“Deaths due to opioid drugs have skyrocketed in women; mothers, wives, sisters, and daughters are dying from overdoses at rates we have never seen before”

                                                                    Dr.Tom Frieden, director of the CDC (Center for Disease Control)

 

 

This is the first of three articles about substance abuse issues impacting Americans today.

Opioid drugs or “opiates” are better known as prescription pain pills or “narcotics.”  Heroin is also an opiate, though it has been banned by the FDA since the 1920s.  With morphine as their active ingredient, opiates have been used for the relief of pain since the 17^th century. However, the dangers of opiates were not appreciated until the 20^th century.

 

As late as 1912, according to The Business Insider, Bayer marketed heroin as a “cure” for childhood bronchitis.  We now know that opioid drugs possess a strong potential for abuse (using more drug than is prescribed or for a nonmedical purpose) and addiction (when the individual’s drug use becomes his primary purpose in life). We are learning that all of the opiates, when not taken as directed, also have a frightening potential for death from overdose.

 

Not all medicines used to treat pain are opiates.  Over- the- counter medications such as aspirin, Tylenol (acetaminophen), and NSAIDs (anti-inflammatory medicines such as Advil or Aleve) are also indicated for the treatment of pain. Opioid drugs are controlled substances generally prescribed for short term use only to treat severe pain, such as occurs after surgery, a traumatic accident, or terminal illness. Opioid drugs have names like oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, fentanyl, methadone, and Tylenol # 3.

 

The amount of opiates prescribed for pain has increased by 300% in the last 11 years according to the CDC, which has classified the increase in abuse of these drugs as an “epidemic.”

 

Due to their ability to cause respiratory depression, so that the overdose victim simply stops breathing, opiates are more dangerous in overdose than other commonly abused prescription drugs (which include sedatives such as Xanax or Ambien, and stimulants such as Ritalin).

 

The rates of opioid abuse and overdose in women are increasing faster than in men because women are more likely to have chronic pain conditions, to “doctor shop,” and to be prescribed opiate medications for longer periods of time than men.  As a result, more women are hospitalized for opiate abuse. The CDC tells us that every 3 minutes a woman goes to the Emergency Room for treatment of opiate abuse or misuse.

 

The opiate abuse “epidemic” has come to the attention of lawmakers, who have restricted the prescribing of these medications.  This past October, for example, Vicodin was changed from a Schedule III to Schedule II drug, making it harder to get.  Most of the other opioids (e.g. fentanyl and morphine) are already Schedule II.  Schedule II drugs require a written or electronic-prescription each time they are filled and refills cannot be honored.

 

The illegal drug, heroin, is most commonly used today by opiate pain pill addicts looking for a stronger, or perhaps cheaper, way to get high. Heroin is a white or brown powder that is snorted, smoked or injected directly into the veins (IV use). “Black tar heroin,” which appears as a black sticky substance, is being seen more commonly as an import from Mexico.

 

As pain pills are more highly controlled by the FDA, making them harder to get “on the street,” heroin is becoming cheaper and more plentiful. As a result, the use of heroin has risen steadily since 2007. Today, over 4 million people, or 1.6% of the adult and teenage US population has used heroin at some time in their lives.

 

Like alcohol, tolerance to opiates develops quickly as the liver becomes more efficient at breaking down these substances. Therefore, with continued use, higher doses of opiates are needed to produce the same results. Also similar to alcohol, if an individual stops using opiates, he will lose this tolerance.  If an addict relapses after a period of sobriety, he will not have the same ability to break down opiates that he did when using.  Therefore, opiate addicts may be most vulnerable to overdose when they relapse and should be educated about this loss of tolerance.

 

With physical tolerance comes the potential also for withdrawal.  Although physical withdrawal from opiates is not usually as dangerous as that from alcohol, it is extremely uncomfortable, and can be risky for individuals with underlying medical issues.  Because opiates act to depress the nervous system and relieve pain, withdrawal causes the opposite effects.  Symptoms of withdrawal include anxiety, agitation, elevated blood pressure and pulse, dilated pupils, insomnia, nausea / vomiting, cramping, diarrhea, and increased pain. Cravings are also a tremendous problem, and a common cause of relapse.

 

The Office of National Drug Control Policy (http://www.whitehouse.gov/ondcp) gives actions that you can take to prevent prescription drug overdose:

• Do not share prescription medications with others.  70% of people who abused prescription pain medicines got them from friends or relatives. 

 

• Dispose of unused medications properly. This FDA site tells you how to correctly dispose of medicines: http://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm

 

• Learn the symptoms of overdose and what actions to take. This link takes you to resources that include a pocket card explaining how to resuscitate someone who is overdosing:

        http://www.asahq.org/WhenSecondsCount/resources

 

• Naloxone, also called Narcan, is a medicine that reverses the effects of opiate overdose for a short time.  This medicine is being distributed to first responders like law enforcement, and may be available to families of addicts, to help prevent overdose deaths.  According to the American Society of Anesthesiologists (who publish the overdose “card”), if you have naloxone, you should administer it according to the package directions after calling 911.

 

Lastly, if you know someone with an addiction, help them seek treatment. I will discuss the treatment of opiate addiction, including medications that address cravings, in the next installment of this series.

 

For more information:

From the CDC: http://www.cdc.gov/media/dpk/2013/dpk-Prescription%20drug%20overdose.html

 

To receive a free opioid abuse prevention toolkit: http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit-Updated-2014/SMA14-4742

 

From the White House Office of National Drug Control Policy: http://www.whitehouse.gov/blog/2014/02/11/5-things-know-about-opioid-overdoses

 

Did you know?

• According to The Office of National Drug Control Policy prescription drugs are now the most commonly abused substances after marijuana.

 

• Opioid overdoses have increased by 400% in women and 265% in men since 1999. In 2010, 18 women died every day in the US from an opiate overdose.

 

• Overdoses are more common after an individual has been sober for an extended period of time, such as while in treatment.

 

• Tylenol is often added to opiate medications to enhance their pain relieving effect. Though Tylenol is not physically addictive, it is dangerous in overdose due to liver toxicity.  Pain medications containing Tylenol possess an added danger of liver damage if overused.

 

Dr Bonanno is a board certified psychiatrist with nearly 20 years of patient care experience. She currently serves as a behavioral health medical director for the Anthem central region.