Author: Addiction Counselor

What To Do When You’re Prescribed Opioids

The Opioid Epidemic in America is a terrible and growing problem that has already impacted the lives of millions. The opioid overdose rate has skyrocketed, as has addiction. When communities fall into the grip of opioids, everyone stands to lose. Families are wrecked and businesses falter due to addicted employees and the crimes that follow drug abuse. Since the problem begins in a doctor’s office, it’s easy for many to overlook the danger hidden in a prescription intended to relieve pain. After all, we are taught to trust every doctor’s judgment as well as all the products we purchase from a pharmacy. However, it’s important to know what to do when you are prescribed these addictive and potentially deadly drugs. After all, everyone wants to avoid addiction and overdose.

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Why do doctors prescribe opioids?

Opioid medications are intended to help patients relieve pain. Doctors prescribe them for a variety of reasons, including relief from acute pain resulting from injury or post-surgery. They also prescribe them to patients who suffer from chronic pain that can result from a wide range of sources. However, that is only part of the story. The opioid epidemic sprung from circumstances that go beyond simple treatments. A ProPublica investigation found that doctors have been effectively bribed into prescribing, and over-prescribing, opioid pain medications. Some pharmaceutical companies have been marketing opioids to doctors and including incentives for doctors who sold or prescribed the most product. When doctors sell a certain quota of opioid medications, they are invited to special luxury retreats in tropical locals. The doctors might present a paper, but other qualifications required are minimal. Over time, executives from various pharmaceutical companies have pled guilty or have been found guilty by juries of various crimes connected to this. The charges have stemmed from aggressive marketing programs that prompted doctors to over-prescribe medications. That is, doctors were enticed to write prescriptions for patients who might have done as well with a high-milligram dose of Ibuprofen or some other, non-addictive, pain medication.

What are some common names for opioids?

Prescription opioids come in a wide range of sizes and under many different names. Different brands are typically indicative of varying strengths. Some of the more common opioid prescriptions come under the following names:

Codeine

If you’ve ever had a severe cold or flu, your doctor may have prescribed a cough syrup with codeine. While this is considered a milder opioid, it is still addictive and poses an overdose risk.

Hydrocodone

This is commonly found under the brand names Lortab or Vicodin. When found in Lortab pills, it is paired with acetaminophen (Tylenol.) Since acetaminophen damages the liver, addicts often cap off their use at around 40 pills per day, as the pain from their liver prohibits a higher dose.

Hydromorphone

Commonly known as Dilaudid, this opioid often comes as in suppository form. Dilaudid is prescribed for mild to moderate pain.

Meperidine

You might find Meperidine branded as Demerol. It is commonly prescribed for severe acute pain, such as in the case of kidney stones.

Methadone

This opioid is addictive but is considered a mild opioid that can facilitate functioning among addicts while maintaining a minimal level of opioids in their routine. Though often used in a rehabilitative context, methadone can induce overdose and should never be used in conjunction with any other drugs. Benzodiazepines, alcohol, and other opioids should be avoided at all cost, lest a fatal drug interaction/overdose ensue.

Morphine

Morphine is prescribed for patients with moderate to severe pain. You might have seen or heard of surgery patients receiving a morphine drip in the form of an IV. The medication has an extended-release form which should be used with extreme caution as overdose can result when this form is misused.

Oxycodone

This opioid is often marketed under the names Percocet or Oxycontin and is prescribed for acute pain conditions. It is rather powerful and is recommended for moderate to severe pain. You might receive this medication for broken bones or during a post-surgery convalescence.

Oxymorphone

This opioid is sold as Opana, Opana ER, and Numorphan Hcl.

Fentanyl

This opioid is one of the most powerful and should only be prescribed for very extreme cases. It is approximately 50 to 100 times as powerful as Morphine. This painkiller is frequently marketed as a time-released transdermal patch. However, it is also found in pill or powder form, and heroin producers have been known to boost their product with this exceptionally powerful opioid. When Fentanyl is introduced to a batch of heroin, the overdose rate spikes for affected areas.

How big is the opioid problem?

This is a very difficult question, as statistics are difficult to track down. One of the only ways to track the opioid crisis is by the trail of overdoses, particularly those that result in death. Prior to an addict’s untimely demise, they might cause innumerable problems for themselves, their families, and their wider community. If they are lucky enough to enter a rehabilitation facility, addicts are protected under privacy laws so that it is still difficult to gain reliable numbers to help measure and track the problem. It’s even difficult to measure how many prescriptions are passing from doctors to users because the only data available is from Medicare Part D, which is only available to senior citizens and disabled people. Even when using these numbers, different agencies can have wildly different numbers for the same regions. According to a ProPublica report, one agency found the prescription rate of Piatt County, IL to be twice the state average. However, when the CDC examined Piatt County, they found that prescription rates were below the state average. When the CDC, for example, measures overdose rates the numbers can never be fully relied upon. That is, in order for a death to be counted as an overdose, the coroner or medical examiner must determine that opioids were the determining factor in the person’s death. Already we know that Rhode Island has under-reported opioid overdoses and it is far from certain that other states either have or have not reported accurate numbers. Furthermore, by the time an addict overdoses, they may have already passed on from prescription opioids to illicit drugs, such as heroin. Since heroin is often more powerful and far less reliable in terms of strength, the likelihood for overdose increases. If a person overdoses on heroin, they are less likely to be considered part of the problem surrounding prescription pain killers.

Aren’t illicit drugs like heroin the real problem?

Heroin has long been the scourge of the inner city. It is highly addictive and has many attendant problems that impact medical and social systems. Though Bayer originally designed it, it is now manufactured and sold primarily on the black market. While Heroin is a terrible problem, the new opioid epidemic has its roots in legal, pharmaceutical painkillers such as Oxycontin, etc. When a patient becomes addicted to their prescription medications, they are likely to seek relief on the black market once their doctor ends refills. While some addicts are successful in finding unethical doctors, who will refill their prescription opioid medications, most seek heroin or opioids on the black market if they cannot face the terrors associated with opioid withdrawal. Though both prescription and illicit opioids pose terrible overdose risks, heroin is perhaps even more troublesome. Since the FDA does not regulate the black market, an addict is likely to find drugs that are far more powerful or are mixed with other drugs, such as amphetamines, which add a risk of cross-addiction. In extreme cases, criminal dealers mix heroin with the pharmaceutical Fentanyl. The addicts whose tolerance is too low are subject to overdose and death while the addicts who survive the mega-dose are thrust even deeper into their addiction. Since heroin relies on the black market, its entire supply chain is rife with problems including money-laundering, violence, and even ties to darker crimes such as human trafficking. Thus, it is seen as more problematic. However, the heroin market has seen great expansion since the influx of addicts from the legal side of the opioid coin.

How does opioid addiction work?

Opioids not only help to ease or block pain, but they deliver a great deal of pleasure. This pleasure results from a rush of dopamine in the nervous system. Dopamine is a large part of our lives. It is often thought of for the extreme pleasure it can deliver, but it also helps you enjoy small things, as well. However, when you start using opioids, you begin to tamper with the normal equilibrium in your brain chemistry. Dopamine levels spike when you take your medication and effectively deplete your dopamine receptors over time. When you run low on dopamine, your body begins experiencing the phenomenon of craving. You suddenly cannot find any pleasure or contentment. You become irritable and inconsolable until you take your opioid prescription. Before long, the only possible form of relief is in the form of another pill. Unfortunately, this phenomenon begins to set in almost immediately. Depending on the strength of your first dose, you might experience some form of craving or withdrawal when your first dose wears off.

How do I know if I’m on the brink of addiction?

Addiction is a disease that tricks a person into thinking they don’t have it until it’s far too late. Thus, if you truly need to use opioid painkillers, keep a close eye on how much you are using. Since these drugs can be very disorienting, you might consider a pill organizer, so you are sure to keep track of what medicine you’ve used and which you need to take later. This is vital for older patients who might become confused and accidentally overdose. As for a growing addiction, be vigilant regarding your use. If you start needing an increased dose to manage your pain, you have a growing tolerance. Rather than feeding the need for more opioids, discuss the matter with your doctor. Increased tolerance is one of the chief warning signs of addiction. Note that if you start feeling a craving before your scheduled dose, you are stepping into addiction. A craving will take the form of obsessive thoughts regarding your drugs, rationalizations for increasing use, and even thoughts of how to obtain more drugs through some illicit means, such as doctor shopping. Be mindful of aberrant thoughts. If you find yourself thinking or behaving in ways that are not normal for you, it’s time to discuss the issue with your doctor.

Tell-Tale Signs of Opioid Addiction

Opioid addiction often sneaks up on its victims. You might start taking your painkillers as prescribed but before long, you find that you need stronger doses and then you can’t keep on the dosage schedule. When the cravings start, you don’t even notice them; you just have a feeling that you need a pill several hours early, then an additional one to go to sleep at night. Before long, you are desperate to avoid any withdrawal symptoms. There are many more signs of opioid addiction. Keep the following warning signs in mind for yourself or if a loved one has an opioid prescription.

  • Simple, uncharacteristic mistakes
  • Odd, inappropriate sleepiness and sometimes falls asleep, nods off
  • Avoids social situations that used to give pleasure
  • Unusual trips to the bathroom
  • Leaves work or social gatherings early
  • Suddenly experiences financial troubles
  • Relationships begin to suffer
  • Becomes defensive in light of the slightest criticism
  • Loses job and cannot seem to find another
  • Runs afoul of the law for petty crimes or bizarre behavior
  • Excessive doctor or pharmacy visits
  • Needle marks on the arm
  • Bleary appearance while also scratching the face
  • Perpetually broke and needing to borrow money while never repaying.

The above list is a brief overview of many symptoms that result from opioid addiction.

How do I avoid opioid addiction?

Diligence is key when it comes to avoiding opioid addiction. One of the first things you can do is to familiarize yourself with the various warning signs of addiction. If you are determined that yourself or your loved one is going to avoid this horrible disease, you will find that knowledge and education are absolutely vital to survival. Another part of diligence is making sure that you are prepared for a pain management routine. First off, you should educate yourself concerning the possible treatment routines. Learn everything you can about opioids and other pain management medications. You might be presented with a single solution where there may be options. If you are seeing a doctor for extreme pain, make sure that they thoroughly rule out all other forms of painkiller. Even if they insists that opioids are the best or only option, request an alternative such as a high dose of ibuprofen. See if you can manage your pain with something non-addictive first. You may have to live with a bit of discomfort for a while, but if your pain is expected to be short-term, such as a period of recovery from a surgery or injury, a little discomfort far outweighs a potentially deadly addiction. Not only can this help you avoid addiction, but the prescription will likely be cheaper, too. Plus, you won’t have any interference with daily activities such as driving or working, but please confirm this with a professional before operating heavy machinery. If opioids are indeed the only option, talk to your friends or family members about the situation. Keep a trusted loved one informed of your use, including how many pills are in your prescription and how often you are recommended to take them. A pill organizer will also be helpful, as opioids tend to disorient patients, and you might lose track of how many pills you’ve taken. This might feel like infantilization, but the addiction rates for opioid medications are far too high to gamble with. When you arise healthy and happy from a round of pain medications, you will be glad for whatever discomfort you’ve endured.

How Do I Get Help for an Opioid Addiction?

If you suspect that you have become addicted to opioids, please seek help immediately. The Substance Abuse and Mental Health Services Administration has a national hotline to help: 1-800-662-HELP (4357). As soon as you recognize that you cannot stop using opioids on your own, call the SAMHSA hotline or contact a trusted addictions specialist. You might try a local counselor or even your local hospital. If you are able, have someone drive you to a local detoxification center. While opioid withdrawal can be successfully carried out at home, there are dangers. The process is also extremely unpleasant and might even result in you returning to your drugs of choice. The risks are too high to go it alone. When you check into a detoxification center, you’ll find trained professionals who will deliver the best care. Furthermore, they will be able to help you find the best rehabilitation center. There are many different sorts of rehabilitation centers. The two general categories are in-patient and out-patient rehabilitation. There are also halfway houses and three-quarter sober houses. Depending on your local area, there may be many options. When you are weighing the options and making your decision keep in mind that the goal is not to find a comfy, cozy rehabilitation center. Rehab is not a vacation nor are centers anything like resort spas, though they might seem that way. Keep in mind that part of the root of addiction is escaping certain hard realities. Therefore, your recovery will likely include a re-familiarization with certain difficulties. In fact, your relative sobriety might be gauged by how well you manage your difficulties without resorting to popping a pill, snorting a powder, or injecting a potent brew. If at all possible, try to enter a rehabilitation center away from home. When you can totally immerse yourself in a rehabilitation culture, it has a greater chance of making a lasting impact. Being away from your usual surroundings will enable you to focus on the most important things: yourself and your sobriety. Your rehabilitation center will probably insist that you leave behind certain personal items such as your cellphone, pictures of loved ones, or other reminders of your outside life. Most patients are justifiably irritated at what is perceived as extreme measures, but it’s important to keep everything in its proper context. All of those creature comforts were a part of a life of addiction, one which only leads to jail, an institution, or death. Given that the rehab is an institution, there’s no need to see if you can make the trifecta. You should also seek out programs that last a minimum of 60 days. The 30-day model was based on a military standard and not anything to do with long-term sobriety. Studies have shown that the 30-day format is ineffective for any sort of long-term success. While you might feel that 60 days, or longer, is too long to be away from your life, consider that every day past 60 vastly improves your chances for a long life of happiness and sobriety. Though your family may dislike being apart for so long, they will surely appreciate your smiling face for a lifetime.

The Opioid Crisis: A Timeline

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The opioid crisis has metastasized from its relatively humble beginnings as an urban scourge to a national epidemic. This problem is not without precedent, nor was it impossible to see that introducing mass quantities of addictive drugs to the market would do massive harm to society. However, if we have a greater understanding of how the problem arose, perhaps we will have an easier time solving it.

Essentially, the current opioid epidemic began when pharmaceutical companies developed and pushed high-powered, dramatically addictive painkiller medications. Their marketing campaigns prompted doctors to write more prescriptions, and thus, more people became users and, soon enough, addicts. When addicts become more desperate, they resort to criminal behavior. That can mean robbery, prostitution, illicit drug use, doctor shopping, and more.

When whole towns are overwhelmed by opioid addicts, social decay sets in. Families and businesses are severely damaged, if not destroyed. Some towns have become virtual ghost towns as a result of the opioid epidemic.

Addiction also brings a more terrifying result: overdose. While it’s difficult to track use and abuse in terms of numbers of addicts, it is somewhat easier to track overdoses. However, even these numbers can be unreliable. Coroners and medical examiners don’t always attribute death to opioids. Nonetheless, there is enough evidence to proclaim the opioid problem is a full-blown epidemic.

Deep History of Use

Opium has been a part of human history since the earliest civilizations. There are records of its use that date back to 3,400 BCE. It is derived from special poppy flowers much like those depicted in The Wizard of Oz. Ancient civilizations used opium for medicinal purpose and probably for recreational use, too.

Use of opium is thought to have begun in Mesopotamia. Its use spanned from Persia and India to ancient Rome. It even seems that an early victim of opium addiction was none other than Marcus Aurelius, emperor of Rome, who relied on the drug for sleep and to cope with the stresses and burdens of war.

Eventually, Arab traders brought the drug to China, where it found an eager audience. Meanwhile, the drug was seemingly eradicated from use in the West, as the Holy Inquisition deemed all Eastern influence as akin to devilry and sin. The drug has no known references in literature until 1527 when Paracelsus wrote of the opioid drug Laudanum. The use of opium expanded in the 15th and 16th centuries, as monks prepared the drug for delivery in a wide range of herbal preparations. Indeed, there are still codeine cough syrups available by prescription.

Mass Opium Addiction and Ensuing Opium Wars in China

Once Arabian traders introduced opium to China, trouble was around the corner. The Chinese experience with opium is perhaps the first opioid epidemic on record. The earliest indication that a problem was imminent is found in 1729 when Emperor Yung Chen outlawed opium sales and the opium dens which facilitated recreational, and addictive, use of the drug.

Similarly, the first English governor of India, Warren Hastings, sought to control and limit use by monopolizing cultivation and sales. When the market was thus controlled, misuse of the drug was limited. However, the opium market remained artificially restricted. This problem was eliminated when the Chinese market was discovered. With such profit at stake, English traders encouraged the cultivation, processing, and shipping of the drug to Chinese shores.

Despite imperial edicts, the Chinese opioid problem metastasized. With such massive profits at stake, even high-profile figures such as John Jacob Astor became involved in smuggling opium to China. Astor would eventually pull his opium operations out of the Chinese market and seek his profits solely from England.

Eventually, the Chinese problem came to a head when Lin Tse-Hsu, a Chinese commissioner, forbade all foreign traders from importing the additive substance to the nation. This sparked the First Opium War, as the British were not interested in relinquishing such a profitable business. The Chinese lost this conflict and ceded Hong Kong to the British.

Since the Chinese continued their ban on opium imports, the French and English joined forces to wage a Second Opium War. The Western forces were again victorious, and they were able to convince the Chinese to release their restriction on the deadly and destructive product.

Opioid Painkillers

Opioids have always been used as painkilling medications. Since their discovery in the earliest civilizations, humans have used them to assist in surgeries or to numb the pain of injury. They have also been used to aid sleep, and it would seem that Roman Emperor Marcus Aurelius used opium to assuage his painful emotions regarding war.

Contemporary people use opioids in much the same way. In fact, most people are introduced to opioids after surgery. People are often issued an opioid prescription after having their wisdom teeth removed. Other common ailments, such as kidney stones and tonsillectomies, are also deemed worthy of an opioid prescription.

People who suffer from chronic pain also receive regular prescriptions for opioid medications. Since their symptoms never abate, this puts them in the position of living a life of addiction. In effect, they trade a life of clear-headed sobriety for pain management. Many find that this is an equitable trade because their pain is so great.

These days, there is a wide range of medications to choose from. There is the relatively mild codeine and there is the incredibly strong Fentanyl, which is often implicated in overdose deaths. There are also many ways to deliver the drug into one’s system. The most common drug-delivery method is in pill form, but doctors can choose IV delivery, transdermal patches, and even drinkable forms.

Heroin’s Part in the Epidemic

Heroin is perhaps the #1 opioid that comes to mind for people when they think of addiction and overdose. For most people, heroin’s only availability has been on the streets. Cartels in Asia and Mexico have been effective in converting poppies from Afghanistan, and elsewhere, into a relatively mild tar form or a potent powder.

It may be surprising to learn that heroin first was created by Bayer AG, a German pharmaceutical company that still exists today. It was created as a substitute for morphine. Though morphine is addictive, heroin is far more so. The addictive nature of the drug is what makes it very valuable to the black market. Since it takes relatively little to create an addict, black market dealers can create a devoted clientele in short order.

These days the black market is seeking new and better ways to produce and market its heroin. The Mexican cartels used to produce and sell milder black tar heroin, but they have discovered how to mimic the Asian methods for creating powerful powder forms. They are also discovering how to introduce amphetamines to the drug so that users can remain alert during their high. Fentanyl is also used to create super-addicts due to the pharmaceutical’s extreme potency and short-lived effects. Fentanyl also tends to induce massive overdoses when a spiked batch hits a market.

When a patient becomes addicted, or strung out, on prescription opioids, they often resort to street drugs to assuage their cravings. This is how and why heroin is making its way out of the inner cities and throughout the nation. Since doctors are induced to prescribe opioids in every town, and every chain drugstore carries those products, it’s easy to create new addicts. When an addict’s prescription runs out, it’s common to seek relief on the black market with either illicit opioids or heroin.

While heroin has always been a significant factor in overdose deaths, its role in overdose took off starting in 2010. Between 2010 and 2017, heroin overdose death increased by 400%. According to the CDC, a chief risk factor in heroin overdose is an addiction to prescription opioids. Heroin killed 15,482 people in 2017. Thankfully, heroin overdose rates appear to be at a plateau. However, without a serious decrease in over-prescription of pharmaceutical opioids, it is unlikely that heroin will leave the picture.

The Crisis Begins

The opioid epidemic that we are now fighting can be linked back to 1995. In that year, Purdue Pharmaceuticals was approved by the United States Food and Drug Administration to manufacture and sell OxyContin. The drug was so powerful that its high created new addicts within a few doses. When that high became insufficient, addicts began to crush the pills for IV injection.

Purdue made the initial claim that their drug was not very addictive. However, this claim was found to be false and deliberately misleading. Now, the drug maker is dogged by lawsuits. The Sackler family, owners of the company, have faced civil and criminal charges in state and federal courts as a result of the devastation their profits have wrought.

However, the Sacklers discovered a way to offset their court fines and make new markets. They developed treatments for the addictions they themselves were accused of causing. Whether this business scheme will be deemed a criminal conspiracy is yet to be determined. Since their unethical, if not criminal, behaviors have been exposed it’s possible doctors will think twice about following recommendations from their pharmaceutical representatives.

Overdose Rates on the Rise

According to the Center for Disease Control, 130 people die every day from an opioid overdose, and around 700,000 died of a drug overdose between 1999 and 2017. Of those overdoses, over half, 400,000, were attributed to opioids. The CDC cites three separate but coinciding waves of overdose deaths. The first starts with naturally sourced and semi-synthetic prescription opioid drugs, heroin fuels the second, and the third is comprised of synthetic opioids.

The first wave of overdose deaths began in the 1990s. When doctors started prescribing opioids on a large scale, those drugs began causing more deaths than heroin. The pharmaceuticals outstripped heroin for many years, at times producing several times more overdose deaths than heroin. Regardless, doctors continued to prescribe these deadly drugs.

The second wave of overdose deaths is charted from 2010 when the number of overdose deaths associated with heroin spiked. In a mere seven years, heroin caused 400% more deaths than in previous years. Though heroin and naturally sourced prescription opioids have done terrible harm to communities, families, and individuals, they have new competition.

Synthetic opioids are now far outstripping the devastation wrought by naturally sourced opioids, semi-synthetic painkillers, and heroin. Since approximately 2013, Fentanyl has taken the spotlight as the deadliest opioid in the nation. In the span of a mere year, from 2016 to 2017, synthetic opioid overdose deaths spiked by 47%. The drugs took 28,400 lives in 2017 alone. To make matters worse, it appears that black market chemists have discovered how to manufacture Fentanyl, so the black market no longer has to rely on doctor shopping or other cumbersome procurement methods.

Since the black market is, of its very nature, completely unregulated, it is difficult for a user to know what he or she is purchasing. Users who purchase heroin might receive a spiked batch that contains Fentanyl. Some will experience a dramatically stronger high followed by a rapid come-down which triggers even stronger cravings. Others will not be able to handle the extreme potency of Fentanyl and will go into respiratory distress and risk dying from an overdose, even though they took their usual dose.

How to Avoid Overdose

Naturally, the best way to avoid an overdose is not to use opioids. Since that is not a reasonable expectation for those suffering from opioid addiction, there are other ways to avoid this problem. Some involve diligence; others include more pharmaceutical products.

When a patient receives an opioid prescription, it is first wise to discuss the issue of addiction with the doctor. Discuss lower dosages and even prescriptions that expire after a single filling. It’s also wise to discuss alternative ways to manage pain. For instance, your doctor might be able to prescribe high doses of non-addictive, and non-overdose inducing Ibuprofen. Some patients even have good results when they practice mindfulness meditations and breath work to get through the pain.

If an opioid prescription is inevitable, precautions are necessary. One simple way to ensure that patients stay on track with their prescribed doses is by purchasing a simple pill organizer. These allow patients to dole out their medications in advance. This helps to avoid overdose because it strives to eliminate simple human error. Elderly patients, in particular, might not recall whether they’ve taken their allocated doses for the day and accidentally take too much. A pill organizer allows them to see what they have and have not taken easily.

Opioid patients should also have a strong support network of loved ones who are aware of their prescription. Patients should be diligent and tell their loved ones how many pills are in each refill, when the prescription expires, and how many refills are included.

Finally, each opioid prescription should be accompanied by a prescription for intra-nasal Naloxone. This medication can stop an overdose in its tracks. It is a regular part of every EMT’s toolkit, many police officers and more counselors are starting to carry this as well.

Naloxone works by blocking the opioid receptors in the brain. This means that any opioids in an overdose victim’s system are quickly nullified when the drug is introduced. Since the drug can be administered via intracranial spray, it can be easily given by a friend or loved one. Usually, a single dose is enough to save the life of an overdosing person, but if their dose is very large, it may take multiple attempts with Naloxone. Nevertheless, even a single, semi-effective dose might buy the victim enough time for an ambulance to arrive.

Getting Help

When a patient finds that he or she is addicted to the powerful pain medications that their doctor prescribed, they might feel helpless. After all, the very nature of addiction is that it takes all of the power away from a person. They are a slave to their next fix, their next dose of opioid whether that is still a pharmaceutical or an illicit dose from the black market.

When a patient’s life begins to spin out of control, time is of the essence. They must seek help immediately. This is not always realistic since addicts frequently crave their drugs enough that they choose to dive deeper into the depths of addiction. Nevertheless, once an addict is ready, they should admit themselves to a detoxification center.

While many addicts have successfully detoxified themselves at home, a clinical detox center is an optimal choice. That is because the doctors and nurses there can administer the proper medications to ensure a safe detox experience.

While in detox, medical professionals can diagnose any secondary addictions or other problems. If one’s use has gone so far as to include IV drug use, the medical staff can test for HIV and hepatitis. They might find other problems, such as infected injection sites or other health problems that arise from a life of drug addiction.

Detox can also be a great first step towards finding a rehabilitation center. The medical staff will surely have recommendations for local rehabs where a freshly detoxed patient can begin to learn more about their problem and work toward a long-term solution.

When deciding on the best rehabilitation center, patients should seek out programs that extend far beyond the typical 28-30 day treatment centers. That model for sobriety was based on bureaucratic, military realities, and not the realities of addiction and recovery. In fact, relapse rates from 28-day facilities are astronomical. When a patient spends more time, say, 60 or 90 days with a diligent focus on sobriety and the tools of a healthy life, they have far better chances of living a long, happy, drug-free life.

If one’s life circumstances or insurance only allow for a 30-day stay in an inpatient rehabilitation center, make plans to continue working on sobriety through an outpatient program. The inpatient program may be connected with an outpatient program that helps patients maintain a sense of continuity, but other options are out there.

Sober houses are available, and they are known to coordinate with rehabilitation centers as a way to continue treatment. Some sober houses will take patients who, for whatever reason, were prematurely discharged from their rehab for poor behavior or other reasons. These sober houses often have strict rules, regular in-house meetings, and even drug tests that keep residents focused on what matters most: sobriety.

Alternatives to Addictive Opioid Medications

Though the opioid epidemic might seem to present a bleak prognosis, there are glimmers of hope on the horizon. In this era of increased liberalization of cannabis laws, the typical problems associated with opioids seems to be decreasing. States that have robust medical cannabis or even fully legal frameworks for cannabis are showing lower overdose rates. There is even evidence to show that usage rates are falling. People are finding that they can manage chronic and acute pains without resorting to a pharmaceutical solution, which carries tremendous downsides.

Recent discoveries related to cannabidiol, commonly known as CBD, indicate that this less dangerous option can reduce a person’s desire for morphine or heroin. Since CBD is widely available throughout the nation without the need for a full medical cannabis program, pain patients can experiment with this substance to see how effective it is for their pain.

CBD is effective in patients who suffer from a wide range of pains. Since this cannabinoid has been isolated from THC, patients can use it free from worry regarding the disorienting features that accompany THC. Recent studies have also shown that CBD is effective with aiding sleep, easing stress, and quelling anxiety. Since it’s not physically addictive and doesn’t cause overdoses, patients can experiment to discover the specific doses they need. However, it should be noted that CBD can induce drowsiness, so it should never be used while using heavy machinery or delicate instruments, etc.

The Overdose Reversal Drug Narcan and Counselors

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The Opioid epidemic is ravaging the United States and there seems to be no end in sight. Where opioid addiction and overdose was once an exclusively urban problem, it has now spread to all corners of the nation. The health crisis is fueled by opioid pharmaceuticals such as Oxycodone and other seemingly legitimate prescription medications.

The problem devastates families and their communities, and it also exacts an economic toll. Under President Obama, the Council of Economic Advisors determined that the financial cost of opioid fatalities was between $221.6 and 549.8 billion dollars in 2015. Unfortunately, regulating the industry is not as easy as discovering the cost in dollars or lives. However, until significant regulatory measures are enacted, there are overdose reversal drugs available to help reduce overdose fatalities.

What is it?

Naloxone, also known as the brand names Narcan and Evzio, is a medication that is known as an opioid antagonist. That term means what it might seem to imply: Naloxone is the enemy of opioids and thus seeks to ensure that they don’t work. The drug works by blocking the opioid receptors in the user’s brain. Opioid receptors are special nerve cells that are shaped in such a way that opioid molecules fit them much as a key fits its lock.

Opioid antagonists have an almost exact molecular structure to that of their nemeses. When introduced to the body, they remove opioid molecules from receptors and take residence on the opioid receptor sites themselves, blocking drugs such as Oxycodone and heroin from actively affecting the brain. Thus, when Naloxone is active in the body, it removes the opioids causing the negative reaction and neither prescription nor illicit opioids will be effective for a period of time. In this way, it can put an immediate halt to any opioid effects, including (and especially) overdose.

Where do you get it?

Naloxone is a prescription drug that can be obtained without a doctor’s approval in most states. It is most commonly found with Emergency Medical Technicians, law enforcement officers, and Emergency Room professionals. They keep the drug in stock for when they encounter a victim of opioid overdose. Since the drug is easily administered via nasal spray and other methods, even untrained people can have the opportunity to provide help when the need arises. Naloxone also has very few side effects that stem specifically from its use and not the use of opioids. For this reason, it is recommended that those who use prescription or illicit opioids also have Naloxone available.

Injection & Auto-injection vs. Nasal Spray

There are three ways to deliver Naloxone to the body: injection, auto-injection, and as a nasal spray. To administer Naloxone via injection, the administering agent needs to have professional training. Thus, this delivery method is primarily used by doctors and nurses in Emergency Rooms and EMTs on crisis calls. Please keep in mind that Naloxone is commonly known by its brand name, Narcan.

Auto-injection is a method that enables laypeople to easily administer the drug to themselves or to someone in the throes of overdose. This delivery system involves a single-use device that can be easily uncapped and pressed to the overdose victim’s outer thigh, whereupon a small needle will inject the life-saving drug. These devices also usually have an audio instruction recording that plays when you remove it from its case, allowing those unused to the application of an auto-injector the best possible chance of administering the medication correctly.

Intra-nasal Naloxone is perhaps the easiest method of all. When a person is overdosing, all their friend or loved one needs to do is squirt Naloxone into their nose, much like any nasal spray. This method, along with auto-injection, has become quite popular among harm reduction advocates. These nasal sprays also only have a single dose in each spray bottle. If the administering party believes that another dose is needed, they must have another nasal spray applicator on hand.

While intra-nasal and auto-injection Naloxone are easily administered by medical professionals and laypeople alike, the difficulty is that these methods may not always deliver a dose adequate for halting an overdose in its tracks. However, each intra-nasal and auto-injection kits come with two doses. This helps to ensure that an overdose is stopped at least long enough to ensure that the victim receives medical attention, including a professionally administered injection. Extra doses should not be given right away or at the same application site. Most applicators suggest waiting 3-5 minutes for signs of revival and, if there is none, administering the next does in an alternate injection site, the opposite thigh for auto-injectors, or the alternate nostril for the nasal spray.

How to Use it

Injection

Injected Narcan or Naloxone is perhaps the most effective. The doses can be specially tailored to suit the specific needs of an individual based on their body size and the amount of opioids they may have ingested. However, this method requires a medical professional for the procedure. The overdose victim must be held steady while the syringe is filled, the skin cleared with a swab, and then the dose injected. Additionally, only medical professionals have access to the bottles of naloxone used for this injection.

Auto-injection

Auto-injection is a relatively safe and easy way for most anyone to deliver Naloxone to an overdose victim. The kit only requires that one remove a cap and press the auto-injection device to the outer thigh of their overdosing friend or loved one (making sure there is nothing in their pockets that may interfere with the dose, such as keys or a phone). Sometimes a single dose from an auto-injection kit is not adequate to fully stop an overdose, or the first dose may wear off before an ambulance arrives. Thus, these kits commonly come with two doses.

Nasal Spray

Intra-nasal Naloxone is a favorite among harm reduction advocates who have been known to advocate for free and open distribution of this method. That is because this overdose cessation method is perhaps the easiest to administer. When an overdose victim is in the middle of their overdose, a friend or loved one only needs to spray the drug into their nose to see instant revival. However, the doses are not always enough. For that reason, each intra-nasal Naloxone kit comes with two doses. Thus, a person might be able to administer a second dose to a friend in need or help two people if a non-opioid has been spiked with Fentanyl, for instance, which is becoming much more common.

Naloxone can reverse the effects of:

Naloxone primarily works as an antagonist for any and all opioid drugs. Thus, it is effective against drugs such as:

  • Oxycodone
  • Lortab
  • Fentanyl
  • Oxycontin
  • Heroin
  • Vicodin
  • Morphine

What it Can’t Do

Naloxone, known by brand-name Narcan, seems like a wonder drug. In fact, the fact that it works with immediacy against opioid overdose is wonderful. However, it does not work against other overdoses or with any other class of drugs whatsoever. The receptors that Naloxone clears and protects are only those that accept opioid molecules. Thus, if a person is overdosing as a result of multiple drugs, including an opioid such as prescription Oxycontin, a dose of Naloxone will only inhibit the opioids in a patient’s system. If their overdose is mainly created by the non-opioid in their system, naloxone will be ineffective at reviving them. This is part of why it is imperative that you always, always call for emergency medical personnel if you believe someone may have overdosed. Do not rely on Naloxone to be the only miracle they need.

Naloxone does NOT work with the following drugs:

  • Alcohol
  • Cocaine
  • Valium
  • Xanax
  • Klonopin
  • Any and all benzodiazepines
  • Amphetamines
  • Adderall
  • Ritalin
  • Methamphetamine

Why Carry It Anyway

Any illicit drug use is fraught with danger, and that danger has dramatically increased with the introduction of Fentanyl to street drugs. Once considered a last resort painkiller, the drug has been unleashed onto the illicit drug market. In powder form, pure Fentanyl can induce overdose with only a few grains. Thus, when it is used to augment a supply of heroin or even amphetamines, it is extremely dangerous. For an illustration of its potency, the National Institute on Drug Abuse states that Fentanyl has 50 to 100 times the potency of morphine. Its clinical use is generally reserved for chronic pain patients who have developed a high tolerance to other opioid painkillers.

Drug dealers often mix Fentanyl with their other opioids in order to create a more potent product. Users are likely to deepen their opioid dependence if they survive a dose laced with Fentanyl. It is also mixed into amphetamine, cocaine, or other uppers as a way to distinguish a dealer’s product in the market.

Whether a user anticipates finding Fentanyl in their amphetamines or other illicitly obtained drugs, it is wise to carry Naloxone. If they happen to come across a bad batch of cocaine, for instance, the Naloxone may be the only thing between living and death by overdose.

Side Effects

One of the great things about Naloxone is that the only effect it has is to block the activity of opioid drugs on the nervous system. For that reason, most states allow access to Naloxone by non-professionals, opioid users, and those with opioid users in their lives. Various states have enacted Naloxone access laws that expand access far beyond medical professionals.

It should be noted that although Naloxone only acts to antagonize the activity of opioids, there may be unpleasant after effects. That is, since the drug stops opioid activity, the user might immediately go into withdrawal. The user might seek to immediately ingest more opioids that they have on their person, or seek to find more. Opioid addicts have also been known to react very negatively upon regaining consciousness following overdose cessation. For instance, one addict was so upset to have lost the effect of his drug that he punched the doctor who had just then injected him with Naloxone.

Thus, while there is no true danger inherent to the use of Naloxone, it is not without after effects for both the user and their caregivers. As with any medications or powerful substances, it is wise to be fully informed prior to use.

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