WHAT IS THE OPIOID EPIDEMIC?

An opioid is a synthetic version of an opiate (pain relievers derived from the opium plant such as morphine). Recently though, "opioid" is used as an umbrella term for both opioids and opiates. Medically, opioids are strong pain medicines such as oxycodone that are prescribed to treat moderate-to-severe acute and chronic pain and fentanyl used mostly with advanced cancer pain. When prescribed appropriately, opioids are effective in managing pain but when misused or abused they can cause addiction, overdose and even death. Due to the addictive nature of opioids, the number of abusers as well as accidental overdose related deaths in the U.S. is spiking creating a nationwide epidemic.


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The Epidemic

To understand the opioid abuse epidemic of today, it is important to understand how pain management treatment changed twenty years ago. In the mid-90s, there were extensive educational campaigns regarding the under treatment of pain by physicians. By 2001, new pain-management standards ("How much does it hurt from 1 to 10?") became a top priority to help physicians treat pain appropriately. Opioids, such as OxyContin and Percocet, were being marketed as useful pain management medications without causing addiction. They were seen as miracle drugs helping many patients suffering from acute and chronic pain.


Unfortunately, the underestimation of the addictive nature of these drugs combined with the growing acceptance of a "no pain" medical environment resulted in the amount of prescription opioids sold in the U.S. to nearly quadruple. In fact, 2014 had more overdoses than any other year on record and much of those deaths (more than 6 out of 10) were due to opioids -drugs like oxycodone, hydrocodone, and methadone. The number of people dying from drug overdoses has more than quadrupled since the early 2000s. In December 2016, the U.S., Centers for Disease Control and Prevention reported death rates from synthetic opioids, including fentanyl, increased 72.2% from 2014 to 2015 - that's 91 Americans every day. Opioid overdose is now the leading cause of accidental death in the U. S., surpassing automobile and gun deaths.


Pathway to addiction: An initial prescription for opioids opens the door for many patients to succumb to the addictive properties of these drugs. It is common to hear from people in recovery that once their medical doctors determined their pain needs were met and a prescription was no longer needed, they were already unknowingly addicted to the opioid. To fulfill their addiction, many in desperation sought out options on the "street" -- fueling the increasingly dangerous illegal trade of unregulated versions of opioids that may tarnished with harsh chemicals. A recent report from the National Institute of Drug Abuse (NIDA) revealed that individuals with heroin use disorder reported that accessibility, cost, and high potency of heroin are driving its popularity as a substitute for prescription opioids.

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Addiction

Addiction is a disease characterized by compulsive drug seeking and use despite the harmful consequences to the brain, body, and other aspects of the individual's life. Like other diseases, addiction does not discriminate. It affects all races, genders, ages and socioeconomic brackets and reaches into all communities large and small, urban to suburban.
A person's susceptibility to addiction can increase though based on genetic factors, exposure to addictive substances and trauma history. Additional factors that increase risk include if a person has obtained overlapping pain prescriptions from multiple doctors, is taking a high dosage of opioids, has a history of addiction and if they live in a rural and low income area.
Opioids are particularly addictive because they impact the brain and create intense feelings of pleasure when taken. Over time, most users (even those taking their opioid prescription correctly) will develop a tolerance and require a stronger dose to produce the same level of pain relief and "good feeling". It becomes harder for the body to feel good without them. When users start feeling signs of withdrawal when the opioid is no longer in their system, it leads them to have a negative association from not taking the drug. For these individuals, taking the drug is no longer about the positive feelings that were felt the first few times, now the opioid use is about avoiding negative feelings and symptoms. Addiction has set in and the opioid has begun changing the brains chemistry.
There are four common traits that define addiction and they are called the 4 Cs of Addiction:

• Compulsive Behavior of Using: The person has an irresistible urge to use the substance.
• Negative Consequences of Use: A person continues to use despite negative consequences brought on by their substance use.
• Loss of Control: The person cannot control their use of or abstinence from the substance.
• Craving: The urge feels like a physical need, such as hunger, and is just as demanding.

Per the CDC, as many as 1 in 4 people who receive prescription opioids long term for noncancer pain in primary care settings struggle with addiction.
Physical Signs
Physical signs of opioid use include drowsiness, constricted pupils, mental confusion, nausea, constipation, and, depending upon the amount of drug taken, it can depress respiration.
Health Consequences
People who abuse or are addicted to opioids are at an increased risk for premature death and serious health complications. Quitting is the only way to minimize or eliminate these risks.

• nausea
• vomiting
• weakened immune system
• slowed breathing rate
• coma
• increase risk or hepatitis
• hallucinations
• increased risk of HIV or other infectious diseases.
• overdose

Women who use opioids during pregnancy can pass the dependency onto their unborn child -- meaning the baby will be born addicted to opioids and experience withdrawal symptoms.
Withdrawal
Shortly after the last opioid dose, withdrawal (when your body crashes from its high and craves more) will set in. Withdrawal symptoms can be very severe however a person will not die from opioid withdrawal. Symptoms of withdrawal include:

• Anxiety
• Sweating
• Racing Heart
• Muscle Aches
• Fever
• Nausea
• Vomiting
• Stomach Cramps
• Diarrhea
• Goosebumps
• Depression
• Drug Cravings
• Insomnia
• Extreme Fatigue
• Hallucinations

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Overdosing

Over time, opioid users develop an increasing tolerance of the drug. The higher the tolerance the greater the amount required to achieve the desired euphoric state. At its worst, users walk a thin line between taking a large enough dose to achieve a "high" and taking too much that it results in an overdose. In December 2016, the U.S., Centers for Disease Control and Prevention reported death rates from synthetic opioids, including fentanyl, increased 72% from 2014 to 2015 - that's 91 Americans every day. Since 2000, the rate of deaths from drug overdoses has increased 137%.

When someone overdoses on an opioid, they do not die immediately. They can be helped if basic life support and naloxone is administered soon after the overdose is suspected. Naloxone, sold under the name Narcan, works by reversing the effects of opioids on the central nervous and respiratory systems.

More and more communities are providing Narcan to their emergency response teams to help those experiencing an opioid overdose. In the United States, naloxone's (or Narcan) use is estimated to have prevented 10,000 opioid overdose deaths. It is available as an injection and a user-friendly FDA-approved nasal spray. Family members can ask their health providers or pharmacists how to obtain the nasal spray. The intranasal delivery system could reduce the thousands of opioid-related deaths each year, and give patients a second chance to enter into long term addiction treatment. It should be said that Narcan only helps with an opioid overdose - it is not meant to treat addiction.

A few other noteworthy facts about Narcan:

• It is non-addictive.
• There's no street value - it cannot get you high.
• You don't need to be a doctor to have it.
• It has no effect on someone who does not use opioids.

Physical signs of an overdose are:

• Loss of consciousness
• Unresponsive to outside stimulus
• Awake, but unable to talk
• Breathing is very slow and shallow, erratic, or has stopped
• For lighter skinned people- skin tone turns bluish purple; for darker skinned people - skin turns grayish or ashen.
• Choking sounds, or a snore-like gurgling noise (sometimes called the "death rattle")
• Vomiting
• Body is very limp
• Face is very pale or clammy
• Fingernails and lips turn blue or purplish black
• Pulse (heartbeat) is slow, erratic, or not there at all

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Prevention

Many cities and counties are working to strengthen their collaboration with state, federal, private-sector and non-profit agencies to tackle the opioid crisis. Massachusetts, for example, is one of many states that have implemented projects to reduce the number of overdoses and provide grant money to assist community efforts. Click here to learn more about Massachusetts' efforts.

At a high level, the CDC is advocating that the best way to prevent opioid overdose deaths is to improve opioid prescribing which will reduce the usage of medically obtained opioids, help prevent abuse, and stop addiction. The opioid epidemic is mobilizing a broad range of efforts from the highest level of government to the smallest community organizations to find a solution to this serious problem.

In addition, health experts are noticing the people with underdeveloped coping skills are at risk for drug addiction. Whether it is a young teen or an adult, substance abuse often starts off as a substitute for coping with an uncomfortable time or situation in life. Teaching coping skills and educating adolescents early about the dangers of drug addiction can help prevent future problems.

If you are prescribed an opioid for medical reasons, arm yourself with knowledge and be a self-advocate. Learn what to ask your doctor before accepting an opioid prescription. The FDA has created a list of questions to ask that can be found here.


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RESOURCE AND RECOVERY

Opioid addiction treatment is readily available. Recovery is not easy but it is possible. Science is providing more evidence in how to successfully treat drug addictions and conclude that behavioral therapies are often an important part of treatment, especially when combined with medication. Most recovering addicts also share that a strong community of supporters are essential to helping with recovery. For inspirational recovery stories, please view this video to hear firsthand how life will be better after recovery. One important thing to remember is that shame should never be a factor in someone's decision to seek treatment. There is no shame in needing recovery - addiction is a disease and should be treated just like any other illness.

Like other addictions, opioid use disorder affects more than just the user and can put a serious strain on family relationships so it is recommended that family members and close friends attend meetings such as Al-Anon or Nar-Anon, as well.

There are three major options for opiate treatment including: detox, inpatient rehabilitation, and outpatient therapy.

• Detox involves withdrawing from the drug at an inpatient facility. Medical staff oversees withdrawal and may prescribe medication such as Methadone, Vistaril, Clonidine, or buprenorphine.
• Rehab in either a residential program or on an outpatient therapy basis is the next step. Programs are typically 30 to 90 days and focus on activities that promote recovery, assist patients in uncovering triggers that led to addiction and teach effective coping skills. Evidence has shown that the longer a person remains in treatment, the better their chances are of long term recovery.
• For someone in recovery from opiate use disorder, a sober living facility provides a safe and supportive environment to build a sober life. Others may only need a peer support group such as Narcotics Anonymous.

For more information about drug addiction treatment visit Drugabuse.gov.

Below is a compilation of resources and website to assist in learning more about opioid Addiction and recovery programs.

The Substance Abuse and Mental Health Services Administration (SAMSHA ) has a free 24-hour confidential hotline for treatment referrals and support: 1-800-662-HELP (4357).

The Veterans Crisis Line confidential toll-free hot line directs vets and their loved ones to qualified, caring Department of Veterans Affairs responders: 1-800-273-8255, option 1.

The Partnership for Drug Free Kids has a toll-free hot line (1-855-DRUGFREE) for parents seeking help for their children.

Narcotics Anonymous or Alcoholics Anonymous provides continued support during and after a treatment program. Find a local chapter online.

Suicide & Depression Prevention Hotline, 1.800.273.TALK https://suicidepreventionlifeline.org

Alcoholics Anonymous
413.532.2111
www.aa.org

Narcotics Anonymous
413.443.4377
www.na.org

SMART Recovery
866.951.5357
www.smartrecovery.org

Crisis Text Line
Text "Go" to 741741
www.crisistextline.org

Detox Local
866-315-7061
www.detoxlocal.com

Learn To Cope
508.801.3247
www.learn2cope.org


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