2017-07-19 / Health Care

Understanding the disturbing rise of opioid overdose

By Dr. David Samadi

The headlines shouted, “Louisville, Kentucky receives 52 overdose calls in 32 hours.” As surreal and unimaginable as this caption screams, sadly, this has become an all-too common headline in this part of the country. In fact, Louisville and the surrounding county of Jefferson, has been averaging 22 overdoses a day this year so far, keeping emergency rooms very busy.

The overdoses were all due to opioids such as heroin, morphine and prescription pain relievers. Unfortunately, Louisville is not the only city grappling with this problem. Statistically, significant increases in drug overdose due to opioids have been seen in other states such as Connecticut, Florida, Massachusetts, New York, and Pennsylvania.

This should remind all of us of the growing and alarming rate of the use of opioids in the United States.

What are opioids?

Opioids are pain relief medications that, when taken in low doses, are safe and effective. They are the strongest pain relieving medications available, with morphine considered as the benchmark opioid. All other licit prescription opioids – oxycodone, hydrocodone, codeine and fentanyl – fall either above or below morphine in terms of pain-reliving potential. The illicit drug heroin also falls under the same class of drugs called opioids.

Opioids are just like any other medication in that they can come with risks and side effects including the risk of death, particularly if abused or not taken exactly as prescribed by a doctor.

In the past, opioids were generally prescribed for cancer patients undergoing painful treatments of radiation, chemotherapy or other symptoms of pain that were too difficult to manage otherwise. Nowadays, opioids are routinely given to individuals who do not have cancer and can range anywhere from chronic back pain to muscle pain relief.

Why are opioids a problem?

Opioids can become a potential problem for anyone because of how they work in the body. The drug interacts with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain. Addiction is the primary concern with their use and a reason why people can become dependent on these drugs. If you are someone who has endured years of chronic pain and you are suddenly are prescribed an opioid for the relentless pain rewarding with tremendous relief, it’s quite easy to become hooked on this medication.

Being addicted to a medication like an opioid is characterized when a person pathologically pursues the reward and/or relief of the substance offering them what they seek. Addiction to opioid drugs is a huge problem in the United States. In 2014, 1.9 million individuals had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder involving heroin.

The factors of dependence and tolerance are a main force driving this epidemic. Dependence can occur when opioids are taken daily and the body begins to rely on these medications. If a person suddenly stops taking the medication the body can go into withdrawal. A person cannot control dependence on an opioid, as it is simply the body’s natural response to this drug.

Tolerance is another issue. Many people experiencing chronic pain find they have to continually increase the dose to get the same pain relief. The longer a person is taking an opioid, the less sensitive opioid receptors in the body become.

Opioid overdose epidemic

The leading cause of accidental death in the United States is drug, overdose and driving this epidemic is addiction to opioids. In 2015 opioids were the cause of 33,091 deaths with opioid overdoses having quadrupled since 1999.

The American Society of Addiction Medicine states that sales of prescription pain relievers in 2010 were four times those in 1999 with the substance use disorder treatment admission rate in 2009 six times higher than the 1999 rate. In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.

Another very disturbing trend is that four in five new heroin users started out misusing prescription painkillers. Because of this, death from heroin overdose nearly quadrupled from 2000 to 2013. In a 2014 survey given to people in treatment for opioid addiction, 94% stated they chose heroin because prescription opioids were “far more expensive and harder to obtain.”

Between men and women, women are prescribed more prescription pain relievers due to the fact they tend to have more chronic pain. Women are often given higher doses and will use them for a longer period of time than men. This also makes them more likely to become dependent on opioid painkillers more quickly.

Other risks associated with opioid use

Accidental overdose or death is the greatest threat of using an opioid pain reliever. It should be noted to never combine opioids with other
medicines or drugs that cause sleepiness, such as alcohol, certain anti-anxiety and seizure medications, muscle relaxants, or sleep aids.
Other side effects and risks of opioid use include:
• Constipation
• Low sex hormones such as testosterone and estrogen, leading to less sex drive or difficulty achieving an erection
• Dependence
• Tolerance
• Sleep apnea
• Lung and heart problems
• Dry mouth

How to avoid addiction to opioids and what to do if you already are addicted

Avoiding addiction to opioids can be done when a person understands and knows how to go about this. If a person is taking an opioid for minor pain, limit the use to no more than seven days. What can lead to an addiction or dependence is when they are used for 30 or more days.

For long-term use, use opioids exactly prescribed by the order from the doctor. Always consult with the doctor on how to go off a pain killer and don’t do it on your own. Using a medical team to advise and reassess the need and use of an opioid, is another way of avoiding addiction.

Treating an opioid addiction has several options available to effectively help a person withdraw safely from the medication. Research has shown that whether it is treating a heroin addiction or addiction to a prescription opioid, several medications such as naltrexone, methadone, and buprenorphine as well as behavioral counseling approaches have been successful in accomplishing this.

If you are addicted, or notice more dependence on an opioid medication, discuss it with your doctor right away. Do not hesitate to inform them of your concerns, as the sooner you treat the problem, the greater the chance of a full recovery.

For further information on opioid addiction and where to go to for help, visit www.addictionsandrecovery.org

Patients newly diagnosed with prostate cancer can contact world-renowned prostate cancer surgeon and urologic oncologist, Dr. David Samadi. For a consultation and to learn more about prostate cancer risk, call 212-365-5000.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel's Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pintrest, SamadiMD.com and Facebook

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