by Diane E. Russo, MS, CASAC
Chief Executive Officer of CoveCare Center
We are constantly hearing that we are in the midst of an opioid epidemic. Many may wonder what opioids truly are, why they are causing so much death and destruction across our country, and what can be done about it. While we hear countless troubling stories, there has been progress in many areas that offer hope and the opportunity for recovery. Ongoing research, health care and criminal justice efforts, and community involvement are just the beginning steps as we look at this epidemic and find ways to offer help to those in need.
Opioids are a class of drugs often prescribed to treat moderate to severe pain. Prescription opioid pain medications (such as OxyContin, Vicodin, Percodan, Morphine, and Fentanyl) have effects similar to heroin, and research suggests that misuse of these drugs may open the door to heroin use. Heroin is an illegal opioid made from Morphine that can be injected, snorted or smoked. Opioids, including heroin, are highly addictive because they impact the brain leading to a temporary feeling of intense pleasure. And in most communities, heroin is cheaper and easier to obtain than prescription drugs.
Prolonged use of opioids leads to tolerance—meaning that one requires higher doses of the drug in order to keep feeling the same level of effect. Higher doses can result in abuse which quickly leads to physical addiction as the user’s body craves the drug. This addiction increases the risk of serious health problems including clogged blood vessels leading to the lungs, liver, kidneys, or brain, which can cause permanent damage and can eventually lead to death. In addition, individuals who inject heroin are at high risk of contracting the HIV and hepatitis C viruses through contact with blood or other bodily fluids which can occur when sharing needles or other injection drug use equipment.
Most of us know someone with a substance use disorder and many of us know someone who has lost or nearly lost a friend or family member as a consequence of substance use. Our communities are suffering as a result of drug-related crimes and violence, abuse and neglect of children, and the increased costs of health care associated with substance use disorders.
In 2015, The Centers for Disease Control and Prevention (CDC) and the US Surgeon General statistics showed that over 27 million people in the United States reported current use of illicit drugs or misuse of prescription drugs. In 2014, approximately 61% percent of overdose deaths in the U.S. involved a prescription opioid. Another alarming statistic is that between 2002 and 2013, heroin use among women increased 100%, with an increase of 50% among men.
Despite the statistics, this is also a time of great opportunity in terms of knowledge about how opioids are impacting our community and what we can do to combat this issue. There are ongoing health care and criminal justice reform efforts, as well as advances in clinical research technologies, that are creating new opportunities to provide effective prevention and treatment services. There is supported evidence that indicates outpatient, inpatient, and residential treatment facilities for opioid use, as well as medication assisted therapy, are cost effective and successful. Currently, there are three FDA-approved drugs–Buprenorphine, Naltrexone and Methadone–that are used to treat heroin and opioid addictions. For immediate emergencies, Naloxone is a medicine that can treat an opioid overdose when given right away. Also, friends, family and others in the community can use a nasal spray called NARCAN to save someone who is overdosing. Training on how to use NARCAN is available in many communities.
There are also many other resources. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends seeking nonpharmacological therapies for managing chronic pain; rather than pain medications, suggestions for relief of pain include therapeutic exercise, physical therapy, cognitive-behavioral therapy, and complementary and alternative medicine. There is also some evidence that exercise can help manage various types of pain as well as reduce anxiety and depression to reduce opioid use, especially in women.
The good news is that substance use disorders can be treated as effectively as other chronic illnesses such as diabetes, asthma and hypertension. Supported evidence indicates that substance use disorders can be reliably and easily identified through screening and that less severe forms of these conditions often respond to physician advice and other types of brief interventions. We need to ensure the availability and delivery of early intervention, referral, and treatment services in general health care practices. With comprehensive, integrated, continuing care, recovery from opioid and heroin addiction is an achievable outcome.