Misperceptions about opioid dependence, including how to screen for and treat the disorder, continue to persist for the public and for many clinicians. Almost half of the adult public and a third of primary care physicians surveyed said they believe that opioid dependence “is more of a psychological problem,” such as a lifestyle choice, than a chronic physical illness. In addition, 35% of the clinicians admitted that they do not know much about opioid dependence; 66% said they feel that a low level of education is a likely cause of the disorder; and 57% said that low income was a likely cause. Read the article.
According to the Centers for Disease Control and Prevention (CDC), 100 people in the United States die from drug overdoses every day, and death rates as a result of drug overdoses have more than tripled since 1990. The CDC also reports that nearly three out of four prescription drug overdoses are caused by opiates.
Opiates are commonly referred to as painkillers. They are derived from opium or synthetic versions of it and used in pain relief. Common opiates include Vicodin (hydrocodone), Percocet, OxyContin, oxycodone, Fentanyl, Opana, and codeine. They work by binding to the receptors in the brain to decrease the perception of pain. Side effects include sedation, dizziness, nausea or vomiting, constipation, physical dependence, tolerance, and respiratory depression.
In addition to decreasing the perception of pain, opiates can create a feeling of euphoria that some people find pleasing and can cause a hyperactive response, or energize the person.This pleasant feeling can often lead to addiction and cause physiological dependence.
As a result, the brain perceives needing more and more opiates and one may take larger doses to reduce withdrawal symptoms or simply produce a euphoric effect.
Sedation and slowed respiration are effects of opiate use. In larger doses, respiration can become so slow that it eventually stops, leading to death.
Prescription opiate addiction has surfaced in recent years as one of the most prevalent addictions. According to the CDC, research shows that some groups are particularly vulnerable to prescription overdose. These groups include:
- People who participate in the practice known as “doctor shopping” — receiving prescriptions from several different providers.
- People who take high daily doses of opiates and those who misuse multiple abuse-prone prescriptions
- Indigent (low-income) people, (Tenncare participants) sometimes were found to be prescribed opiates at twice the rate of non-Tenncare patients
- People with mental illness
- People with a history of substance abuse.
As a result of the alarming statistics, several states, including Tennessee, have implemented prescription drug monitoring programs, also known as PDMPs. This is a system used to track the prescribing and dispensing of prescription drugs to patients. This can identify patients who abuse the system as well as doctors who overprescribe.
The reality is that prescription opiates are not difficult to obtain. With the rise in opiate abuse, they are easily accessible on the streets and from people who are prescribed them.
One of the myths about prescription opiate use is that it must be safe because doctors prescribe them. When taken for a specific medical need, under the care of a doctor, with a treatment end date in mind, opiates are very effective.
However, if one is taking prescription opiates with no medical need, this can be very dangerous, as they are highly addictive. The Drug Enforcement Administration has classified many of these drugs as high scheduled controlled substances due to the high potential for abuse and dependence.
If you are concerned about someone abusing opiates, these are a few common signs.
- Extreme fatigue, sleeping more than usual, or episodes of “nodding off” during normal activities
- Pinpoint and fixed pupils unresponsive to changes of light
- Changes in appetite and weight as both will often decrease drastically
- Loss of interest in usual activities
- Decrease in personal hygiene
- Increased laxative use due to constipation
- Withdrawal symptoms (such as muscle cramps/pain, chills, perspiration, irregular heartbeat, itching, restless leg syndrome, flu-like symptoms, diarrhea, vomiting, and weakness) with discontinued use
Opiate dependence treatment often requires long-term treatment. This is usually a combination of detoxification, inpatient, and outpatient services. The main objective is to reduce dependence and issues associated with use such as mortality and infectious diseases. There are several treatment options, which can include office-based opioid replacement treatment (OBOT), where medication assisted therapy is provided to reduce or eliminate the use of illicit opiates.
If you are taking prescription opiates, make sure you are talking with your doctor about a long-term plan. If you notice you are developing a tolerance (needing more than prescribed to relieve pain), or that you are suffering from withdrawals during periods of discontinued use, talk with your health care provider.
If you know someone who is abusing opiates or struggling with opiate addiction, reach out to them and offer help, contact via internet or toll free the Here to Help hotline; (call a TnSAM member near you).
If you know of a health care provider who is overprescribing opiates, contact our Tennessee Healthcare Boards and file a report. You could save your life or the life of someone else.
On June 20, 2013, the ASAM Patient Advocacy Task Force will convene invited guests for a Stakeholder Summit at The National Press Club to unveil and discuss their survey and research results about patient access to pharmacotherapies for opioid dependence treatment. In light of state policy developments that sought to limit access to these life-saving medications – FDA-approved therapies such as buprenorphine, methadone, and naltrexone – the ASAM Board commissioned the Task Force to investigate the issue and develop a coordinated campaign to promote access to these medications. Continue reading
Dr. John Standridge had the opportunity June 21, 2013, to speak with Senator Bob Corker’s staff via a conference call. Among the participants was Jenifer Healy, Senator Corker’s DC staff member for medical issues. The following are the topics discussed, with a focus on neonatal abstinence syndrome babies. This outline of bulleted topics and talking points was also emailed to Senator Corker’s staff as a review and to facilitate presenting the topics to the senator. We hope to have far more encounters with key legislators in the future as TnSAM gains recognition as the voice for addiction medicine in Tennessee. Continue reading
The 2013 TnSAM Addiction Medicine Conference, to be held August 29th and 30th, 2013, in Chattanooga, Tennessee is NOW OPEN for registration. Click here to register.
The Tennessee Society of Addiction Medicine and the American Society of Addiction Medicine are proud to present:
2 Conferences approved for a total of 15 AMA PRA Category 1 Credits:
ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care
Approved for 3 AMA PRA Category 1 Credits, at no charge
The 2013 TnSAM Addiction Medicine Conference
Approved for 12 AMA PRA Category 1 Credits, see registration fees below
August 29th and 30th 2013
University of Tennessee Chattanooga
University Center Auditorium, Chattanooga, Tennessee Continue reading
On May 2, Governor O’Malley signed into law two pieces of legislation that will better enable the Maryland Insurance Administration to fully enforce the federal parity law and better allow consumers to exercise their rights. Continue reading