Misuse and Abuse of Opioid Analgesics â the Role of the Internet ...
Misuse and Abuse of Opioid Analgesics â the Role of the Internet ...
Misuse and Abuse of Opioid Analgesics â the Role of the Internet ...
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<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong><br />
– <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
H. Siemann, J. Schnell, N. Scherbaum<br />
LVR Hospital Essen,<br />
Clinic for Dependent Behavior <strong>and</strong><br />
Addiction Medicine<br />
University <strong>of</strong> Duisburg-Essen,<br />
Germany
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
<strong>Opioid</strong> <strong>Analgesics</strong><br />
• Prescription Drugs<br />
– Tramadol, Tilidine, Codeine, Loperamide<br />
– Easy to prescribe<br />
• Schedule III Drugs according to <strong>the</strong><br />
German Narcotics Act (BtmG)<br />
– Morphine, Methadone, Fentanyl,<br />
Buprenorphine, Oxycodone<br />
– Special conditions to be fulfilled for a valid<br />
presciption<br />
Holger Siemann (holger.siemann@lvr.de)<br />
2
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Prescription Rate<br />
Holger Siemann (holger.siemann@lvr.de)<br />
3
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Non-Scheduled <strong>Opioid</strong>s<br />
• Tramadol<br />
– Pain management (post-surgery<br />
treatment, injury treatment)<br />
• Tilidine + Naloxone (Valoron N ® )<br />
– Higher analgesic potency<br />
– Prevention <strong>of</strong> parenteral drug abuse by<br />
combination with <strong>the</strong> µ-receptor antagonist<br />
Naloxone<br />
Holger Siemann (holger.siemann@lvr.de)<br />
4
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Aim <strong>of</strong> <strong>the</strong> Study<br />
• To assess <strong>the</strong> role <strong>of</strong> <strong>the</strong> internet<br />
regarding <strong>the</strong> abuse <strong>of</strong> prescription<br />
opioids<br />
– <strong>Role</strong> as a trading platform<br />
– <strong>Role</strong> as an information system<br />
Holger Siemann (holger.siemann@lvr.de)<br />
5
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Methods<br />
• Analysis <strong>of</strong> <strong>the</strong> first 50 websites provided by<br />
<strong>the</strong> leading search engine Google for <strong>the</strong> 3<br />
search terms:<br />
– Tramal (registered trademark)<br />
– Tramadol<br />
– Tramadol rezeptfrei (no need for a valid<br />
prescription)<br />
• 150 websites<br />
• No focus on Tilidine due to <strong>the</strong> combination<br />
with Naloxone <strong>and</strong> <strong>the</strong> low abuse potential<br />
Holger Siemann (holger.siemann@lvr.de)<br />
6
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Results<br />
• Analysis <strong>of</strong> 150 websites<br />
• About 800 webpages<br />
• Following some discussion boards in<br />
addition<br />
Holger Siemann (holger.siemann@lvr.de)<br />
7
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Site Ownership<br />
• High number <strong>of</strong> commercial websites<br />
• Only small amount <strong>of</strong> private <strong>and</strong><br />
institutional/governmental websites<br />
Holger Siemann (holger.siemann@lvr.de)<br />
8
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Trading<br />
• Smart/Head/Herbal shops focus on herbal drugs<br />
• Online pharmacies focus on life-style drugs<br />
Holger Siemann (holger.siemann@lvr.de)<br />
9
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
<strong>Role</strong> as a Trading Platform<br />
• Only a low number <strong>of</strong> opioid drug distributing<br />
websites<br />
– Interdiction <strong>of</strong> „online“ prescriptions in Germany<br />
need for valid prescription<br />
2 sites from <strong>the</strong> Ne<strong>the</strong>rl<strong>and</strong>s <strong>of</strong>fering online<br />
prescription<br />
– Need for a credit card<br />
– Delayed access<br />
– Suspicion because <strong>of</strong> high quality fake sites<br />
(credit card number phising, money transfer)<br />
Holger Siemann (holger.siemann@lvr.de)<br />
10
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
<strong>Role</strong> as an Information System<br />
• Mainly a pro-drug consumption attitude<br />
– Many commercial sites<br />
– Use <strong>of</strong> tramadol as a regular analgesic<br />
drug: „if my doctor is prescribing this drug<br />
it can‘t be harmful“<br />
• Information about methods to obtain<br />
opioid analgesics<br />
Holger Siemann (holger.siemann@lvr.de)<br />
11
<strong>Misuse</strong> <strong>and</strong> <strong>Abuse</strong> <strong>of</strong> <strong>Opioid</strong> <strong>Analgesics</strong> – <strong>the</strong> <strong>Role</strong> <strong>of</strong> <strong>the</strong> <strong>Internet</strong><br />
09/18/2009<br />
Examples<br />
• Tilidine + Naloxone:<br />
– Different boiling points<br />
– Usage <strong>of</strong> toaster to separate both substances<br />
from each o<strong>the</strong>r<br />
Inhalation <strong>of</strong> Tilidine<br />
• Tramadol:<br />
– How to get your doctor to prescribe an<br />
opioid analgesic (e.g. chronic pain)<br />
– How to forge a prescription<br />
Holger Siemann (holger.siemann@lvr.de)<br />
12
Thank you!
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