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War on opioids in California

By: Irene Hilsendager
October 26, 2018

Seeing this headline in newspapers and on-line, ‘Sonoma County doctor indicted in illegal opioid distribution’ made me wonder does no one have any ethics left or do they not honor their profession?

A Santa Rosa doctor was indicted by a federal grand jury after finding the physician gave oxycodone, tramadol and fentanyl for purposes deemed “not legal.” Do the doctors not know that giving these opioids may lead to an addiction problem? Haven’t there been enough deaths and near over doses in Sonoma County that would make a person think that giving all of the medicines could lead to severe consequences?

When opioid medications are used according to the directions from your doctor these meds can safely be taken to help control acute pain but there are greater risks also. Opioids are pain-relieving drugs that work by interacting with opioid receptors in your cells. Opioid may come from the poppy plant such as morphine or made in a lab and can be called fentanyl or Actiq. When opioid medications trek through your blood and attach to the opioid receptor in your brain cells, the cells may release signals that will dull your perception of pain and can boost your feelings of pleasure.

Opioids can be effective for treating pain but can also make them very dangerous. At lower doses, opioids may make you feel sleepy but higher doses may slow your breathing and heart rate, which then can lead to death. The feelings of pleasure that sometimes result from taking an opioid can make you want to continue to experience those feelings and may lead to addiction. Make sure your doctor knows all of the other medications and supplements you are taking.

The National Institute on Drug Abuse estimated that over 100 people in the United States die every day after overdosing on opioids. The misuse and addiction is a serious national crisis that affected public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United State is near $480 billion a year which includes the costs of healthcare, lost jobs, addiction treatment and often with criminal justice involved.

In the late 1990s, pharmaceutical companies assured the medical community that patients would not become addicted to prescription opioid pain relievers and healthcare providers began to prescribe them at a much higher rate. Subsequently this led to misuse of these medications before it showed that they indeed could be highly addictive. Overdose rates began to increase. In 2015, more than 33,000 Americans died as a result of an opioid overdose which included opioids, heroin and illicitly manufactured fentanyl.

What do we really know about the opioid crisis? We now know 

‘Opioids’ see page 13

‘Opoids’ see page 13

that roughly between 20 to 30 percent of patients prescribed opioid for chronic pain misused them. That between 8 and 12 percent developed an opioid use disorder. That an estimated four to six percent who misused prescription opioids transitioned to heroin. That the Midwestern region of the United States saw opioid overdoses increase 70 percent from July 2016 through Sept, 2017 and opioid overdoses in the larger cities increased by 54 percent in 16 states.

The rising incidence of neonatal abstinence syndrome is also due to opioid use and misuse during pregnancies. the increase in injection drugs has also contributed to the spread of infectious diseases including HIV and hepatitis C.

It is estimated that 2.4 million people in the United States alone are abusing drugs. People that abuse opioid also often face the additional burden of depression. Left untreated, this often can make recovery even a much harder project.

The association between opioid abuse and depression is bi-directional, meaning that suffering from one increases the risk of the other. Opioid abuse is defined as using a prescription opioid for non-medical reasons or using it longer and in huge amounts than what was prescribed by a doctor.

Many researchers think that depression may stem from how opioids cause change in the brain’s pleasure system as well as hormone levels. Can you spot the signs of depression? They may include a lack of interest in activities, moody or irritable, changes in sleep patterns, changing appetite moods, feeling futile, the body has no energy and with some even suicidal thoughts.

Universal treatments are available for both depression and opioid abuse. Medications, to name a few, methadone, naltrexone and buprenorphine can help to treat opioid dependence and antidepressants can do a great deal to reduce depressive symptoms. Research has shown that medication is much more effective when a person seeks counseling and behavioral support as well. You may find that intensive outpatient or inpatient treatment is necessary to curb addiction and learn how to cope with healthy strategies for depression.

In today’s society, we have been taught to think that when we feel pain, a tiny pill will make us feel better. That is true, but if we take the pills for four or more weeks, it makes you more sensitive to pain and that will make the pain even worse. When a drug wears off, a person experiences more pain for about three days. Pills become less and less effective the longer length of time you take them. Pain will keep increasing but not because of an injury, but due to the opioids themselves. Since the body manufactures natural opioids called endorphins and when the body becomes used to opioid pain, the body’s ability to manufactures its own pain reliever will decrease.

To effectively address the opioid epidemic, states must adopt a public health approach such as prevent opioid misuse and addiction, reduce overdose health’s and other harmful consequences, improve opioid addiction treatment and improve addiction care in the criminal justice system.

How do you tell if a loved one is abusing opioids? Sometimes it is not easy to spot, but parents must be vigilant and watch for unusual signs. Sometimes there are severe mood changes, bad behavior and then your gut is telling you something is wrong. Do they have mood swings from elation to hostility? Is the person borrowing medicine from other people or do they raid a friend’s medicine cabinet? Do they put themselves in harm’s way or others in danger? Do they lie or make excuses for being absent for days at a time? Withdrawing from the family? If you think your loved one may be addicted to opioids, talk with a doctor or professional. Together you can determine the next best steps.

Recovery and healing are very much possible. Take the first important step today and reach out to someone who can help you move towards a fuller, healthier and richer life.