Opiate addiction: Alive and well and thriving

The statistics involving opiates and opioids in Connecticut are grim, and unless you’ve been paying attention, may be surprising: Our State has surpassed the national death rate for drug and opioid overdoses since 2013. From 2000 to 2014, nearly half a million persons in the United States died from drug overdoses, according to the Centers for Disease Control and Prevention (CDC).

The number of prescriptions for some of these medications has increased dramatically since the early 1990s. A consumer culture willing to “take a pill for what ails us” — and the perception of prescription drugs as less harmful than illicit drugs — are other contributors to the problem.  As a result, unintentional overdose deaths involving opioid pain relievers have quadrupled since 1999, and by 2007, outnumbered those involving heroin and cocaine. There has been a rash of high-profile tragedies involving these drugs, including the recent death of singer/songwriter Prince from an overdose of fentanyl. But you don’t have to be rich or famous to access and abuse drugs.

According to several national surveys, prescription medications, such as those used to treat pain, attention deficit disorders and anxiety are being abused at a rate second only to marijuana among illicit drug users. The consequences of this abuse have been steadily worsening, reflected in increased treatment admissions, emergency room visits, and overdose deaths.

Why are opioids effective – and dangerous?

Opioids are synthetic drugs manufactured to work similarly to opiates like heroin or morphine. They include drugs like oxycodone, methadone, hydrocodone, hydromorphine, and fentanyl. In the past several years, the use of opiates, including heroin, has increased significantly in Connecticut, as have fatal doses. In 2015 alone, heroin played a role in 415 deaths in our state.

Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they reduce the perception of pain. Opioids can also produce drowsiness, mental confusion, nausea, constipation, and, depending upon the amount of drug taken, can depress respiration.

Some people experience a euphoric response to opioid medications, since these drugs also affect the brain regions involved in reward. Those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed. For example, OxyContin is an oral medication used to treat moderate to severe pain through a slow, steady release of the opioid. People who abuse OxyContin may snort or inject it, increasing their risk for serious medical complications, including overdose.

Data shows that people who use opioids non-medically don’t typically get them from doctors or prescriptions. Rather, they come from a relative’s medicine cabinet or a friend, and more often than not, the addiction can stem from a legitimate use, such as a prescription for painkillers following dental work, surgery or to help manage chronic pain.

Although most people take prescription medications responsibly, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for non-medical reasons at least once in their lifetimes. A National Institute on Drug Abuse survey found that about one in 12 high school seniors reported past-year nonmedical use of the prescription pain reliever Vicodin, and one in 20 reported abusing OxyContin — making these medications among the most commonly abused drugs by adolescents.

Tightening controls on prescription pain killers, however, drives some people abusing pills to switch to heroin, which is cheaper and far more available. In fact, according to CDC data, heroin use is rising again even as abuse of opioids is leveling off.  From 2014 to 2015, the number of times fentanyl was found in the bloodstream of overdose victims increased 150 percent, and last year it was responsible for one quarter of all drug overdoses. Law-enforcement officials report an increased availability of illicitly manufactured fentanyl, and drug dealers cut heroin with fentanyl to increase the potency of the product.  Drug overdose deaths involving heroin continue to climb sharply, with heroin overdoses more than doubling from 2012 to 2015.

Addressing the problem

Addiction, which can include physical dependence, is distinguished by compulsive drug seeking and use despite sometimes devastating consequences. Someone who is physically dependent on a medication will experience withdrawal symptoms when use of the drug is abruptly reduced or stopped. These symptoms can be mild or severe (depending on the drug) and can usually be managed medically or avoided by progressively reducing dosage and frequency.

Dependence is often accompanied by tolerance, or the need to take higher doses of a medication to get the same effect. When tolerance occurs, it can be difficult for a physician to evaluate whether a patient is developing a drug problem, or has a real medical need for higher doses to control their symptoms.

Taken as prescribed, opioids can be used to manage pain safely and effectively. However, when abused, even a single large dose can cause severe respiratory depression and death. Properly managed, short-term medical use of opioid analgesics rarely causes addiction.

Only under a physician’s supervision can opioids be used safely with other drugs. Typically, they should not be used with other substances that depress the central nervous system, such as alcohol, antihistamines, barbiturates, benzodiazepines, or general anesthetics, because these combinations increase the risk of life-threatening respiratory depression.

Always follow the prescribed directions, be aware of potential interactions with other drugs, never stop or change a dosing regimen without first discussing it with a healthcare provider, and never use another person’s prescription. Additionally, unused or expired medications should be properly discarded per U.S. Food and Drug Administration (FDA) guidelines or at U.S. Drug Enforcement Administration collection sites.

For people experiencing dependency or addiction issues, there are medical solutions. Years of research have shown that addiction to any drug (illicit or prescribed) is a brain disease that can be treated effectively. Treatment takes into account the type of drug used and the needs of the individual. Successful treatment may need to incorporate several components, including detoxification, counseling, and sometimes the use of addiction medications. Multiple courses of treatment may be needed for patients to make a full recovery.

Rich or poor, black or white, living in the city or in the country, it doesn’t matter – the reach of illicit drug use touches all walks of life. If someone you know may be abusing pain killers, consider speaking with them and suggesting they talk with their physicians or other healthcare providers for guidance, and recognize the same issues in yourself if you’ve been using pain medications, even for legitimate purposes.

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