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.
Over the past several months, substance use disorder policy experts at the AVISA Group and Treatment Research Institute (TRI) have been working under the Task Force’s direction to survey state Medicaid programs and commercial insurers about their coverage policies for opioid dependence medications.
TRI has also been reviewing the scholarly literature on the clinical and cost effectiveness of these medications. “There are costly economic and societal ramifications to limiting access to addiction treatments,” said Task Force Co-Chair Mark Kraus, MD, FASAM. “TRI’s findings will help support a broad educational campaign about the value of treatment.”
“The data that we are researching will be instrumental in understanding how patients with the disease of addiction are able to access evidence-based care,” said Dr. Kraus. “Up until this point, the addiction prevention, treatment and recovery communities have largely been in the dark about these policies.”
At the Summit, attendees will have the opportunity to examine the findings and hear from leaders in the field about how federal and state government agencies, provider groups, payers and patient advocates are responding. Attendees will also brainstorm ways to promote access to care through outreach and education.
Task Force Co-Chair Rich Soper, MD, JD, MS, FASAM anticipates this event will be just the beginning of broader collaboration to educate the public and policymakers about the value of addiction treatment.
“This event will bring together many of our dedicated colleagues in the government, non-profit and private sectors who are truly committed to improving addiction treatment and helping patients access the care they need,” said Dr. Soper. “We want to look back and see this meeting as the event that jump-started a great coalition to advance addiction care.”
After the event, the survey and research results will be available to the public on the project webpage and will be turned into briefing documents that stakeholders can use in their local outreach efforts.