Syndicated by: Montana News
By: Marc Kelley RN
Understanding what is being call our "National Opioid Epidemic", requires a basic understanding of the term "Opioid" as well as identifying both prescription, as well as illicit drugs, which fall into this category. Opioids are substances that work on the nervous system in the body, by binding to specific receptors in the brain called opioid receptors. Opioid receptors, are found not only in our spinal cord and nerve cells, but our digestive tract as well. This distribution of receptors, is what is responsible for the side effects experienced by many people taking opioids including: nausea as well as constipation.
Our own body produces a host natural opioids; of which, the best known, are called endorphins. Endorphins, are our feel good brain chemicals and result in the euphoric feelings we get from of all things… exercise. We have all felt the feeling of satisfaction or being energized after a workout and we are often told, if we are depressed, exercise will help decrease those feelings. The reason….endorphins. As with many other issues, bodily functions, tolerances and predisposition to addiction, it is genetics that play a huge role. This is the same reason, many people have addictions to alcohol, gambling, risky behavior and yes... opioids.
More than three out of five drug overdose deaths involve an opioid. Overdose deaths from opioids, including prescription opioids and heroin, have increased by more than five times since 1999. Overdoses involving opioids killed more than 42,000 people in 2016 and 40% of those deaths were from prescription opioids. According to the CDC, deaths from opioids have followed a trimodal pattern, which began in the 1990's. During this period, Dr's began drastically increasing the number of prescriptions they were writing for what are called, "natural and semi-synthetic opioids. As a result of aggressive marketing, many drug companies found increasing their sales of opioids, would result in a corresponding increase in profits for their shareholders, past that, very little thought was given to the potential, catastrophic, consequences of increasing the availability of such an addictive product into the market. For many people suffering from acute pain, opioids would be seen as a lifeline, providing relief from the agony associated with their injury's. Sadly, as is true with much medical care today, very little education is given to the patients receiving these opioids. The most commonly prescribed natural opioids include: Oxycodone and hydrocodone. Hydrocodone remains the #1 prescription drug sold in the US today. These opioids marketed under several trade names, including: Lortab, Vicodin Lorcet, Norco and Maxidone. While this list is far from complete, many people have no idea, the medication their trusted physician has prescribed to them; is in fact, a highly addictive opioid.
The second wave of deaths from opioids began in 2010 and was marked by an increased number of people using heroin, as their drug of choice. The reason people switch from prescription opioids to heroin, is simply a matter of economics and availability. On the street, a single hydrocodone tablet can sell for as much as $5.00-$15.00 depending upon the strength. Oxycodone, which is more potent than hydrocodone, will command an even higher price per mg. Heroin on the other hand, is often mixed with other drugs and adulterants and can be easily purchased for $15.00 to $20.00 per dose on the street or online. No prescription, no MD's and no consistency in purity or dose. All natural opioids, are derived from the opium poppy. Resin which is harvested from the poppy as black tar opium, which can be smoked or more profitably, used to make heroin. Currently the three main sources of heroin coming into the US are: Mexico which accounts for between 90-94%, Afghanistan, 4-6% and a negligible amount coming into the US from Guatemala.
The current wave of increased deaths from opioid abuse began in 2013, with the greatest number of deaths coming from the use of a drug called Fentanyl. Fentanyl is a synthetic opioid which must be synthesized using a procurer substrate. While Fentanyl utilizes the same opioid receptors as does morphine, the biggest difference is in potency and dosing. Morphine is administered at a maximum loading dose of .1 mg/kg (example a 200 lb man could handle 9mg dose of morphine, via an intravenous injection). Fentanyl on the other hand, is 70 to 100X stronger than morphine, on a mg per mg basis. Therefor, Fentanyl is administered not in milligrams (mg) but rather in micrograms (mcg). Using the same example of a 200 lb man, the maximum loading dose of Fentanyl would be 100 mcg or 1mg. A failure to understand the difference in dosing between morphine, heroin and Fentanyl, can, in many cases, cost the user his or her life. Much like the heroin coming into the US, the bulk of the Fentanyl coming into the US, comes thru our southern border. The overwhelming supply chain for this deadly drug can be found in what is called the IMF market (Illicitly Manufactured Fentanyl). Illicitly manufactured, brought into our country and distributed through the US, by drug cartels and gangs, such as MS13.
Given all of the horrific numbers and all of the senseless deaths from opioids, there is something we can all do to help protect our loved ones. There is a drug called Naloxone, (Narcan) which reverses the effects of opioids. It can be administered by anyone, without medical training, simply by spraying it into the nose of an overdose patient. Narcan is carried by our First Responders and many of our Police Departments, and recently there has been talk of suppling it to USPS Letter Carriers. The issue now, is once again money and until we find a way to curb opioid use and abuse, funding this intra-nasal medicine, is something we should all want to see happen.
While some believe, our country should have open borders and people should be allowed to freely cross into the US, unchecked and without border security, this would simply reflect, our acquiescence to a problem, killing our citizens in record numbers. As with any issue, critical thinking dictates the first step to solving an issue, is identifying it. Only when we recognize the problem, can we move forward in implementing a plan to solve the issue. It will take a great deal more than building a wall on our southern border, before our citizens will safe from the Grim Reaper, riding on "The horse with no name".
Center for Disease Control: Opioid Overdose [electronic version] retrieved August 21, 2018 from: https://www.cdc.gov/drugoverdose/index.html (Information last updated October 23, 2017
Much of the time when I am working, I listen to music. While working one afternoon, I ran across an artist by the name of Brandy Clark. Her lyrics touch my heart and she speaks directly to so many of us, who have known and lived the songs she writes. This song was the inspiration behind this article. I hope you will take a few minutes and listen to her message.....Marc