opioidsFighting the Epidemic in Your Medicine Cabinet

There’s a lot of talk lately about opioids, declared an epidemic by the government in late October. So just what are opioids? They are prescription pain relievers like vicodin, percocet, morphine and fentanyl but also include heroin and others. Without even realizing it, people in possession of these common pain relievers could be contributing the problem. Let’s look at the whole picture.

What Does it Mean for the Government to Declare an Opioid Epidemic?

According to the New York Times, the declaration made by President Trump on October 26th allows some grant money to be used to combat the crisis, including allocations for more people to be hired to help. Plus, more telemedicine services will be made available to treat people in rural areas where the epidemic is the worst and fewer doctors are available.

Each day, 90 Americans die from overdosing on opioids, according to the National Institute on Drug Abuse. Almost 2 million Americans abused or became dependent on opioids in 2014.

Addiction at its Core

For those who have not struggled with addiction personally, it might be hard to understand how the disease works. “Susceptibility to addiction is complicated and complex,” says Dr. Nathan Moore, a Denver-based outpatient treatment specialist. “About 50% of one’s susceptibility is genetic, mostly related to a person’s dopamine receptors and opiate receptors in the brain.”

And the other 50 percent? Dr. Moore says that comes down to environmental and other patient factors. “The presence of a mental health disorder such as depression or bipolar mood disorder greatly predisposes a person to becoming addicted to opiates.  Home environment, including the presence of abuse, can predispose a person to addiction.” (Watch our Facebook Live interview with Larry Wolk, Executive Director of Colorado Department of Public Health and Environment for more.)

Treatment Options

If you or someone you know is ready to get help, Dr. Moore, citing the American Society of Addiction Medicine, says there are four different levels of treatment for those who suffer from opioid addiction:

  1. Outpatient treatment
  2. Intensive outpatient treatment (9 hours a week)
  3. Inpatient service, such as inpatient rehab
  4. Medically managed inpatient services

However, whichever treatment is right, Dr. Moore says these patients really have two options to choose from.

Option 1

“Patients can go on to medication-assisted therapy (MAT), also known as opiate replacement therapy (ORT),” says Dr. Moore. “With this option, a patient is converted to either methadone or buprenorphine.  Both of these medications are opiates; however, they do not produce the “high” that patients typically feel with traditional opiates like oxycodone or heroin.  Methadone and buprenorphine can be long-term solutions, and being on either of these medications for years causes very few major problems.”

Dr. Moore says this option reduces the chances of relapse and contracting a communicable disease from the use of needles (many opioid addicts turn to heroin). The drawback with methadone is that it can only be prescribed by licensed methadone treatment facilities, making it cumbersome to get.  Buprenorphine is a partial opiate, so it’s safer, which means physicians can prescribe it in their offices if they’ve gone through special training. It also comes in an implantable form that can be placed under the skin of the upper arm providing medication for 6 months.

Option 2

“Patients can use medication to stop using opiates completely,” Dr. Moore says. “Typically, patients are given medications to make going through withdrawal from opiates more comfortable.” If you stop abruptly you’ll go through withdrawal, which can include intense muscle aches, severe agitation, nausea, diarrhea and vomiting.

“After the withdrawal period is over (typically in about 5 to 7 days) patients are started on naltrexone therapy.  Naltrexone is an opiate blocker,” explains Dr. Moore. “Naltrexone comes in extended release intramuscular injectable form, which lasts in the body for 28 days.  So, if the patient comes in for the injection every 28 days, the patient is ’protected’ from the effects of opiates, both the euphoria effects and the harmful effects.  Naltrexone also comes as an implant that can last in the body for 2 to 6 months, depending on the implant, conferring to patients a much longer period of protection from opiates.”

Why Are Opioids Still Prescribed?

You might be wondering this. If it’s such an epidemic, why are doctors still prescribing opioids in the first place? We asked this question to Dr. Moore.

“Opiates are appropriate medications when used correctly.  They should be used to manage acute pain after injuries or surgeries, but should not be used on a longer-term basis.  It takes less than a week to become addicted to an opiate when it is used on a daily schedule.  So, opiates should be only taken for several days and then discontinued.”

And what about chronic pain sufferers? Dr. Moore admits, it’s a real problem. “Many patients do have chronic orthopedic pain or cancer-related pain that needs to be treated with opiate medication.  And many patients do well on long-term opiate medication without developing addiction.  These patients do develop dependence, meaning they can’t stop the medication or they will go through withdrawal.  But these patients can function normally, go to work, have normal social relationships and do not show the typical signs of addiction.”

Where Do We Go from Here?

First and foremost, if you are addicted to opioids, don’t let the long road to recovery deter you. Get help.

The first thing Dr. Moore recommends you do is reach out to a trusted friend or family member. Then, look online for addiction treatment providers. The Colorado Crisis Services is also a great resource for help.

He also doesn’t recommend going at it alone. “While typically not life-threatening, withdrawing from opiates without medical assistance is dangerous and extremely uncomfortable,” explains Dr. Moore.

If you’re worried about developing an opioid addiction, talk to your doctor about it. Especially if you’re prescribed an opioid. Ask your doctor what other medicines and options are out there to treat your pain.

If you do have unused opioids in your medicine cabinet, dispose of them – but don’t throw them in the trash. Find a collection site where you can properly dispose of them, such as a pharmacy with a safe disposal collection.  You want to do this to help ensure that your prescription drugs are not ending up in the wrong hands. Opioid safety starts with you.