost a year long, I had everybody convinced that I was clean. Up until my sentencing I was told by my public defender that the district attorney was pushing for one year in jail and four years of extended supervision. This idea was like a cancer in my brain that consumed every thought I had. I figured if I’m going to jail I might as well party before I go. I was found guilty of two counts felony burglary and misdemeanor theft among other misdemeanors. To my surprise and relief, I was sentenced to complete a drug court program with extended supervision. I had my family’s support in the courtroom with me that day and it was a rather joyous occasion. However, I knew that I wasn’t out of the woods just yet. I was frantically trying to flush out my system because I knew I was going to be drug tested soon. A couple days after my sentencing I was called in for my first drug court drug screen, and failed. I then was faced with my biggest fear of telling everybody that I have been lying. This was my true turning point and the moment in my life that I look back on as being one of the most important thus far. Some people were concerned but embraced my admittance while others severely shamed me. I felt defeated again, but I decided to keep my nose down and do whatever was suggested to me by support group meetings and drug court officials. I began to make tremendous strides. I embraced the belief in a higher power, which relieved me more than I ever thought it would. Everything seemed to look different to me and I started to notice a path being carved for a better and new life. I continued to do what was asked of me and started to push myself more and more. It was required that I attend three support group meetings a week. This was sometimes a challenge, but I did it.

– Sometimes I sit in silence and look around my house and think to myself, “Wow, you did all of this.” Today I have 1193 days clean and sober. I now embrace the challenges I’m faced with full of gratitude, because I know that there isn’t a problem out there that is worth getting high over.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

A Local Story, continued I really owe a lot to those meetings and the people in them. They taught me how to love myself again and how to deal with feelings of guilt and sorrow. They truly cared for me in a way that was unconditional and didn’t enable me. There were a few times that I was challenged by my higher power and in the end, I won. I was offered drinks, pills, weed, and other drugs but I abstained. When t hese troubles arose, I talked with somebody I could trust (either a counselor, sponsor, or a member of NA). I had to be in this (recovery) for me -not for my family, friends, or even my son. I was the one who had the problem, and I had to be the one to fix it. My recovery had to come before everything while I was in drug court. There was no room for mistaking that.

T he drug court program is intended to be a yearlong program in my county. However, participants may take more time to complete it. I completed the program in 14 months and I was the first in my county to graduate (2015). During that time, I completed my Associates degree and began my Bachelor’s. I was featured on the news (positively), and at my graduation I was given the opportunity to give an exclusive interview with the local newspaper. After I graduated I began to apply the skills I learned while in drug court to my everyday life. Skills such as: scheduling, accountability, and perseverance. I was still under supervision/probation, which was okay with me because quite frankly I was scared to think of being completely unsupervised. I only had 14 months of absolute sobriety and in many ways, I was still working through things. I remained abstinent from drugs and alcohol and stayed in good graces with my probation agents. My sentence of extended supervision was until September 2018, but in January 2017 I was granted an early release. Because of my good behavior, completion of the drug court program, and of course my absolute sobriety, I was also granted the expungement of all my felonies. This meant that all my rights had been restored and I didn’t have this shadow of my past dimming my true potential. I was elated more than I ever had been before.

Since I have been off supervision I have focused most of my energy on schooling. I am diligently working towards my degree and I am now half way done. I continue to give private guitar and piano lessons and have a part time job detailing trucks. On my down time I like to play games with my son, cook, and spend quality time with my family. I occasionally will pop into a support group meeting. But, for the most part, other things consume my time. At one point in my life I was so hopeless that I didn’t care if I was dead, in fact I wanted to be. Because of the dedication of my community, family, friends, and my own perseverance I can live again and serve a role in society. There is hope for every suffering addict. They just need to be willing, and guided in the right direction. I used to live in an apartment that had nothing besides a couch, a bed, and a TV. After that I was homeless, and slept wherever I could. It awes me to think about where I’ve been versus where I am now, and of how “normal” my life is now. Sometimes I sit in silence and look around my house and think to myself, “Wow, you did all of this.” Today I have 1193 days clean and sober. I now embrace the challenges I’m faced with full of gratitude, because I know that there isn’t a problem out there that is worth getting high over. Eddie

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PREVENTION

OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Steps We Can Take to Prevent Prescription Drug Abuse

What’s in your medicine cabinet? Nightstand? Kitchen counter? In your purse? Naturally, you keep prescription medicines, cold and cough remedies handy to take when needed. Unfortunately, they’re also handy for everyone else to take without you knowing it.

of youth in Fond du Lac County obtain prescription medications for non-medical use from either PARENTS HOME, MEDICINE CABINETS OR FRIENDS. Source: Alcohol, Tobacco and Other Drug 2018 survey

LOCK YOUR MEDS Only 4.7% of individuals who abuse prescription drugs, say they get the medication from a stranger, drug dealer, or the internet. Prevent your children from abusing your medications by securing them in places they cannot access. Lock them up or take them out of your house. Find lock boxes at: Lock Med, Walmart or Amazon. TAKE INVENTORY Use a home medication inventory card to record the name and amount of medications you currently have. Check regularly to make sure none are missing. Click here for a printable home medication inventory card.

EDUCATE YOURSELF AND YOUR CHILD Learn about the most commonly abused types of medications (page 5). Then communicate the dangers of abusing these medications to your child regularly; ONCE IS NOT ENOUGH. SET CLEAR RULES AND MONITOR BEHAVIOR Do not allow your child to take prescription drugs without a prescription. Monitor your child’s behaviors to ensure that rules are being followed. Lead by example! PASS IT ON Share your knowledge, experiences and support with the parents of your child’s friends. Work together to ensure that your children are safe and healthy. DISPOSE OF OLD AND UNUSED MEDICATIONS Medications can be disposed of for free at any of the twelve permanent disposal drug drop boxes throughout Fond du Lac County. See page 29 for these locations or visit our website at: www.csifdl.org/fdl-drugdrop-locations Over 6.2 million people age 12 and older report abusing prescription drugs. Due to the fact that prescription drugs improve health when used as prescribed, many teens believe they are a safe way to get high. It is illegal to use someone else’s prescription.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Commonly Abused Prescription Medications Pain Medications – a class of the most abused prescription medications among adults and teens. Opioids, a term commonly used to describe both pain medications and heroin, can be ingested in various ways. Prescription opioids are typically taken in pill form and sometimes with alcohol to intensify the effects. They can be crushed to sniff, snort or injected, as can heroin. Some commonly abused medications include: • Codeine [Promethazine Syrup with Codeine; Tylenol w/Codeine] • Hydrocodone [Vicodin, Lorcet, Lortab, Norco) • Hydromorphone [Dilaudid] • Meperidine [Demerol] • Methadone • Morphine [MS Contin] • Oxycodone [Oxycontin, Roxicodone, Percocet, Endocet, Percodan] • Buprenorphine [Suboxone/Subutex] • Fentanyl [Sublimaze] Percocet 5 mg Percodan 4.5 mg

OxyContin 20 mg

Sedatives – most commonly refer to anti-anxiety medications, the most abused include: • Alprazolam [Xanax] • Clonazepam [Valium, Diazepam] • Lorazepam [Ativan] • Temazepam [Restoril] • Zolpidem [Ambien] Stimulants – abused medications to treat ADHD/ADD include: • Amphetamine [Adderall] • Methylphenidate [Ritalin, Concerta]

OxyContin 80 mg

OxyContin 160 mg

Please visit these sites for detailed information about prescription medications:

https://www.drugabuse.gov/drugs-ab use/prescription-medicinesbuse.gov https://www.drugabuse.com/library/pr

Steroids – are prescribed and also abused: • Anabolic steroids [Anadrol, Durabolin, Depo-Testosterone]

escription-drug-abuse/ https://www.drugfree.org

Commonly Abused Street Drugs • Marijuana/K2/Spice/Synthetic Marijuana • Dabs • Cocaine • Solvents/Aerosols • MDMA/Ecstasy or Molly • Bath Salts • Heroin • LSD • Methamphetamine

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Access to Medication Questions to ask your physician before filling a prescription... • What are some alternatives for pain management? • Can you prescribe a non-opioid pain medication? • If my child must take opioids for pain relief, how can I minimize risks of dependency? • If you must prescribe an opioid, may I limit the quantities?

What Are Your Kids Being Prescribed? Think before you fill and give a pain prescription to your child. Do they really need such a strong medication or will something else do? Pain medications like Vicodin, Oxycontin and other versions are super strong. . They are being prescribed large quantities of very strong medications for things such as simple sports injuries and dental procedures. Be an advocate while you can and look into all options. Pain is no fun, but it’s better than starting an addiction in your child. Our area has a great need for addiction treatment programs based on the number of people affected by opioids and the distance residents must travel for help. A service expansion has been funded through the federal State Targeted Response to the Opioid Crisis grant from the Substance Abuse and Mental Health Services Administration. Considered a high-need area both Fond du Lac and Dodge counties are included. Visit the CDC to learn more about your options for opioid treatments and chronic pain at: www.cdc.gov/drugoverdose/patients

The Center for Disease Control (CDC) , found that differences in county prescription rates depend in part on the number of medical providers in the area and their prescribing patterns, according to Vital Signs . Examining the role of prescribers has increased in recent years as healthcare experts look for ways to stem the tide of opioid addiction. But while fewer new prescriptions are being written, existing patients are receiving larger doses and for longer periods of time, factors that doctors said contribute to persistent addiction levels. A separate report found the diagnosis of opioid-use disorders spiked nearly 500 percent between 2010 and 2016, according to an analysis of 30 million members of the Blue Cross Blue Shield system, a network of three dozen independent insurance companies. July, 2017

Additional Resource from SAMHSA: Medications: Which Approach is Right for You?

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Student Concerns: Fond du Lac County 8th, 10th and 11th grade students reported the onset of non-medical use of any prescription medication to be 13.2 years of age. Source: Fond du Lac County 2018 Alcohol, Tobacco and Other Drug survey

12 Reasons teens use prescription drugs (National Institute on Drug Abuse)

Students who abuse prescription stimulants (e.g. ADHD, Adderall & Ritalin) reported higher levels of: ● cigarette smoking ● heavy drinking ● risky driving ● abuse of marijuana, MDMA (Ecstasy) & cocaine.

Source: Harvard School of Public Health, College Health Study, 2001 Survey

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Factors That Can Increase the Chance of Addiction Home and Family • Influences during childhood and adverse childhood events (read more about this below) is a very important factor • Parents or older family members who abuse drugs or engage in criminal behavior, can increase children’s risks of developing their own drug problems. Peers and School • Drug-using peers can sway even those without risk factors to try drugs • Academic failure • Poor social skills, feeling isolated or being bullied can put a child at further risk for using drugs Biological Factors • Genetic factors account for 40%-60% of a person’s vulnerability to addiction • Effects of environmental factors on the function and expression of a person’s genes • A person’s stage of development and other medical conditions • Adolescents and people with mental disorders are at greater risk of drug abuse and addiction than the general population. Early Use • Research shows that the earlier a person begins to use drugs, the more likely he or she is to develop serious problems. • This reflects the harmful effect that drugs can have on the developing brain • It remains that early use is a strong indicator of problems ahead, including addiction Method of Administration • Smoking a drug or injecting it into a vein increases its addictive potential • Both smoked and injected drugs enter the brain within seconds • This intense “high” can fade within a few minutes, taking the abuser down to lower, more normal levels.

Check out these great resources: Risk and Protective Factors www.drugabuse.gov/publications/preventin g-drug-abuse-among-children-adolescents /chapter-1-risk-factors-protective-factors Building Resiliency www.apa.org/helpcenter/road-resilienc e.aspx As with any other disease, the capacity to become addicted differs from person to person. In general, the more risk factors a person has, the greater the chance that taking drugs will lead to abuse and addiction. (Excerpted from Drugs, Brains, and Behavior: The Science of Addiction by NIDA)

Mental Health and Trauma: Impact on Youth Drug Use There is now powerful evidence showing a strong correlation between opioid addiction and traumatic experiences, particularly early childhood adversity (CTIPP). Any child who has suffered traumatic or stressful events or situations, such as poverty, abuse, loss of a parent, or bullying are called adverse childhood events (ACES), and can cause kids to seek ways to cope that they might not otherwise. Kids being raised by parents who suffered from ACES are also at risk. Comprehensive Services Integrations (CSI) of Fond du Lac County believes in a trauma informed community and universal policies designated to enhance the social-emotional health and well-being of all residents. This includes but is not limited to: adverse childhood experiences screens, how trauma affects our childhood and adulthood mental and physical well-being, as well as how to develop resiliency as a prevention tool. For more information visit the CSI website at www.csifdl.org/.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Why Would My Child Use Drugs? In general, people begin taking drugs for a variety of reasons:

To feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, self-confidence and increased energy. In contrast, the euphoria caused by opioids such as heroin is followed by feelings of relaxation and satisfaction. To feel better. Some people who suffer from social anxiety, stress-related disorders, post-traumatic stress disorder (PTSD), ongoing toxic trauma, and depression may begin abusing drugs in an attempt to lessen feelings and experiences. ACES and stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction. When children are overloaded with stress hormones, they’re in flight, fright or freeze mode. They can’t learn in school, have difficulting trusting and developing healthy relationships. (learn more about ACES here). To do better. Some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids. Curiosity and “because others are doing it”. In this respect adolescents are particularly vulnerable because of the strong influence of peer pressure. Teens are more likely than adults to engage in risky or daring behaviors to impress their friends and express their independence from parental and social rules. (Excerpts from Drugs, Brains, and Behavior: The Science of Addiction by NIDA)

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Signs to Look For The duration of a dose of Heroin can last 3-6 hours and be detected up to 2-4 days. Physical and behavioral signs & symptoms of opioid intoxication include: • Constricted/pinpoint pupils • Sweating

• Clouded mental function • Lower body temperature • Euphoria followed by drowsiness • Flushed skin

• Decreased appetite • Dry mouth/thirsty • Itching/scratching

• Slurred speech • Slowed reflexes • Depressed breathing • Asthma attacks in asthmatic individuals that inhale the drug • Decreased heart rate and blood pressure • Suppressed pain • Mood swings • Apathy • Euphoria • Depression • Feeling of heavy limbs • Track marks • Impaired coordination Lifestyle changes that can be related to opioid addiction: • A change in peer group • Missing classes, skipping school or work • Loss of interest in favorite activities • Deceptive behaviors and dishonest • Trouble in school or with the law • Changes in appetite or sleep patterns • Lose touch with family member and friends • Money loss, asking for money loans or missing items from family/friends • Stealing from family/friends • Community retail thefts • Community related property crimes

Track Marks over 10 days

Fresh Track Marks

Dilated Pupil

Constricted Pupil

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Things to Know... Paraphernalia & Method of Opioids/Heroin Use Includes: • Methods of use: Snort, Inject, Swallow and Inhale • Crushed pills are snorted and inhaled using short straws, rolled dollar bills and other small tubing • Mirrors, razors or credit cards might be used in preparing the drug • Syringes, rubber tubes, syringe caps, droppers and spoons are used when preparing or injecting the drug • To inhale the drug, pipes or pieces of rectangular aluminum foil (3x17cm) are used. • Empty packaging such as corner ties and tin foil squares

Slang Heroin:

Black, Black Eagle, Black Pearl, Black Stuff, Boy, Brown, Brown Crystal, Brown Rhine, Brown Sugar, Brown Tape, Chiba, China, China White, Chiva, Dope, Dragon, H, Junk, Mexican Horse, Mexican Mud, Number 3, Number 4, Number 8, Sack, Scat, Skag, Smack, Snow, White, White Boy, White Girl, White Horse, White Lady, White Nurse and White Stuff Using Heroin: Channel swimmer, Chasing the Dragon, Daytime (being high), Dip and Dab, Do up, Evening (coming off the high), Firing the Ack Ack Gun, Give Wings, Jolly Pop, and Paper Boy. Heroin + Meth = Speedballing Heroin + Alprazolam (Xanax)= Bars Heroin + Cocaine= Belushi, Boy-Girl, He-She, Dynamite, Goofball, H&C, Primo, Snowball, Speedballing Heroin + Cold Medicine= Cheese Heroin + Crack= Chocolate Rock, Dragon Rock, Moonrock Heroin + Ecstasy= Chocolate Chip Cookies, H Bomb Heroin + LSD= Beast, LBJ Heroin + Marijuana (THC)=Atom Bomb, Canade, Woola, Wookie, Woo-Woo

Check out this resource: Tips for Teens: The Truth About Heroin

OxyContin, Percocet, Vicodin and painkillers: Big Boys, Cotton, Kicker, Morph, Tuss, Vike, Watson-387 Using Prescription Drug Use and Abuse: Pharming, Pharm Parties, Recipe (mixing alcohol), and Trail Mix

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

If You Suspect Your Loved One May Be Using... While it may be necessary at some point, harsh confrontation, accusing, and/or searching their room or personal belongings can be disastrous. The first step is an honest conversation.

5 Tips for talking with people about drugs and alcohol: 1. Be open 2. Be non-judgmental

Research shows that 25% of youth who abuse prescription drugs before age 14 develop a substance use disorder some time in their life.

3. Treat them as individuals 4. Don’t make assumptions 5. Don’t move too fast Some suggested things to tell your loved one: • You LOVE him/her and you are worried that he/she might be using drugs or alcohol. • You KNOW that drugs may seem like the thing to do, but doing drugs can have serious consequences. • It makes you FEEL worried and concerned about him/her when he/she does drugs. • You are there to LISTEN to him/her. • You WANT him/her to be a part of the solution. • You tell him/her what you WILL do to help him/her. • Know that you will have this discussion many, many times. Talking to your child about drugs and alcohol is not a one time event.

Did you know: the average age Fond du Lac County youth first use prescription medication for non-medical use is 13.2 . (Source: Fond du Lac County 2018 Alcohol, Tobacco and Other Drug Survey)

For more resources check out drugfree.org articles on: ● How to Talk With Your Teen ● Connecting With Your Teen ● Prevention Tips For Every Age Or check out: www.drugabuse.gov/related-topics/ treatment/what-to-do-if-your- teen-or-young-adult-has- problem-drugs

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Drugs in the Workplace Work is an important and effective place to address drug use by establishing or promoting programs focused on increasing heal th. Employees struggling with addiction are more likely to have accidents, lower productivity, raise insurance costs, and reduce profits. By encouraging and supporting treatment, employers can dramatically assist in reducing the negative impact of addiction and substance use in the workplace, while reducing their costs. DID YOU KNOW? • 70% of substance abusers hold jobs ( American Council for Drug Education (ACDE). • Certain industries tend to have a higher number of employees who abuse substances: construction jobs, trucking, retail sales clerks, and assembly and manufacturing workers • Estimated 10% to 12% of employees use alcohol or illegal drugs while at work (SAMHSA). • 70% of employers are experiencing a direct impact of prescription drug misuse in their workplaces . While, only 19% feel “extremely prepared” to deal with prescription drug misuse. (National Safety Council) • Encouragingly, 70% want to help employees return to work after treatment (NSC) Employees who use are: (according to the ACDE) • 10 times more likely to miss work • 3.6 times more likely to be involved in on-the-job accidents • 5 times more likely to file a worker’s compensation claim • 33% less productive • Responsible for 40% of all industrial fatalities • Responsible for health care costs nearly 3 times that of their non using peers Signs that may indicate possible workplace drug problems: Job Performance • Inconsistent work quality • Poor concentration and lack of focus • Lowered productivity or erratic work patterns • Increased absenteeism Drug abuse costs employers: $81 billion annually (Source: National Council on Alcoholism and Drug Dependence, Inc.)

• Unexplained disappearances from the jobsite • Carelessness, mistakes, or errors in judgment • Needless risk taking • Disregard for safety of self and others on the job and off the job accidents • Extended lunch periods and early departures Workplace Behavior • Frequent financial problems • Avoidance of friends and colleagues • Blaming others for own problems and shortcomings • Complaints about problems at home • Deterioration in personal appearance or personal hygiene • Complaints, excuses and time off for vaguely defined illnesses or family problems

LEARN MORE:

Visit National Safety Council to learn more about prescription misuse in the workplace, download the Prescription Drug Employer Toolkit, Cost Calculator and more.

Contact DFC for additional resources, trainings, and learn what you can do.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

HARM REDUCTION

What is Harm Reduction? Harm Reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use, such as the spread of HIV or hepatitis C from sharing needles, or overdose. Strategies may include overdose education, naloxone (Narcan) distribution, and needle exchange programs. This approach accepts drug use as a reality and aims to reduce its harmful consequences, rather than simply ignore or condemn them.

Health Consequences of Opioid Abuse The potential for physical and psychological addiction is very real! Drug use and abuse, including prescription medications, is associated with strong cravings for the drug, making it difficult to stop using. Most drugs alter a person’s

thinking and judgment, which can increase the risk of injury or death from drugged driving or infectious diseases, such as: HIV/AIDS HEPATITIS B & C CHLAMYDIA GONORRHEA

HIGH RISK HPV GENITAL WARTS HERPES AND SYPHILIS

Unfortunately, all these diseases can occur from unsafe sex practice and needle sharing associated with drug use.

In addition, drug use during pregnancy can lead to neonatal abstinence syndrome, a condition in which a baby can suffer from dependence and withdrawal symptoms after birth (see page 15). Be aware: Drug use & abuse also weakens the immune system leaving you at greater risk for other health issues.

CLEAN NEEDLES TO PREVENT HEPATITIS C Hepatitis C is a liver infection caused by the hepatitis C Virus (HCV). HCV is spread when blood from a person with HCV enters the blood of someone who is not infected. Most people who have HCV develop a chronic, lifelong infections which can cause serious health problems including liver disease, cirrhosis, and liver cancer - but can be cured with proper treatment. Currently there is no vaccine to prevent hepatitis C, but people can reduce the risk of becoming infected! To avoid getting HCV, avoid sharing or reusing needles, syringes, or any other equipment to prepare and inject drugs. www.cdc.gov/hepatitis/hcv/

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Effects During Pregnancy Early Prenatal Care is Important! Treatment is AVAILABLE during pregnancy to reduce the harm to you and your baby. Neonatal Abstinence Syndrome (newborn withdrawal) - A group of signs and symptoms that a baby can have when a mother takes certain medications or other drugs during her pregnancy. These substances may include methadone, suboxone, heroin and other prescription medications such as Oxycontin and Vicodin. Babies exposed to these drugs have an 80% chance of developing withdrawal symptoms.

EVERY 25 MINUTES, A BABY IS BORN SUFFERING FROM OPIOID WITHDRAWAL. An estimated 21,732 babies were born with NAS in the United States in 2012, a 5-fold increase since 2000. Source: Patrick et. Al., JAMA 2012, Patrick et. Al., Journal of Perinatology 2015

SYMPTOMS OF WITHDRAWAL INCLUDE: • High-Pitched Crying or Difficult to Console • Poor Feeding/ Spitting/ Vomiting/ Diarrhea • Difficulty Sleeping • Overly Vigorous Suck or Uncoordinated Suck • Tremors/ Jitteriness

• Occasionally Seizures Can Occur • Frequent Hiccups and/or Sneezing

• Mild Fever • Sweating

If these symptoms occur, your newborn baby may spend more time in the hospital than other

newborns. The exact length of time it takes to wean these substances differs from baby to baby. It is not unusual for babies to be in the hospital for 2-16 weeks.

Resources for Help: ● Prenatal Clinic at SSM Agnesian HealthCare - 920.926.8891 ● Prenatal Care Coordinator at Fond du Lac County Health Department - 920.929.3085 ● Family Resource Center - 920.923.4110 ● New Beginnings Care Inc.- 920.923.1484

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

If You Suspect An Overdose Keeping Them Safe and Alive.

Call 911 immediately. An opioid overdose requires immediate medical attention. An essential first step is to get help from someone with medical expertise right away.

Where to Get Narcan: ● Vivent Health (formally known as AIDs Resource Center of Wisconsin) - free Narcan, clean needles & more resources 920.733.2068 or www.viventhealth.org ● Local Pharmacies & Providers - Narcan may be covered by your insurance or there may be a minimal copay. No prescription is required. ● Drug Free Community Narcan trainings - contact DFC 920.906.6573 or FDL County Health Department 920.929.3085. Signs of an Opioid Overdose: • Sleepiness or drowsiness • Confusion, slurred speech • Slow or shallow breathing • Pinpoint pupils • Pale, blue, or cold skin • Slow heartbeat, low blood pressure Additional Resources: www.cdc.gov/drugoverdose/prevention/reverse -od.html www.narcan.com/recognizing-opioid-overdoses

WHAT IS AN OPIOID OVERDOSE? Overdose is an injury to the body (poisoning) that happens when a drug is taken in excessive amounts. An overdose can be fatal or non fatal. Anyone who uses opioids can experience an overdose. Certain factors may increase risk: ● Taking high daily doses of prescription opioids or more than prescribed ● Combining opioids with alcohol or other drugs such as heroin or fentanyl, that could contain unknown or harmful substances Death from an opioid overdose happens when too much of the drug overwhelms the brain and interrupts the body’s natural drive to breathe.

NALOXONE (NARCAN) may reverse an overdose. Naloxone is a medication used to counteract the life-threatening effects of an opioid overdose. It can be given via, nasal spray device (into the nose) or via intramuscular injection into the muscle of the arm, thigh or buttocks.

YOU CAN SAVE A LIFE. Narcan is now accessible in Fond du Lac County and surrounding areas. With basic training, friends and family members can recognize an overdose and give Narcan. EMTs, police and first responders are also trained to administer Narcan.

HOPE (Heroin Opioid Prevention & Education) LAWS In 2014, Governor Walker signed all seven of Rep. John Nygren’s HOPE Agenda bills into law to help prevent and fight the growing heroin and prescription drug epidemic in our state. For more information, visit www.legis.wisconsin.gov

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Wisconsin Good Samaritan Law. Act 200. Any person who renders emergency care at the scene of any emergency or accident in good faith shall be immune from civil liability for his or her acts or omissions in rendering such emergency care. Good Samaritans

Dos and Don’ts in Responding to Opioid Overdose If you or someone you know exhibits any symptoms of an overdose, Call for Help! Dial 911. AN OPIOID OVERDOSE NEEDS IMMEDIATE MEDICAL ATTENTION All you have to say is: “Someone is not breathing and unresponsive.” Be sure to give a clear address and/or description of your location. • DO support the person’s breathing by administering oxygen or performing rescue breathing. • DO administer naloxone (NARCAN). • DO stay with the person and keep him/her warm.

• DON’T slap or try to forcefully stimulate the person—it will only cause further injury, If you are unable to wake the person by shouting, rubbing your knuckles on the sternum, or light pinching, he or she may be unconscious. • DON’T put the person in a cold bath or shower. This increases the risk of falling, drowning or going into shock. • DON’T inject the person with any substance (salt water, milk, “speed,” heroin, etc). The only safe and appropriate treatment is naloxone. • DON’T try to make the person vomit drugs that he or she may have swallowed. Choking or inhaling vomit into the lungs can cause a fatal injury.

Assembly Bill 447: Provides limited immunity from certain criminal prosecutions for a person who seeks assistance from police or medical professionals for another individual who has overdosed on controlled substances. Act 194

Assembly Bill 446: Provides all levels of EMTs, first responders, police and fire the ability to be trained to administer Naloxone (Narcan). Any person who administers the drug is immune from civil or criminal liability provided their actions are consistent with Wisconsin’s Good Samaritan Law.

OVERDOSE? Call 911 immediately! Without Risk.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Drug Endangered Children: What Caregivers and Educators Should Know What is a Drug Endangered Child? A drug endangered or exposed child can be identified as any child whose brain and/or body has been affected because his/her parents or guardians used drugs or alcohol during pregnancy, and/or who is living in a home where drugs are abused and/or illegally made, used, traded or given away. Understand the Behaviors EMOTIONAL: • Seems sad or does not enjoy activities • Takes on a lot of guilt and blame themselves for what goes wrong • Feels their life will always be bad • May attach to strangers too easily, but have difficulty trusting caregivers BEHAVIORAL: • Likes to be alone • Finds change difficult • Doesn’t get along well with others • Doesn’t seem to care about what happens to them • More interested in sex and drugs or may know more about sex and drugs related topics than most children their age

COGNITIVE: • Difficulty talking and listening • Difficulty remembering a list of things

• Tells detailed stories involving drug use, deals or other indications of illegal activity, such as suspicious adult behavior (Mom sometimes takes medicine and sleeps all day) • Has a strong distrust of authority figures and the police

• Difficulty remembering what they were just told • Often do not learn from mistakes or experiences

Helping a Drug Endangered Child that you care for: Prenatal or drug exposure at an early age can cause damage to the developing brain. What you think is “odd” or difficult behavior might be something the child cannot control. Try to understand that the “behaviors” you see might be the only way that child can express their feelings. You can help by... • Be repetitive, do things the same way, every time, over and over again • Keep things quiet and calm

• Help them feel safe • Help them separate the parent from the substance abuse • Allow them periods of grief • Teach them empathy by showing understanding, sympathy and compassion Remember: Not every behavior indicates a specific concern

• Be realistic about what you expect, and understand that drug exposed children may not act their age • Give support and encouragement

If you suspect or know that a child is in danger, please contact: Fond du Lac County Department of Social Services at 920.929.3400 or your local law enforcement agency.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

LAW ENFORCEMENT

Wisconsin Statutes

Max - Extended Supervision

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Legal Consequences of Prescription Drug Abuse Wisconsin Penalties In Wisconsin, simple possession of Heroin or a Schedule I or II Narcotic (prescription pills) is a 3.5 year FELONY. Delivery or Possession with intent to Deliver is a 10 year FELONY. THREE AND A HALF YEARS IN JAIL. $10,000 BUCKS. Heroin possession is a felony in Wisconsin. And the penalties if you get caught can be pretty fierce. What Happens When You Are a Convicted Felon? If you are convicted of a felony in Wisconsin you cannot: • Vote • Apply for federal loans/students loans • Possess a firearm In addition, you must disclose you are a felon on all applications—university and employment. It is then per university or employer policy as to whether you are eligible for admittance or employment. Len Bias Law Leonard Kevin “Len” Bias was a first-team All-American college basketball forward at the University of Maryland. He was selected by the Boston Celtics as the second overall pick in the 1986 NBA Draft on June 17, and died two days later from cardiac arrhythmia induced by a cocaine overdose. He is considered by some sportswriters to be one of the greatest players not to play at the professional level.

In 1988, the U.S. Congress passed a stricter Anti-Drug Act that is known as “The Len Bias Law.” It was backed by both parties and reinforced the War on Drugs with stiffer penalties and expanded the DARE program. Specifically, this law allows the District Attorney to charge the supplier of a drug with homicide when the user dies.

Overdose deaths are treated as homicides and law enforcement responds accordingly. This is important because it sends a strong message to drug dealers: consequences for dealing are stiff.

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TREATMENT

OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families Addiction is a Medical Condition

Addiction is a brain disease that affects the priorities, physiology and thought process. Opioid drugs work by binding to opioid receptors in the brain, thereby reducing the intensity of pain signals that reach the brain. However, frequent use of opioids can physically change the brain to the point where it needs opioids to function normally. www.outthemonster.com When a drug user can’t stop taking a drug even if he wants to, it’s called addiction. The urge is too strong to control, even if you know the drug is causing harm. When people start taking drugs, they don’t plan to get addicted. They like how the drug makes them feel. They believe they can control how much and how often they take the drug. However, drugs change the brain. Drug users start to need the drug just to feel normal. That is addiction, and it can quickly take over a person’s life. Addiction is a brain disease. • Drugs change how the brain works. • These brain changes can last for a long time. • They can cause problems like mood swings, memory loss, even trouble thinking and making decisions. Addiction is a disease, just as diabetes and cancer are diseases. Addiction is not simply a weakness. People from all backgrounds, rich or poor, can get an addiction. Addiction can happen at any age, but it usually starts when a person is young. www.drugabuse.gov/drugs-abuse What’s Relapse Sometimes people quit their drug use for a while, but start using again no matter how hard they try not to. This return to drug use is called a relapse. People recovering from addiction often have one or more relapses along the way. Drug addiction is a chronic (long-lasting) disease. That means it stays with the person for a long time, sometimes for life. It doesn’t go away like a cold. A person with an addiction can get treatment and stop using drugs. But if he started using again, he would: • Feel a strong need to keep taking the drug. • Want to take more and more of it. • Need to get back into treatment as soon as possible. • He could be just as hooked on the drug and out of control as before. Recovery from addiction means you have to stop using drugs AND learn new ways of thinking, feeling, and dealing with problems. Drug addiction makes it hard to function in daily life. It affects how you act with your family, at work, and in the

community. It is hard to change so many things at once and not fall back into old habits. Recovery from addiction is a lifelong effort. www.drugabuse.gov/related-topics/recovery For local treatment and recovery resources, see page 24.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

When Someone You Love is Addicted 1. Educate yourself about addiction; search credible online resources such as government, university, medical and research-based sites for the most updated information on addiction. Look to local resources for information and steps to take to stay involved. 2. Be aware of “Doctor Shopping” the practice of requesting care from multiple physicians or medical practitioners at the same time without coordinating care between the practitioners for the purpose of obtaining narcotic prescription medications from more than one practitioner at the same time. 3. Attend family support groups such as Al-Anon, Ala-Teen and Nar-Anon to provide support for yourself as well as find ideas and resources from other individuals that are faced with similar challenges. Attend an Al-Anon meeting if you cannot locate/attend a Nar-Anon meeting. 4. Set boundaries and limits. It’s a fine line between enabling and support. Do not provide money or access to money and other valuables. Consider providing food and other life necessities as an alternative. Do not accept unacceptable behavior such as violence or abuse, drugs in your home and drugs around children. Call local law enforcement if needed. 5. Focus conversations toward recovery, not blame. Do not threaten or shame your loved one. Reinforce that the addiction is an illness and that you are there to assist in the recovery process. 6. Offer to attend therapy and be part of the recovery process . Clinicians and treatment providers cannot legally talk to you unless your loved one asks them to and then signs a written consent form allowing you to communicate with the treatment provider. Ask that your loved one take care of this. 7. Take care of yourself! Loving someone with an addiction can take a major toll on your physical and mental well being. You need to take care of yourself to continue to be the best support that you can. Take care of basic needs such as sleep, healthy eating and exercise. Engage in pleasurable activities regularly and seek support for yourself.

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OPIOID & HEROIN AWARENESS TOOLKIT A Prevention Guide for Families

Treatment Options DETOX OR DETOXIFICATION IS THE FIRST STEP TOWARD RECOVERY. This is when an individual will stop using heroin and begin to overcome physical dependence on the drug. Often individuals will return to use to stop the pain and adverse effects of the heroin withdrawal. The effects of withdrawal will vary from person to person depending on various factors including the frequency and dose of use as well as the length of time using. Individuals can seek assistance with the withdrawal from a local emergency room, a primary care physician or on a behavioral health unit. INPATIENT refers to a behavioral health unit or a psychiatric hospital with a length of stay from a couple of days to a couple of weeks. Inpatient care involves that detox process as well as limited individual and group therapy. RESIDENTIAL TREATMENT is a 28 -90 day program in which an individual resides in a facility specific to substance abuse treatment. Individuals are immersed in treatment throughout their day. PARTIAL HOSPITALIZATION AND DAY TREATMENT involve attending treatment daily at a facility while staying at home at night. INTENSIVE OUTPATIENT is a group therapy that is held up tp seven times per week for more than an hour at a time. OUTPATIENT COUNSELING/THERAPY is individual counseling that is held 1-2 hours per week to address any previous trauma or pain that may have led to and been a result of their drug use. Counseling can also help identify any triggers and assist in preventing relapse. MEDICAL INTERVENTION OR REPLACEMENT THERAPY use medications; Buprenorphine (Suboxone), Naltrexone (Vivitrol), or Methadone to alleviate the withdrawal symptoms and physical dependence on heroin. This is a long-term solution that requires years of being on the medication. Replacement therapy is combined with counseling and support groups to provide the best chance for a successful recovery. FAMILY AND PEER SUPPORT addiction impacts not only those with the disease, but also their family and friends. The following resources are available to help you learn about addiction and find support for you and your family members. COUNTY CRISIS a comprehensive and efficient response to any resident experiencing a crisis situations. Crisis services are available 24 hours/day to residents of each county and provide follow up care and/or provide linkage to appropriate services. SUPPORT GROUPS such as a 12 step Narcotics Anonymous are usually peer driven meetings to offer social supports and connections.

Are You Covered? If you have Insurance: call the number on your insurance card to find out what providers and services are covered. If you do NOT have Insurance: call or contact the following agencies: ● Fond du Lac County Department of Community Programs - visit or call 920.929.3565 ● SSM Agnesian HealthCare, Samaritan Clinic - visit or schedule an appointment online or call 920.926.4841 or Waupun Memorial Hospital, 920.324.6540

Online Resources for Insurance: ● www.access.wisconsin.gov ● www.healthcare.gov

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