Sobriety

David Todd Loffert B.S., M.H.S., (Ph.D. Candidate)

THE DEVASTATION OF DRUG ADDICTION: MY STORY

WHAT IS ADDICTION

WHAT IS ADDICTION

Addiction is a primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addiction is characterized by behaviors that include one or more of the following:

• Impaired control over drug use• Compulsive use• Continued use despite harm• Cravings

WHAT DOES ADDICTION LOOK LIKE

WHO IS BECOMING ADDICTED

Rx Addicted

Doctors

WHO IS BECOMING ADDICTED

WHAT IS THE ORIGIN OF ADDICTION

GENETIC, PSYCHOLOGICAL, PHYSIOLOGICAL

YOUR OPTIONS IN ADDICTION

1 • Sobriety

• Jails / Institutions

• Death

2

3

• 21 Million Americans using prescriptions for non-medical use (addicted)2011

• Non-medical use of prescription drugs the #1 drug of abuse in U.S.2011

• 30,000 overdoses in U.S.2011• Prescription Drug Abuse Results in

One Death Every 19 Minutes in U.S.2011• 39 out of 50 states have a Prescription

Drug Monitoring Program2010• Over 1 million visits to ERs for drug

related complications2009

FACTS OF Rx ADDICTION


Rates of Prescription Painkiller Sales, Deaths and Substance Abuse Treatment

Admissions (1999-2010)

SOURCES: National Vital Statistics System, 1999-2008; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), 1999-2010; Treatment Episode Data Set, 1999-2009


Prescription Drug Overdose Death Rates By State per 100,000 People (2008)

SOURCE: National Vital Statistics System, 2008

THE ADDICTS WORLD

STAGES OF CHANGE THEORY

• The drug or other substance has a high potential for abuse, no medical use.1

• The drug or other substance has a high potential for abuse, medical use.2

• The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I and II.3

• The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III.4

• The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule IV.5

SCHEDULE OF DRUGS

•Prescription Drugs (2-5)1•Marijuana (1)2•Cocaine (2)3•Heroin (1)4•Methamphetamine (2)5

TOP 5 DRUGS OF ABUSE IN 2011

• University of Northern Colorado, B.S. in Biology and Chemistry1

• Johns Hopkins University, Master of Health Science in environmental/radiation/respiratory health2

• Medical College of Virginia/Virginia Commonwealth Universtiy, Ph.D. in respiratory medicine3

MY EDUCATIONAL BACKGROUND

4 Peer-Reviewed Journal Articles

53 Papers Presented At

Various Medical Conferences &

MeetingsContributing author for the book, “Inhalation

Aerosols, Physical and Biological Basis for

Therapy” by Anthony J. Hickey

Masters Thesis: Fundamentals of Aerosol Delivery to the Respiratory

Tract with an Emphasis on the Performance of Medicinal Spacer

Devices

PUBLICATIONS

Delivery of glucocorticoids by jet nebulization: Aerosol characteristics and output

Jeffrey Leflein, MD, a Eleanor Brown, MT(ASCP), a Malcolm Hill, PharmD, aH. William Kelly, PharmD, b David Todd Loffert, BS, a Harold S. Nelson, MD,"and Stanley J. Szefler, MD ~ Denver, Colo., and Albuquerque, N.M.

Background: Since inflammation has been identified as a critical factor in thepathogenesis of asthma, use of inhaled glucocorticoids has increased. Because youngchildren are often unable to coordinate properly the use of metered-dose inhalers and noglucocorticoids preparations for nebulization have been approved in the United States,parenteraI and intranasal glucocorticoids preparations are occasionally administered bynebulization.Methods: We examined whether a parenteral preparation (triamcinolone acetonide [TAA];Kenalog) could be delivered by nebulization. TAA, 1000 txg (0.1 ml), was placed in thenebulizer bowl (MB5 [MeFar, Brescia, Italy] or Pari-Jet [Dura Pharmaceuticals, San Diego,Calif.]), then diluted with 2. 9 ml normal saline solution for a total volume fill of 3 ml. Usinga laser panicle analyzer, high-performance liquid chromatography, and cascade impactor, weexamined the percentage of aerosol volume produced with panicles in the respirable range of1 to 5 lazn in diameter, actual TAA output (in micrograms) and concentration of TAAcontained in the panicles within the respirable range.Results: Laser particle analysis indicated that 34% +- 3% (mean +- SEM) (MB5) and 47 +-3% (Pari-Jet) of the total aerosol volume produced were within the respirable range of I to 5txm in diameter, and this remained consistent throughout nebulization. The nebulizer wasstopped serially for determination of TAil output with high-performance liquidchromatography. TAA output (1000 tzg less the amount in micrograms remaining afternebulization) was essentially complete after 2 minutes with the Pari-Jet and within 4 minuteswith the MB5 and totaled 352 +- 19 ixg and 367 +-- 9 Ixg, respectively. Finally, cascadeimpactor studies confirmed that 33.4% of the TAil aerosol generated by the MB5 nebulizerwas contained in panicles in the respirable range.Conclusion: Approximately 35% (Pari-Jet) and 37% (MB5) of the initial 1000 lag of TAAwas delivered with the two nebulizers tested. The panicles generated within the respirablerange were limited to 34% (MB5) and 47% (Pari-Jet) of the amount delivered. TAA wasequally distributed in the particles generated. The theoretic amount delivered in the respirablerange was approximately 12.5% for the MB5 nebulizer on the basis of the cascade impactorand 16.5% for the Pari-Jet (assuming TAA distribution equivalence) of the TAA placed ineach of the nebulizers. Additional clinical studies are needed to define efficacy and safety inview of the excipients used in preparing the parenteral preparation. (J ALLERGY CLINIMMUNOL 1995;95:944-9.)Key words: Triamcinolone acetonide, glucocorticoids, laser panicle analyzer, high-performance liquid chromatography, cascade impactor.

THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

COMPARISON OF DISPOSABLE JET NEBULIZERS, A METHOD FOR DETERMINING WHICH BRAND TO USE. D. Todd Loffert, PARI Respiratory Equipment, 7493 Whitepine Road, Richmond, Virginia, 23237.

Four commercially available nebulizers from 4 sources were studied (Misty-Neb/Baxter, PARI LC-D/PARI, Updraft II/Hudson RCI, and Whisper Jet/Marquest medical). The nebulizers were operated using an PARI Master compressor and reanalyzed with an Devilbiss Pulmo-Aide compressor. Delivery rate(Ml/Min), percent Particles in the Respirable Range(PRR), Respirable Particle Delivery Rate(RPDR), and standard deviation of all parameters were compared. All nebulizers were filled with 2.5 ml of saline. PRR was measured by continuous sampling by Laser Particle Analyzer, Malvern Mastersizer X. The nebulizers were sampled at a simulated flow rate of 20 liters per minute.

PARI MASTER COMPRESSORMl/Min varied from 0.23 to 0.56 ml/min. The Whisper Jet (0.23) had the lowest ml/min while the PARI LC-D (0.56) had the highest. PRR varied 22.74 to 59.89%. The Misty-Neb (22.74%) had the lowest PRR while the PARI LC-D (59.89%) had the highest.To combine the previous variables RPDR was calculated, = Ml/Min multiplied by PRR. The Misty-Neb (0.06) had the lowest RPDR while the PARI LC-D (0.34) had the highest RPDR (means significantly different at p<0.0001).

PULMO-AIDE COMPRESSORMl/Min varied from 0.14 to 0.48 ml/min. The Whisper Jet (0.14) had the lowest ml/min while the PARI LC-D (0.48) had the highest. PRR varied 25.00 to 51.92%. The Misty-Neb (25.00%) had the lowest PRR while the PARI LC-D (51.92%) had the highest.To combine the previous variables RPDR was calculated, = Ml/Min multiplied by PRR. The Misty-Neb (0.04) had the lowest RPDR while the PARI LC-D (0.25) had the highest RPDR (means significantly different at p<0.0001).The Ml/Min, PRR, and RPDR of the commercially available nebulizers varies greatly with each compressor used. Consideration must be given to these efficiency parameters when deciding which nebulizer brand to use.

RESPIRATORY CARE

Comparison of the bronchodilator response to albuterol administered by the OptiHaler, the AeroChamber, or by metered dose inhaler alone.Nelson HS, Loffert DT.National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.

Eighteen subjects with moderate asthma participated in this double-blind study comparing the bronchodilator response to albuterol or placebo used in conjunction with three inhalation devices; the metered dose inhaler (MDI) actuator alone, the AeroChamber, and the OptiHaler. The principal comparison was the increase in FEV1 over 30 minutes. Also recorded were heart rate, time required to use each device, and patient acceptance of each device. There was a large bronchodilator response with albuterol with each of the devices, but there was no difference in the promptness or the magnitude of the bronchodilator response among the three devices. There was a small but statistically significant increase in heart rate which did not differ among devices. Subject ratings of acceptability were MDI alone best, followed by OptiHaler, then AeroChamber. We conclude (1) the bronchodilator response obtained with use of the MDI alone, the AeroChamber and OptiHaler were not significantly different; (2) patients, as a group, found the MDI required less time to use and they favored it over either spacer; (3) while in subjects employing good MDI technique, the addition of either an AeroChamber or an OptiHaler did not improve bronchodilator response. Spacers may have a role in those with poor inhaler technique or in conjunction with inhaled corticosteroids.

ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY

DR. SUTER FIRST VISIT FIRST QUESTION

“If you were stranded on a desert island,

what pain medicine

would you want to have

with you”

RX HISTORY FROM DR. SUTER, MCV/VCU, VISIT 1

RX HISTORY FROM DR. SUTER, MCV/VCU, VISIT 1 (Cont.)

FDA Schedule Visit # Prescription

#RX Ordered/Refills

Date Rx Written Last Filled

2 1 Demerol 100mg tubex shots (needles)

5 7/30/1998 XXX

2 1 Demerol 100mg Tablets 60 7/30/1998 XXX

2 1 Dexedrine 5mg Tablets 30 7/30/1998 XXX

2 1 Mepergan (Demerol & Phenergan)

60 7/30/1998 XXX

4 1 Valium 100 / w3 Refills

7/30/1998 XXX

2 1 Percocet 10mg Tablets 100 7/30/1998 XXX

RX HISTORY FROM DR. SUTER, MCV/VCU


#RX Ordered/Refills


2 Called in between visit 1-2

Percocet 10mg Tablets

100 8/10/1998 7/30/1998


Dexedrine 5mg Tablets

60 8/11/1998 7/30/1998



60 9/15/1998 8/11/1998


Demerol 100mg Tablets

60 10/6/1998 7/30/1998


Demerol 100mg Tubex (needles)

20 8/28/1998 7/30/1998

RX HISTORY FROM DR. SUTER, MCV/VCU (Cont.)


#RX Ordered/Refills


2 2 Percocet 10mg Tablets

100 10/20/1998 8/10/1998

2 2 Dexedrine 5mg Tablets

100 10/20/1998 9/15/1998


Demerol 100mg Tubex Shots (needles)

20 11/18/1998 8/28/1998



60 11/18/1998 10/6/1998


Valium 5mg Tablets

100 / w4 Refills

11/18/1998 7/30/1998



#RX Ordered/Refills


2 3 Percocet 10mg Tablets

100 12/4/1998 10/20/1998

2 3 Dexedrine 5mg Tablets

120 12/4/1998 10/20/1998

2 3 Mepergan (Demerol & Phenergan)

100 12/4/1998 7/30/1998



#RX Ordered/Refills Date Rx Written Last Filled



100 12/21/1998 12/4/1998



100 12/15/1998 11/18/1998


Demerol 100mg Tubex Shots (needles)

20 12/21/1998 11/18/1998


Valium 5mg Tablets 100 / w4 Refills 12/15/1998 11/18/1998



120 12/21/1998 12/4/1998



100 12/31/1998 12/21/1998



120 12/31/1998 12/21/1998


Mepergan (Demerol & Phenergan)

100 2/15/1999 12/4/1998



100 2/24/1999 12/15/1998



#RX Ordered/Refills


2 4 Dexedrine 5mg Tablets 100 3/10/1999 12/31/1998

3 4 Vicodin HP 10mg Tablets 100 / w3 Refills

3/10/1999 XXX

4 4 Valium 100 / w3 Refills

3/10/1999 12/15/1998

xx 4 Ultram 50mg 100 / w6 Refills

3/10/1999 XXX

xx 4 Ultram 50mg 100 / w3 Refills

3/10/1999 XXX

4 4 Klonopin 60 / w3 Refills

3/10/1999 XXX



#RX Ordered/Refills


3 Called in after visit

4

Vicodin HP 10mg Tablets

100 / w3 Refills

3/28/1999 3/10/1999

3 Called in after visit

4

Vicodin HP 10mg Tablets

100 3/31/1999 3/28/1999

Total # of Visits

Total Days Under Dr. Suter’s Care

Total # of Pills

Average Pills Per Day

4 243 (7.9 Months) 6,647 27.35


AMOUNT OF CONTROLLED PRESCRIPTION PILLS GIVEN IN 243 DAYS & 4 VISITS

• VALIUM 5MG1800• VICODIN HP 10MG900• MEPERGAN (DEMEROL &

PHENERGAN)260• ULTRAM 50MG (1 VISIT)1100

• FIRST VISIT655• DEXEDRINE 5MG710• DEMEROL 100MG380• PERCOCET 10MG600•DEMEROL SHOTS 100MG65

09-24-99 Cary G. Suter, M.D., 0101-011492, Richmond, VA – Acceptance of surrender of license, in lieu of further administrative proceedings, based upon inappropriate prescribing of controlled substances and inadequate documentation and monitoring of this prescribing.

LICENSE REVOKE

REALIZATION OF ADDICTION

• After months under Dr. Suter’s care, I decided to stop.1

• On my way home from school.2• Started to have a horrible feeling.3• Ended up in the hospital that night with

severe withdrawal complications/symptoms.4

32

87

31

20

19

648

6

23

12

8

16

7

16419

21

9

24

4613

3

24

29

10

9

15

45

16

20

7

18

13

2

8

11

0

0

0

0

11

2

0

0

0

109

CONTROLLED RX OBTAINED FROM INDIVIDUAL STATES OVER 9 YEARS

• GERMANY65• AUSTRIA8• HOLLAND10• PAKISTAN12• CANADA15• BERMUDA17

• CARIBBEAN12• MEXICO21• JAPAN4• SPAIN5• BRAZIL9• INDIA11

CONTROLLED RX OBTAINED FROM OUTSIDE THE UNITED STATES OVER 9 YEARS

Controlled Substance Rx

Doctors

HOW I ACQUIRED PRESCRIPTIONS

THROUGHOUT MY 9 YEARS OF ADDICTION THE FOLLOWING EVENTS HAD A SIGNIFICANT DETRIMENTAL EFFECT IN MY LIFE

1) 67,457 controlled substance pills ingested

9) Fired from 5 prominent scientist positions2) 45 grand mal seizures

10) 19 prescription related arrests3) 323 narcotic related hospital visits

11) 180 forged prescriptions4) 9 in-patient rehabilitation programs

12) 2 suicide attempts5) Homeless 3 different times

13) 167 bad checks for prescriptions/Dr. visits6) 35 hospitalizations from drug overdoses

14) 1,434 medical visits to obtain narcotics7) Total medical debt over 9 years = $310,650.00

8) Dropped out of my Ph.D. due to addiction issues

DETRIMENTAL EVENTS

Lecture in Atlanta

Forged Demerol Rx

Arrested At Conference

Taken Past Colleagues

In HandcuffsSpent 2 Weeks In

Atlanta Jail

MY FIRST ARREST

On Way To Conference

Had Drug Seizure

Hit Wall, Rolled 3 Times

ROLL-OVER ACCIDENT

High On Prescription

DrugsLooking For

My DogWoods Behind

House4 Masked Individuals With Guns

Burglarizing HousesWalking Away

Waiting To Be Shot

FACE-TO-FACE AT GUNPOINT

Desperation

No Way OutContinuous Physical &

Emotional Pain

SUICIDE ATTEMPTS

•Denver Cares1•PEER I (Needed at least 1 yr.)2•Family3•Acceptance/Responsibility4•Has Become a High Risk5

REALIZATION FOR SOBRIETY

PERCEIVED RISK AND USE

• During Employment (1 Day)1• Arapahoe House (1 Week)2• West Pines (2.5 Weeks)3• Step 13 (2 Months)4• Denver Rescue Mission (6 Months)5• PEER 1 (1 Year)6

REHABILITATION FACILITIES

• Publish From Hopkins to Homeless: My True Story of Prescription Drug Addiction1

• Complete My Doctorate In Public Health Education (1 Year Before Completion)2

• Find Full-Time Job In Public Health or In The Addiction or Addiction Related Field3

• PRePARe (People Recovering from Prescription Addiction and Relapse)4

• Maintain Positive Outlook 5

MY FUTURE ENDEAVORS

MY SOON TO BE RELEASED MEMOIR

• CELL = 303-898-78591• E-MAIL = [email protected]• P.O. BOX 631344, LITTLETON, CO.

80163-13443

CONTACT INFORMATION

Sobriety

Documents

Transcript of Sobriety