Our Nation and Panama City Area, in particular, is facing Opioid Crisis. We are #3 in severity of this deadly disease in the country. Federal and State governments have declared this as a Serious Health Crisis. Everyday 100 lives are lost due to Opiate Addiction. Addiction is now the number 1 killer among young people, surpassing accidents and violence. Examples of Opiates include Codeine, Morphine, OxyContin, Oxycodone, Percocet, Percodan, and Vicodin, etc. Recently Fentanyl -synthetic opiate that is 100 times more potent morphine and is responsible for the increase in overdose related deaths. Worse yet is Carfentanyl, which packs 5,000 times the punch of heroin.
Foremost, it does not discriminate by race, ethnicity, gender, age, or socioeconomic status. The victims are our sons, daughters, brothers, sisters, mothers and fathers, friends and coworkers. Secondly, it is a condition with a prevalent rate that is increasing at an alarming pace, and a cure rate that remains woefully low. Lastly, and most tragically, it is a condition largely brought on by the healthcare system itself with its failure to protect individuals from the dangers of indiscriminate prescribing and consumption of these drugs. Doctors have prescribed way more opiates during the time of 1991 until 2011, based on good intentions. About ½ of all Opiates that are prescribed are misused.
Addiction is a brain disease. The reward circuit of the brain becomes “hijacked.”
Two main criteria of Addiction are: loss of control and use despite negative consequences. Doing drugs is no longer a matter of choice. Addiction is not merely a bad habit. Addiction may have started with wanting to get high or wanting to relieve psychological pain, but within a matter of time, it is no longer a choice.
Risk factors for addiction can include:
1. High stress levels
2. Having a parent with a history of drug addiction
3. Psychological trauma, including the loss of a loved one
4. Chronic loneliness
5. Sexual trauma
6. Severe physical injury
7. Exposure of substances of abuse at an early age
8. Mental health conditions such as depression, anxiety, PTSD, ADHD, etc.
Symptoms of addiction include:
1. Loss of control
2. Inability to stop doing drugs despite adverse consequences
3. Persistent pursuit of self-destructive behavior and high-risk actions
4. Ongoing desire to limit their drug use
5. Drug use as a primary coping strategy to deal with ongoing challenges of daily life
6. Tolerance to drug of choice
7. Severe mood changes around drug activity
8. Problems with interpersonal relationships
9. An inordinate amount of time spent obsessing or obtaining drugs
10. Using drugs of recovering from withdrawal
11. Neglect important social, occupational or recreational activities due to drug use
Most, but not all people will usually exhibit several of these factors, before they finally seek treatment.
Stages of addiction include:
1. Recreational use
2. Compulsive use
3. Social isolation and messed up priorities
4. Cycle of shame and abuse
5. Institutionalization and death
The first step in seeking help is admitting the fact that one needs help. Addiction is a chronic disease and relapse is very common and frustrating for everyone. Like other chronic diseases such as diabetes, hypertension or heart disease, lifelong maintenance is recommended. That does not necessarily mean the person would have to be on medication for the rest of their life. Normally, most people (patients) will regain their normal pleasures of life within 2-3 years of being sober and addiction will loosen its grip on them.
Twelve Step fellowship describes loss of control as being powerless. Powerless does not mean hopelessness; it only means people need more help, more than just will-power to try to stop the grip of addiction. Opposite of addiction is connection. People in recovery need to find a safe place to feel connected. They need to express their feelings without fear of being judged, specifically on their past experiences, while in the deepest parts of their addiction. This can be accomplished by being part of a Church, a Twelve (12) step program, a group therapy, as well as individual psychological therapy.
There are many different treatment options for treating addiction. These include Inpatient and Outpatient rehabilitation programs.
I like the concept of a Five (5) prong approach to treatment:
1. Medication for detoxification, minimize cravings and maintenance for giving the brain time to heal and the obsessing to be reduced. It is very important during this time to treat co-occurring symptoms of depression, PTSD or anxiety.
2. Individual counseling to address trauma issues, such as sexual abuse or being an Adult Child of an Alcoholic.
3. Group therapy.
4. Family intervention, to understand it is a chronic relapsing brain disease.
5. Participation in a 12-step program, like NA.
Combining these treatment options, gives the person a full fighting chance against the deadly disease of addiction.
Medication Assisted Therapy offers an opportunity to treat Opioid Dependence in the privacy and confidentially of a doctor’s office. People treated with M.A.T. generally do not need to be hospitalized or make daily visits to a clinic. As a result, treatment with M.A.T. and counseling may allow more time for work, family and other activities.
There are 3 agents currently available to treat Opiate Addiction.
Most people are familiar with Methadone. It has been used for severe cases of Addiction where people are in and out of rehabs and prison/jails and have medical consequences such as Hepatitis or HIV. Methadone is a full agonist, meaning it works just like Heroin, but has a longer half-life. The problem is that tolerance develops, the dose must be continuously increased and it can be abused. It is essentially a harm reduction strategy.
A second treatment option, is Buprenorphine, a partial agonist, and is like Suboxone. This is my favorite because it is useful for both detox and maintenance. It is a partial agonist with a “ceiling effect”. Increases in dosage does not allow patient to get higher and higher and it stops craving and withdrawal. It frees them to engage in psychological aspects of recovery without the patient being consumed with the obsessions. In my opinion, it must be used with psychological help to address the STINKING THINKING of ADDICTION.
The third treatment is Naltrexone, or Vivatrol Injections. These preparations are complete blockers of the opiate receptors. It essentially blocks the high if a patient tries to use opiates while on this medication. Court systems like this preparation due to the assurance of compliance to treatment associated with injections of Vivatrol.
Once an Addict always an Addict. This means there is always a high risk of relapsing and progression of disease. Example, if you smoked 1 pack of cigarettes a day and stopped after 6 months, then you picked up cigarettes again, you would go right back to a pack a day within a week. This is compared to the slow progression for a twin sister who has never smoked.
Here are a few examples of ways the community can help with the rising Opioid Epidemic:
1. By disposing of excess/unused medication promptly.
2. Prescriptions written for Opiate pain pills should be written by a specialist for short term periods, such as one to two weeks at a time for acute pain only.
3. Patients undergoing pill count compliance.
4. Point of care urine analysis.
5. Emergency Medical Personnel to have access to Narcan since it has a value in reversing overdoses and is cost effective.
6. Allowing the prison system to be more therapeutic rather than punishment driven.
7. Prescriber education.
8. Training on addiction.
9. More trained specialist.
10. Public Awareness.
