What are the chances of someone becoming addicted to prescribed opiate pain killers, and or heroin? Dr. Anna Lembke, an addiction-medicine specialist at the Stanford University School of Medicine, has discovered that people whose parents or grandparents were addicted to drug-or alcohol have increased odds of becoming addicted too. Genetics accounts for 50-60% of that risk. Other factors are poverty, unemployment, multigenerational trauma, and access to drugs.
Years ago, in my role as the school resource officer for the Big Rapids Department of Public Safety, I was doing a presentation in a classroom at the high school on the drug abuse among young people. A teacher asked a question on what I thought the most abused drug was.
He told me at the conclusion of the class, after the students had been released, he was surprised to hear my answer, “Prescription medication.”
He thought my answer would be alcohol or marijuana. In my profession, I was seeing a growing trend of the abuse of prescription medication among the general population. Specifically ADHD medication and narcotics, like Adderall and OxyContin.
Accessibility is the No. 1 reason these medications are being abused. Narcotics were being over-prescribed and are considered addictive. They could be easily taken from friends and loved one’s bathroom cabinets, or not taken properly by the people they were prescribed too. Instead, these prescriptions were being sold in parking lots and public bathrooms.
OxyContin, which began being marketed as a “wonder drug” in 1996, was primarily prescribed by doctors for severe pain and cancer patients. It quickly was abused by people, who learned that crushing an Oxy could release its narcotic payload all at once.
Nearly 15 years of pressure from the U.S. Attorney’s Office and a public outcry, Oxy was reformulated to make it resistant to be crunched up and used to snort or shoot up intravenously.
As a result of these changes law enforcement, doctors, and pharmacists’ were able to follow a person’s prescription history to see if individuals were doctor shopping, and to monitor the overall regulating of prescribing narcotics. Due to the tightened restrictions and now limited accessibility, those that were addicted to opiates sought out a cheaper alternative, heroin.
Some signs of an opioid overdose are unconsciousness, very small pupils, shallow or slow breathing, vomiting, an inability to speak, faint heartbeat, limp arms and legs, pale skin and purple lips and fingernails. In the end, if any of these signs go unnoticed and not reversed, death is common.
Due to the continuing use of opiates’, including heroin, law enforcement and first responders regularly carry Narcan on them now while on duty. Narcan, or Naloxone, as it is commonly known is a medicine that rapidly reverses an opioid overdose. It can be given as a nasal spray, which is the most common method used by law enforcement and first responders, or it can be injected into the muscle, under the skin, or into the veins.
MIXING DRUGS
Another drug that has become popular in our area is fentanyl. It is a synthetic opioid, which was typically prescribed in patch form for advanced-cancer patients. Fentanyl is considered 25-50 times stronger than heroin. What has become more alarming is that other drugs, including heroin and marijuana are being laced with fentanyl. Not only is fentanyl extremely dangerous to those using it, but it and carfentanil — which is a synthetic opioid approximately 10,000 times more potent than morphine and 100 times more potent than fentanyl — are potentially deadly to the first responders providing aid to overdose victims.
First responders need to be trained on how to protect themselves to avoid accidental exposure when providing medical assistance. Carfentanil is commonly used as a tranquilizing agent for elephants and other large mammals. The lethal dose in humans is unknown.
People who abuse drugs frequently combine different drugs to get an enhanced effect of one or both substances. Combining sedative and stimulant drugs has been attractive to people using drugs for a long time. This combination is said to produce a significant high, it can also result in dangers and long-term health circumstances that pose relatively high risks for the person who decides to use them. Mixing an opiate with a stimulant — commonly referred to as a “speedball” — is a popular method of getting an intense high.
One of the major risks of taking a stimulant with an opiate is the potential that the stimulant masks the negative effects of the depressant, making it hard to tell when an overdose point has been reached. For example, while the opiate may slow breathing, the stimulant might accelerate it, making one feel like breathing is normal.
This can make it harder to tell when the dose of heroin that is tolerated might have been exceeded, which can then lead to death. In addition, the meth high generally lasts longer than the heroin high, causing the person to move from a slowed heart and respiration rate to a dramatically increased one. As with normal meth use, this can lead to a sudden heart arrhythmia, increased blood pressure, and potential heart issues, such as stroke or heart failure.
M.A.T. TREATMENT
There are three drugs approved by the FDA for the treatment of opioid dependence: buprenorphine, methadone, and naltrexone.
Buprenorphine is an opioid medication, sometimes called a narcotic. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse. Methadone changes the way patients’ brain and nervous system respond to pain. Its effects are slower than those of other strong painkillers like morphine. It also is said to block the high from drugs like heroin and similar drugs. Methadone and Suboxone (which is a combination of buprenorphine and naltrexone) are just part of a treatment plan, not cures for addiction.
As the abuse of opioids increased, Medication Assisted Treatment, otherwise known as M.A.T., became a more prominent part of a drug treatment program. There is still a divide between M.A.T. proponents and its opponents. Honestly, I stand somewhere in the middle, still relying on my experience in law enforcement, but also feeling more educated and sympathetic to those suffering from addiction. Those opposed to M.A.T. feel that using Suboxone and Methadone is just a substituting one drug for another. The proponents feel that M.A.T., when followed correctly, improves the quality of lives of those using it.
I feel the problem lies with the broken system we have in place with M.A.T. Many of those offices were lacking in the support they were supposed to be provided. Not offering the true counseling aspect of the training that is essential to the patient’s recovery. You can’t have one without the other. In doing so, you are just setting up people to fail.
Overprescribing by doctors specializing in addiction treatment was also prevalent, with patients being prescribed twice as much Suboxone as they needed, fully aware, on occasion it was traded by those who had it for heroin or other opioid pills.
Positive change is happening and there is power in numbers to make a lasting change, and the opioid epidemic is no different. There has been a lot of headway made in the fight against opioid and narcotic addiction. This continues to be an upward battle that needs to be fought through education, communication, collaboration, rehabilitation, and potential imprisonment for those who are dealing the drugs.
Brian Miller is the sheriff of Mecosta County.
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SHERIFF: It's time to make a lasting change in the opioid epidemic - The Pioneer
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