Category Archives: Opioids

How Heroin Kills You

The U.S. is facing a dangerous health crisis. Rates of heroin use and overdoses haven’t been so high since the 1970s. In 2017, more than 70,000 Americans died as a result of a drug overdose. Approximately 47,600 of those deaths were opioid-related fatalities, and 15,482 were heroin overdoses. Even these high statistics may not tell the whole story because they don’t count the deaths of people in states who don’t specify the drug on the death certificate after an overdose. Nor do the statistics take into account the drug users who died from exposure to the cold because they were too high to go indoors in below-zero temperatures or the individuals who committed suicide while they were on drugs.

It’s easy to think of heroin and other drugs as only affecting marginalized populations in poor neighborhoods with gangs and drug dealers. In reality, heroin use and overdoses affect all strata of American society from blue-collar employees to wealthiest celebrities. Even if you don’t believe that heroin overdoses directly impact your life, you’re at an increased likelihood of being indirectly affected by the heroin epidemic going on in the country. Communities with high levels of drug addiction tend to have the less educational achievement and more crime. Long-term heroin users at risk of an overdose not only do harm to themselves but to their friends and family as well.

How People Get Hooked on Heroin

Heroin is an opioid derived from morphine. The populations most susceptible to death from a heroin overdose are long-term users who suffer from a heroin addiction.

The initial decision to use heroin may not be a behavioral flaw. Heroin addiction is a sickness in which the brain becomes dependent on increasing levels of the drug to function even as it causes neurological breakdown and other physical symptoms. Sometimes, heroin addiction can spring from the overzealous prescription of painkillers. Heroin bought off the street is much cheaper than prescription drugs, so prescription pill addicts may turn to heroin to continue to get the high they felt before. Another reason for continued heroin use is to stave off the physically devastating side effects of withdrawal from the drug.

People addicted to heroin may have difficulty stopping their drug use and relapse often because heroin affects the dopamine receptors in the brain. Dopamine is a special chemical that makes pleasurable feelings radiate through the body. In short, heroin makes the user feel good. However, continued heroin use dulls the ability of the dopamine receptors to experience the same amount of pleasure from the drug. Over time, the user requires more and more heroin to get the same high. Eventually, the addicted individual consumes more heroin than their body can handle, oftentimes resulting in death. Many factors affect heroin addiction such as the individual’s environment, genetic makeup and whether they started drug use at an early age.

Heroin overdoses indirectly affect other individuals, especially children, and teenagers. Children who grow up observing heroin addiction and who have relatives who have overdosed on heroin are more likely to use the drug themselves. Starting any kind of drug use at an early age affects critical decision-making skills, learning, and judgment. Younger drug users are less likely to decline heroin when it’s offered and more likely to move on to heroin from a gateway drug like marijuana.

Indicators of a Heroin Addiction

As the common prerequisite for heroin overdose is an addiction to the drug, it’s beneficial to know the signs and symptoms of a heroin addict. Some symptoms are common among addicts, such as manipulation, lying, stealing, avoidance of family and friends and unexplained disappearances. Other symptoms include long sleeves to hide track marks from repeated injections, missing belts or shoelaces, trails of white powder, burnt spoons and missing prescription medications. If you notice valuable items in your house going missing at the same time, your loved one might be selling them for heroin. Belts and shoelaces go missing because the addict uses them to tie their arm and prep a vein for injection. Spoons get burnt when an addict puts the heroin in the spoon and slowly burns it with a flame to ready the substance for intravenous ingestion. If you see any of these signs, do your best to obtain and carry naloxone with you so that you can save your loved one from overdosing should that occur.

Signs of a Heroin Overdose

It’s important to know the signs of an overdose so that you can help the affected person. The U.S. Surgeon General has recommended that relatives of known heroin addicts carry naloxone, an anti-overdose drug that can save lives.

Heroin can be ingested in multiple ways. It can be taken orally or injected under the skin or into muscles. Smoking and injecting heroin are the most dangerous methods because the drug enters the bloodstream more quickly and the effect is felt almost immediately. Sometimes, it may be difficult to know the root cause of a heroin addict’s death. Repeated injections can lead to deadly communicable diseases like HIV and hepatitis. Advanced cardiovascular disease can result in pulmonary embolisms and instant death.

It’s very important not to confuse signs of an overdose with signs of heroin withdrawal. Administering naloxone during heroin withdrawal can be deadly. Signs of withdrawal include agitation, insomnia, sweating, muscle pain and a craving for the drugs. This means that a friend or relative in withdrawal will be complaining of pain, awake for hours and hours on end, and exerting his or her best efforts to find more heroin to use.

In contrast, signs of overdosing are drastically different. Someone about to die from too much heroin intake will have difficulty breathing and take shallow breaths. This means that brain stem function is decreasing. The pupils will become very small, a condition is known as pinpoint pupils. The mouth becomes so dry that the tongue becomes discolored. The pulse becomes weaker and weaker, and as the body is deprived of oxygen, the skin and lips begin to turn blue. In some cases, the individual could enter a comatose state before death. If you see an individual exhibiting these symptoms such as gasping for air with a discolored tongue, bluish lips and pinpoint pupils, you should administer naloxone. It could save their life.

What Happens to the Body During a Heroin Overdose?

Heroin’s route upon its entrance into the body’s bloodstream takes it right to the individual’s brain. In the brain, it is converted into morphine and binds to the brain’s mu-opioid receptors. Mu-opioid receptors are located in the cerebrum, cerebellum and brain stem. The binding of morphine to the cerebral and cerebellar receptors is what causes slurred speech, slowed movement, delayed reactions and outbursts of uncontrolled violence from poor impulse control. However, when there is too much heroin, the converted morphine binds to the receptors in the brain stem. The brain stem is responsible for automatic breathing. When the brain stem is compromised, the individual enters into a state of severe respiratory depression and ceases to breathe. Respiratory arrest can lead to cardiac arrest. That’s how heroin kills you.

Intervening Factors in Deaths From a Heroin Overdose

Knowing how heroin kills you may help save you or someone else from an overdose. Unfortunately, naloxone may not always work. Sometimes, heroin overdose is the secondary cause of death, not the primary one. Many heroin users are abusing other drugs such as cocaine, methamphetamine or prescription drugs.

Another intervening factor is a reluctance to seek medical help and attention. Even if you were doing drugs or committing illegal activity while your friend or relative was overdosing, don’t use that as an excuse to avoid calling the authorities. Many states now have Good Samaritan fatal overdose protection laws. These laws are a special form of legislation that allows individuals to call police and ambulance services without being subject to arrest or imprisonment. Statistics show that one of the most common reasons for failing to call 911 is fear of arrest by the police.

How You Can Help Prevent Heroin Overdose-Related Fatalities

Carrying naloxone and learning how to inject it is the quickest and surest way to help someone suffering from a heroin overdose. If you don’t have naloxone and you believe that someone is overdosing or entering respiratory distress, call 911 immediately. Explain the symptoms to the 911 operator in detail. Be sure to tell the 911 operator the victim’s weight, age, the amount of heroin they took if you can, and when they took it. An ambulance will come and take the affected person to the emergency room.

People who don’t regularly use drugs might not know what heroin actually looks like. Drug addicts can be manipulative and try to convince their loved ones that they’re not actually doing heroin. One of the ways that heroin kills you and the people close to you is through ignorance. Heroin is a white, brown or cream-colored powder that is cut with sugar or powdered milk to make it more palatable than its purer form, which is quite bitter. As powdered heroin looks very similar to powdered sugar or crushed candy, it’s important to keep very small children away from the presence of heroin users and out of users’ homes. For children, the oral ingestion of heroin, even in small quantities, can lead to a fatal overdose. The darker form of heroin, known as “black tar,” is the type of heroin that’s injected.

At the emergency room, try to be a supportive presence. Overdosing can be a scary experience, not just for the person witnessing but for the person going through it as well. Emergency room doctors will probably run diagnostic tests like CAT scans, blood tests, and ECGs. Treatment options include intravenous fluids, naloxone and breathing support with oxygen therapy. Feel free to ask the doctors and nurses questions about follow-up care and treatment at home. If treated quickly, patients can be discharged after 24 to 48 hours in the hospital. Longer hospital stays occur when the heroin has caused significant organ damage. Some hospitals have programs in which the drug user can go from the hospital directly to a private rehab facility if they have health insurance. While overdosing can be scary, it just might be the “rock bottom” situation that an addict needs to push them into getting help for good.

Another way you can help is by getting educated. Familiarize yourself with the symptoms of heroin use, withdrawal from the drug and overdosing. Support your loved ones in their fight against addiction. You can’t fight their battles for them, but you can encourage them to go to inpatient or outpatient rehab and get clean. Let them know that they’re not alone in their fight and that getting clean is possible. Through proper care in the right treatment center, your loved one can kick their heroin habit and become sober.

Drugged Driving Statistics

Driving under the influence is one of the most preventable crimes in the United States. Especially in the age of ride-hailing services and apps, it’s easy to avoid drugged or drunk driving, yet statistics from the Bureau of Transportation report that three people are killed in alcohol-related crashes every two hours. In the same survey, the Bureau cites that in 2010, 4 million American adults said they’d driven drunk at least once.

Many people are aware of the effects that alcohol and illicit drugs can have on the human body, but many legal and doctor-prescribed drugs also affect a person’s driving ability, making accidents far more likely to occur. If there is any intoxicant present in a person’s body, they are considered to be driving under the influence. Not only is it illegal to drive high or drunk, possibly resulting in getting a DUI citation or arrest, but it’s also incredibly dangerous. Drugged driving can bring harm to more than just the user, and the ramifications of doing so can have an impact on many people’s lives.

What Is Drugged Driving?

Drugged driving is driving under the influence of any intoxicant whatsoever. Alcohol and marijuana use are two of the leading causes of DUIs in the United States, but drugged driving is not limited just to these two substances. Illegal drugs like heroin, methamphetamine, LSD and cocaine significantly impair someone’s ability to drive, and prescribed pharmaceuticals of any sort can do the same. Even some store-bought or over-the-counter medications can alter a person’s consciousness enough to turn driving into a more dangerous activity.

Most people know the moral and legal consequences of drunk driving, but they may be unaware that even medication prescribed by a doctor can result in an accident or DUI if misused. It’s wise to ask your doctor if a medication that he or she prescribes to you will affect your ability to drive, and, if so, how long after taking it you have to wait before you can operate a vehicle.

Drugged or drunk driving is a common occurrence in some people’s lives. Many believe that just one drink or one hit of pot won’t affect their driving ability, but even a small amount of alcohol or drugs in the body can be enough to alter someone’s motor abilities and reaction times. Statistics from a 2013 – 2014 Governors Highway Safety Association roadside survey indicate that nearly 22 percent of all weekend drivers were under the influence of alcohol or drugs. This number could be much higher, however, as it’s substantially more challenging to test drivers for drug use than for alcohol in roadside conditions.

How Many Accidents Are Caused by Drugged Driving Each Year?

In 2016, 20.7 million drivers drove under the influence of some substance, and 11.8 million of them were under the influence of something other than alcohol. Every year, millions of people are arrested for drugged driving. A survey by the GHSA reported that 44 percent of drivers involved in fatal traffic accidents were under the influence of alcohol or drugs. Not all of these drugs were considered illicit; over-the-counter drugs and doctor-prescribed pharmaceuticals were also accounted for in these statistics.

State law enforcement agencies are having a challenging time adjusting to changing marijuana laws. Though still illegal on a federal level, many states have legalized pot for medicinal or recreational use. With marijuana use increasingly becoming legalized throughout the United States, the rate of drugged driving accidents each year has increased. From 2007 to 2014, states saw a 48 percent increase in drivers testing positive for THC, the psychoactive compound contained in marijuana.

How Do Drugs and Alcohol Affect a Driver?

Every drug, including alcohol, affects a person’s ability to drive a vehicle, but not every intoxicating substance goes about this in the same way. Each substance changes various aspects of the brain and other bodily systems, making driving dangerous because of the possibility to react differently than while sober.

Alcohol, for instance, affects drivers’ central nervous systems by limiting activity in the brain’s neocortex and cerebellum. These parts of the brain are responsible for high-level decision making, coordination, and motor skills. Alcohol greatly reduces these systems’ ability to function, resulting in blurred or doubled vision, slurred speech, impaired balance and the possibility of blacking out, to name a few symptoms.

Marijuana affects different parts of the brain that respond to the plant’s cannabinoids. Memory loss, paranoia, hallucinations and a loss of coordination are some symptoms of pot use that may cause a driver to weave in and out of lanes, not respond to traffic lights or signs, or briefly lose consciousness, all of which can be incredibly dangerous when operating a vehicle.

Opiates, a widespread class of medication that has both prescribed varieties, i.e., Oxycodone, Oxycontin, Dilaudid and Vicodin, as well as illicit forms like heroin and fentanyl, affect a person’s brain differently than alcohol and marijuana. However, symptoms like memory loss and incredibly marked drowsiness can cause a driver’s abilities to become significantly impaired. Other illegal drugs like methamphetamine or cocaine can cause a person to become agitated, aggressive and reckless, to name only some of their effects. A driver under the influence of these or any other illicit drugs can cause injury or death to themselves or others.

Many people who drive drunk have other intoxicants in their systems. These substances can combine to create an even stronger effect on the user, so anyone driving intoxicated is substantially more likely to cause a potentially fatal accident.

Who Are the Most at Risk for Drugged Driving?

Anyone who drinks or uses any form of drugs and then chooses to drive is at risk of getting into a severe accident. However, men are much more likely than women to be involved in an accident involving drugs or alcohol. In 2010, men committed four out of every five DUIs, and 32 percent of these belonged to males between the ages of 21 and 34.

Another group that’s more at risk than others is those who engage in drug or alcohol use on a regular basis. People who binge drink, which is having more than five drinks in a setting for men or four drinks for women, are more likely to find themselves behind the wheel of a car more often, resulting in a much higher rate of accidents. This group was responsible for over 80 percent of drunk driving accidents in 2010.

Teens are especially susceptible to drugged driving. Their lack of experience with driving as well as with drug and alcohol use results in a particularly deadly combination. Teens exhibit less regard for speed limits and safe driving habits than adults, and drugs and alcohol can especially exacerbate this behavior. Car crashes are the leading cause of death for teens between the ages of 16 and 19. According to a 2016 survey by the Center for Behavioral Health Statistics and Quality, 12 percent of high school seniors reported driving under the influence of marijuana while 9 percent said they’d driven drunk.

Some people believe that they have a high tolerance for liquor or drugs and therefore are better suited to drive a car inebriated. This belief, however, is not true. Any amount of alcohol or drugs in a person’s system can result in a DUI or arrest by the police. The legal blood alcohol content, or BAC, limit in most states is .08  although a police officer can arrest anyone who’s showing signs of intoxication even if their BAC is below that percentage.

What Are the Penalties for Drugged Driving?

The most significant penalty that can occur because of drugged or drunk driving is causing death to yourself or others. Vehicles of any sort can turn into deadly weapons if operated by a driver who’s drunk or high. It’s for this reason that every state has strict laws regarding DUIs and DWIs.

Sixteen states have zero tolerance laws making it illegal for any measurable amount of a drug to be present in a driver’s system while operating a vehicle. Seven states have “per se” laws that make it illegal for any measurable amount of drugs to be in a person’s body outside the legal limits. States are also making more specific regulations regarding the parameters and legality of marijuana use.

Penalties for breaking these laws can be strict. Citations, arrests, jail or prison time, hefty fines, DUI classes, and rehab are just some of the punishments a person convicted of drugged driving can expect if they are pulled over or involved in an accident.

How Can Drugged Driving Be Prevented?

There are many ways to prevent drugged driving. The simplest and by far the most effective way is to never get behind the wheel when you’re under the influence of any substance whatsoever. If you’ve had anything to drink or you’ve consumed any intoxicant, find a designated driver to take you home. A ride-hailing or taxi service can take you where you need to go without you having to drive at all. If you’re in addiction recovery, it’s strongly suggested that you avoid going to places or events where alcohol and drugs are readily available.

It’s also important to not let anyone you know drive drunk or high. If you see a friend about to drive in this state, and if you’re not under the influence of anything, offer to take them where they need to go or get a taxi for them. Even if you’re not intoxicated, it’s important to pay attention to the road when you’re driving, especially on popular drinking days like the weekends and holidays. Always be sure to wear your seat belt.

Despite alcohol being legal to purchase by anyone over 21, the legal status of most drugs varies considerably. Marijuana is legal in only some states and still illegal on the federal level. Doctor-prescribed drugs, especially opiates, are highly controlled and illegal to use without a prescription. Illicit drugs, which include but are not limited to heroin, cocaine, fentanyl, LSD, inhalants, and methamphetamine, are entirely illegal no matter the state. Using these drugs can result in DUIs, injuries or fatal accidents.

Drugs and alcohol can significantly inhibit your ability to drive. With many states legalizing marijuana use, and with more and more people using it, drivers need to be aware of the risks that can come from drugged driving. With more ways available to people to travel without driving under the influence, drugged driving is more avoidable now than it ever has been.

Medications to Reverse Heroin Overdose

Heroin is a highly addictive illegal opioid derived from morphine. Used to produce feelings of euphoria, the drug takes a toll on individuals, their families, and society. It contributes to crime and violence, and it creates problems in work and educational settings. One study estimates that heroin use costs at least $51,000 for each user annually, which equates to $51 billion for the entire United States.

The Centers for Disease Control and Prevention says almost 500,000 people in the U.S. reported using heroin in 2017. That same year, 15,000 people died from drug overdoses involving heroin, a death rate that was five times higher in 2017 than in 2010. The states with the highest percentages of heroin deaths were California, Illinois, and Virginia.

There are medications that can help those struggling with both heroin use and overdose.

How Is a Heroin Overdose Treated?

Heroin can be deadly. A large dosage depresses breathing and heart rate so much that a person cannot survive without medical intervention. When help arrives in time, there are medical treatments that can reverse or stop an overdose. They include:

Polyethylene glycol can sometimes be used to flush an overdose of heroin from the body. Although it is usually prescribed as a laxative for severe constipation, it can also flush opioids that have not been metabolized from the system. It may not work in large doses, however.

Naloxone is an old medication that has become more popular in recent years because of the opioid and heroin addiction crisis. It is a mainstay in emergency rooms where it is used to stop a heroin overdose. It is also given to first responders and police officers to give to people who have taken too much heroin. Individuals and families are also trained to administer the medication if a loved one takes an overdose.

Naloxone works by binding to the same receptors in the brain as opioids. Because it binds more quickly than heroin, it stops the body from reacting to the heroin, ending the deadly effects of the overdose. It may not work when an individual has taken a massive amount of heroin.

It also leaves the body faster than heroin, meaning the heroin can stay in the system after the naloxone is metabolized. If this happens, the overdose may return. That is why it is important to call for emergency medical help after administering the naloxone.

Studies are being done to see if naloxone can also be used to treat heroin abuse and addiction. Although more research is needed, it may be helpful as a therapy for tapering people off an opioid addiction. Its ability to stop heroin’s effects in the brain could potentially help with withdrawal symptoms and cravings.

Nalmefene is routinely used to stop or reverse the effects of alcohol poisoning. Because it binds to the same receptors in the brain that heroin does, it can treat heroin overdoses. Studies suggest that it can also quickly reverse the effects of heroin overdose. It may, in fact, be more effective for treating overdoses than naloxone, but it has only been approved for use in hospitals. It does not work for symptoms of cocaine withdrawal.

Buprenorphine, known by its brand name as Suboxone, is prescribed to help with withdrawal symptoms and cravings. Patients can take the drug at home to decrease the risk of a heroin overdose.

Are There Safe Natural Alternatives?

A controversial alternative called kratom is an herbal supplement derived from the same botanical family as coffee and gardenia. It comes from tropical evergreen trees in Southeast Asia. Its leaves can be smoked, chewed, as well as made into a tea, extract, or capsule. Its effects can be felt at low doses, and euphoria occurs at higher doses. Kratom has been used for hundreds of years but has been made illegal in some Asian countries. It is also illegal in some states in the U.S.

In the past, kratom has been used in the U.S. to relieve pain and reduce opiate withdrawal, but its effectiveness and safety have been questioned. In 2018, the FDA said that it has no scientific evidence of its use for medical reasons. The FDA also says that kratom should not be used as an alternative treatment for opioid addiction.

In 2018, the U.S. Centers for Disease Control and Prevention (CDC) reported an outbreak of kratom-linked salmonella infections in 20 states. No deaths were reported, but 11 people were hospitalized. The supplement had been consumed in teas, pills, and powder. Officials were not able to find the source of the tainted kratom. The supplement may also have dangerous pesticide residue and unsafe additives.

How Is Heroin Addiction Treated?

Substance use disorder is a chronic condition, but medications can be prescribed to reduce cravings and withdrawal symptoms, making it easier for users to stay sober. Each person’s treatment is tailored to individual needs and takes into consideration other illnesses and health issues that occur at the same time as the addiction. Treatments for heroin use disorder may include medications, behavioral therapy, or a combination of the two.

Studies show that treating heroin use disorder with medication helps to keep people in a treatment program. It also helps to decrease drug use, reduce criminal activity, and lessen the risk of transmitting infectious diseases like hepatitis and HIV.

People who give up heroin often have severe withdrawal symptoms that include nausea, diarrhea, and vomiting. Medications can ease the detox process and make relapse less likely.

Behavioral therapy may take place in outpatient or residential environments. To reinforce and encourage sobriety, treatments may rely on reward systems or cognitive-behavioral therapy, which teaches ways of coping with stress and dealing with relapse.

Some programs also use the 12-step system or other kinds of support groups to encourage patients and give them an opportunity to share their feelings. Every treatment should be tailored to fit the specific needs of an individual patient.

What Drugs Are Used to Treat Heroin Addiction?

Medications used to treat heroin and other opioid use disorders use the same opioid receptors as the drug that causes the addiction, but they are safer and less likely to lead to behavioral problems than the opioid. Three kinds of medications are used to treat addictions. They include:

  • Agonists

Agonists activate opioid receptors.

  • Partial agonists

Partial agonists activate opioid receptors, but they create a smaller response.

  • Antagonists

Antagonists block the opioid receptors, but they also change the reward effects of the addictive drug.

The type of medication used to treat a specific patient depends on their individual needs. Treatment centers use three types of drugs:

Methadone

Methadone is sold under the brand names Dolophine or Methadose. It is an opioid agonist that is taken by mouth so that it reaches the brain slowly to lower the risk of a high. It has been used since the 1960s to treat heroin addicts, and it can be effective for individuals not helped by other medications. Methadone must be administered through an approved daily treatment plan.

Methadone also has the following benefits:

  • It is not likely to cause an overdose.
  • Methadone maintenance gives the patient an opportunity to stay stable long enough to make constructive changes.
  • Doses are only required once a day or less.
  • It cuts down on health problems, such as injection-related infections and vein problems.
  • Methadone is more affordable than heroin.

The Alcohol and Drug Abuse Foundation says that methadone treatment is more effective if it is part of a comprehensive program. These types of programs combine methadone maintenance with counseling, support groups, and alternative therapies.

Buprenorphine

Buprenorphine is sold under the brand name Subutex. Buprenorphine helps to relieve heroin cravings but does not produce the highs or side effects of other opioids. It is taken sublingually, or orally, and contains an antagonist called naloxone that keeps an addict from getting high if they inject the buprenorphine. If a heroin user injects Subutex, the naloxone causes withdrawal symptoms not caused when the drug is taken by mouth.

Buprenorphine has the following benefits:

  • It is less likely to cause physical dependence or euphoria.
  • It has a mild withdrawal when compared to heroin.
  • It lessens cravings and has a lower risk of abuse.
  • It suppresses opioid withdrawal symptoms.
  • It cuts down on illegal opioid use.
  • It blocks the effects of other opioids.

Buprenorphine, approved by the FDA in 2002, was the first drug that could be prescribed by certified doctors through the Drug Addiction Treatment Act. This made it possible for patients to take medication without visiting a treatment center. Buprenorphine availability has given many people the opportunity to get the treatment they need.

In 2016, the law was expanded with the Comprehensive Addiction and Recovery Act, or CARA, to include eligible physician assistants and nurse practitioners. There are two FDA-approved generic forms of the drug, making it more affordable and more widely available for the people who need it. In 2016, the FDA approved a buprenorphine implant that lasts six months and an injection that is taken once a month.

Naltrexone

Naltrexone is an opioid antagonist licensed under the brand name Vivitrol. It prevents the effects of heroin, does not sedate, is not addictive, and does not cause physical dependence. However, it is sometimes not effective because patients have trouble following the treatment. An injectable long-acting version of the medication came out in 2010, allowing patients to be treated monthly rather than through daily doses.

Naltrexone has the following benefits:

  • It can be prescribed by any health care provider with a license to write prescriptions.
  • It reduces cravings.
  • It decreases reaction to drug-conditioned cues.
  • There is less risk of withdrawal than with opioids.

What Happens After Treatment for Addiction or Overdose?

Individuals who have a long-term problem with heroin, or those who overdose on the drug, recover more quickly and experience fewer relapses when they undergo treatment in a residential facility. Trained caregivers and medical professionals can monitor the use of prescribed medications and daily activities, but the stay also gives people a chance to take a break from the stress and temptations they face in their daily lives. Therapy usually includes medication, counseling, and information that offer support, encouragement, and skills for avoiding relapse and returning to a normal lifestyle.

If you or someone you love has a problem with heroin, there is help available. Heroin addiction is a chronic condition that requires lifetime maintenance, but the rate of relapse is similar to that of medical conditions like type 2 diabetes. Recovery requires commitment and lifestyle changes, but it is worth the effort.

America’s Heroin Epidemic

How does taking opioids make someone feel? We usually avoid asking this question when discussing recreational drug use because nobody wants to encourage drug experimentation, let alone drug addiction. When the topic is addressed, it’s easy for people to assume that only weak-minded, reckless people turn to drugs.

Sadly, not many people are prepared to understand that drug addiction, particularly heroin and opioid addiction, has risen to epidemic proportions. America’s heroin epidemic affects all of us. It could be your significant other, your neighbor or even your child. No one ever thinks that it can happen to them or someone they love. However, heroin addiction doesn’t discriminate.

Dating back to the 1990s, pharmaceutical companies claimed that patients taking certain opioid medications would not become addicted. As such, health care providers began prescribing opioids for everything from sprained ankles to post-partum pain control. With this increased rate of opioid prescriptions, it slowly became clear that these types of medications were highly addictive and often led to substance abuse issues. As addiction levels rise, so does the need to understand that opioids, legally or illegally, led the U.S. to its current heroin epidemic.

The U.S. Centers for Disease Control and Prevention, or CDC, estimates that the economic burden brought about by prescription opioid and heroin use comes in at $78.5 billion. This figure includes addiction treatment, the cost of health care, legal expenses and lost productivity.

Understanding the Epidemic

The opioid epidemic has been described as the deadliest drug crisis in American history. According to the CDC, more than 115 people die from opioid overdoses every day.

People used to think that only unemployed people from broken homes turned to heroin to escape reality. No longer is opioid use limited to low-income areas; it has transcended into all geographic areas, affecting people of all ages and ethnicities. Now, the faces of heroin addiction include veterans who cannot find work after leaving the military, moms who needed pain relief after giving birth and even people who had oral surgery.

Many people who become addicted to heroin do not have a prior history of substance misuse. Substance use disorder is not linear or predictable. Some people who were introduced to drugs through prescription pain relievers end up on heroin. Health care officials say that the ever-increasing abuse of prescribed painkillers leads users to the street when they no longer can obtain the drug legally. Unfortunately, because heroin is so addictive, it leads to increased drug-seeking behavior.

Those who misuse the drug and become addicted look for a stronger and possibly cheaper high. Heroin is both, but it is also deadly. It can be laced with other drugs that cause death. Deaths from heroin overdose doubled between 2010 and 2012. The death toll also increased dramatically in 2014 when heroin mixed with fentanyl became more common. Fentanyl, when combined with heroin, is lethal. Users can die within seconds of ingestion.

Although the issue is multifaceted, drug makers and physicians play a key role in this epidemic. After all, if there were no pharmaceutical opioids, physicians wouldn’t be able to prescribe them. That is not to say that they are responsible for another person’s substance use disorder, but the snowballing effect of prescription drug use and not being able to gain access to them has led many Americans to heroin.

Veterans and Heroin Use

Veterans have also been affected by America’s opioid epidemic. Untreated chronic pain has led many veterans to seek out pain relief on the street. After being discharged from their service, some veterans find themselves unemployed and homeless. Depression and the need to escape create the perfect backdrop for substance use disorders. According to the VA, it is estimated that 68,000 veterans are currently struggling with opioid use disorders, and when they can no longer gain access to prescription pain medication legally, they may turn to heroin.

Heroin’s Effects

Heroin can be snorted, injected or swallowed. The speed at which heroin reaches the brain depends on the method taken. Users who inject heroin can feel its high within seven to eight seconds. Astonishingly, not all first-time users experience the feeling of euphoria we hear about. Since heroin slows down the digestive tract, some users may become nauseated and vomit.

Many users report that the high they experience is similar to the feeling after a satisfying sexual encounter, only much more intense. It is this sensation that drives users back to the drug. The brain cells that are affected by heroin eventually become damaged, causing the inability to feel pleasure without heroin. In turn, these cells create the intense craving heroin users have. Unfortunately, the more that individuals take the drug, the larger amounts they need to achieve a high. Often, users become convinced that they can’t function normally without the drug.

Symptoms of Heroin Addiction

It is not surprising that an estimated 23 percent of all people who try heroin will become dependent. The brain’s receptors change almost immediately upon use, leading to an inexplicable high within minutes. Since heroin produces a downer effect, using it produces an almost instantaneous feeling of relaxation and euphoria. Similar to other kinds of opiates, heroin prohibits the brain’s ability to feel pain.

Initially, heroin users can hide the signs of their habit. Over time, family members and co-workers may start to notice the signs of drug use, which include cycles of alertness followed by falling asleep, constricted pupils, rapid behavioral changes and shortness of breath.

The above red flags are not unique to heroin. There are more definitive signs that a heroin user exhibits and these typically include possession of paraphernalia used to prepare the drug. In addition, behavioral changes become more evident as drug users sink further into the substance abuse cycle. Individuals may lie to cover up their addiction and avoid making eye contact. Speech may be incoherent. Performance at work and school may decline, resulting in unemployment or expulsion.

Long-Term Effects of Heroin Use

When someone continues to use heroin despite the deadly consequences, they can develop all kinds of health issues as follows:

Central nervous system

Heroin’s impact on a user’s brain is profound. The receptors that produce chemical signals for happiness and pleasure shrink. People who use heroin for long periods of time also show deterioration of white matter on CT scans of the brain. As such, their ability to make sound decisions and regulate their behavior is altered.

Respiratory system

Like other opiates, heroin slows respiratory function. People who use heroin may breathe much slower and shallower when they are high. If someone uses too much, they may stop breathing. The risk of cardiac arrest is one of the major health risks of heroin. Although it can occur the first time someone uses heroin, chronic users usually need to take higher doses to feel the same effect, which increases the risk of respiratory failure.

Cardiovascular system

Large doses of heroin can cause sudden death. Long-term heroin users also face a slew of other cardiovascular issues including vein damage. With each injection, the damage is done to the veins and arteries that lead to the heart. In turn, infection and abscesses can occur. According to the CDC, approximately 32 percent of heroin users in New York City suffer from a drug-induced abscess.

Digestive system

Heroin can also negatively impact the user’s digestive tract. Its sedative properties slow the movement of food and water, causing constipation and bloating. Users may not disclose these symptoms nor seek treatment, putting them at greater risk for developing intestinal blockages.

What’s Being Done

The FDA believes a multidisciplinary approach to treatment would help bridge the gap between substance use disorders and treatment. Stricter limitation of the frequency and the number of opioid prescriptions would force people to look for alternative ways of pain management, including cognitive therapy, occupational therapy, and physical therapy.

The CDC has also partnered with many states to combat both opioid addiction and heroin use. By educating the public and setting up safe zones for those who are suffering from addiction, the hope is that users will go to those safe zones to inject or use as opposed to getting high on the street.

The Opioid Crisis Response Act of 2018 marks a breakthrough in the fight against the heroin epidemic in the U.S. Federal action is intended to make people more aware of the crisis and provide resources for those who want to get clean. However, one the largest hindrances to this bill being passed are funding. If the legislation is successful, some pharmaceutical companies could be bankrupt, thus making treatment of other chronic medical conditions more difficult.

Getting Treatment

Behavioral and pharmacological treatment can be effective for heroin users. Comprehensive treatment allows users to remain abstinent and restore a level of normalcy into their lives.

Heroin users must complete a detoxification program prior to entering a long-term treatment program. During detoxification, patients may be given medications to reduce the intensity of withdrawal symptoms, which can include pain, diarrhea, nausea, and vomiting. Even though the detoxification period is not a treatment for the addiction itself, it is an effective first step.

After detox, many users manage their cravings with medication. Several medications have been approved for the treatment of heroin addiction. Since they work on the same receptors as heroin in the brain, they are considered safe and effective. They satisfy cravings while blocking opioid receptors in the brain; even if a user relapses and takes heroin, they would not experience a high, which can help them on their road to recovery.

The most common medication used for recovery is methadone. Taken orally, it is slow-acting and prevents withdrawal symptoms. If the user is not at an inpatient facility, the medication is usually dispensed through an approved outpatient treatment center on a daily basis.

Buprenorphine has also been approved for the treatment of heroin addiction. This medication is only available through certified physicians. However, it also eliminates the need for daily trips to a methadone clinic. Generic options are available, making it a more affordable treatment option.

Getting treatment for any substance use disorder may be frightening and, for some, embarrassing. People with long-standing emotional problems or chronic pain are usually at a higher risk of developing substance use disorders. However, that should never dissuade anyone from asking for help. The good news is that heroin addiction is treatable. The first step is asking for help and admitting that there is a problem. Both inpatient and intensive outpatient treatments are available for those in need.

How Long Does Heroin Stay In Your System?

What Is Heroin?

Heroin is a controlled substance in the United States, and the USDA classifies it as a Class-1 highly addictive drug. It is a plant-based but heavily manufactured and altered opioid drug derived from the poppy flower. Heroin is processed and cut with other substances before it gets to the consumer. Users of the drug typically smoke, snort or inject it intravenously. The immediate effects are feelings of euphoria and sedation.

Health Impacts of Heroin in Your System

Opiate addiction is a significant problem around the world and in recent years, opioid abuse has been on the climb, leading to numerous cases of overdose. These types of drugs have a negative impact on energy levels and sex drive as well as the weight and functions of major organs such as the liver and kidneys.

Most significant, however, is the effect of opiates on brain function. As this drug is used for its effects on brain chemistry, it can cause changes to the way your brain operates and how it sends and receives signals.

In fact, the biggest danger of heroin abuse results from the drug’s ability to block or alter signals in your brain that control important bodily functions. Emergencies from opioid abuse often stem from breathing difficulties associated with overdose. The reason for this is that heroin can change the chemistry of the brain stem and cause depressed breathing.

Parts of your brain control the basic functions of your body, such as breathing and the beating of your heart, so that you don’t have to think about it. Heroin can alter and interrupt these signals that are telling your body to do what it needs to do to survive.

Drug Testing in the USA

In the United States, drug testing is used in many different types of situations. This is a common reason people may ask how long drugs will stay in your system. Many employers require pre-hire drug testing, and some also perform random drug tests on their employees.

Types of Tests

There are several ways to test for opiates and other drugs in the human body. Depending on the type of test performed, heroin can show up on the tests results whether a person has used recently or been abstinent for some time. Here’s a closer look at some of the tests currently in use:

Blood

Blood tests are one of the best ways to test for substances in the body, such as prescription or illegal drugs. This is not the most common type of drug test used, however. Blood testing is sometimes used by law enforcement, but it’s most commonly utilized in emergency medicine. In fact, blood testing is rarely used for legal issues and more often for medical diagnostic purposes.

The invasive nature of this test has raised constitutional issues. Of course, blood testing involves taking blood from a person’s body, and this requires either consent or due process of law, including a court order. While blood tests are great for medical purposes to determine what is going on in the body right now, they are not ideal for detecting prior opioid use because opiates may not be picked up in the bloodstream if it’s only been a few hours after use.

Urine

The most common type of drug test used in the United States is the urinalysis test. This is the preferred method for employment testing and probation and parole testing. This is because it is a fast and reliable form of testing that is also far cheaper to perform than blood and hair tests. Additionally, there are fewer legal and constitutional concerns when using urinalysis.

Hair

Hair testing is not especially common, but it does have a significant history of use in the U.S., primarily in the court systems. This method does have one benefit over other methods: While blood and urine tests have a more limited time frame to work in, hair testing can detect drugs months after their use.

Saliva

Testing of oral fluid is another somewhat common testing method for illegal and prescription drugs. This method involves using a cheek swab to collect a sample of saliva and other oral fluids. The test works much the same as a blood or urine test and detects the same content as other forms of testing.

The issue with saliva testing is that it can be a less reliable method due to medical conditions or drug side effects that may cause dry mouth. If a good sample can’t be collected, then the test will fail. In certain instances, the very drug being tested for can cause side effects that will negate the saliva test. This type of test isn’t typically the first choice when it comes to heroin detection.

Understanding Half-life

In science, half-life refers to the time it takes for a substance to be reduced by half, either by decay or through elimination within the human body. In medicine, half-life is used in formulas to determine proper doses and duration for treatment. For example, an antibiotic would have to be administered at a certain dose and frequency to ensure that antibodies remain present long enough to effectively fight the bacteria or infection.

The half-life of a drug determines how long the substance will be present and detectable in your body. If you are not a chemistry person, the concept can seem confusing, but it is fairly simple. Essentially, different substances take longer to clear from your body than others.

On one hand, there is the time it takes for the substance to be cleared to the extent that you no longer feel the effects of the drug, and on the other hand, the time it takes for it to not be detectable by tests. As an example, you could take a medication for pain and at the end of its half-life, you may feel your pain return and no longer feel the effects of the drug. However, a blood test would still show the presence of pain medication.

Variables to How Long Heroin Will Stay in Your System

 

When people ask how long a particular drug will remain in their system, it is not a simple answer that is the same for everyone. The best answer is always going to be a range because not all people are the same and not all drug mixtures are the same. Below are some of the many factors to take into consideration when asking how long a drug will be detectable in your system.

Age

Your age has a lot to do with your metabolism and the way your body processes substances you take in. An older person with a slower metabolism may show the presence of a drug longer than a younger person with a fast metabolism. Additionally, a person who has not yet reached full maturity may process the drug at a different rate than an adult. This is one reason that addiction in youth is of particular concern.

Weight

It stands to reason that weight would be a factor in the half-life of heroin and other drugs. Doses for medication are often based on weight. The reason for this is that the dose may need to be larger to have the intended effect on a larger person while a smaller person may get stronger effects from a drug at a smaller dose.

Body Fat

Body fat plays a role in how your body metabolizes what you put into it and how it breaks substances down. Excessive body fat impacts circulation, digestion, and liver and kidney function.

Hydration

Hydration plays a key role in removing toxins from your body. Good hydration is very effective in reducing the duration of time that drugs can be detected in urine. Using water to clean the urine is so effective that many people will drink large quantities of water in an attempt to pass a drug test. However, many tests will count clear urine as an automatic fail on the assumption that the subject was trying to falsify the results.

Drug Quality

This is one of the biggest variables in determining both the effect of the drug and how long it remains in your system. The fact that heroin is an illegal drug means that supplies are not checked for quality or held to an FDA standard. When using black market products, there is little way to know the purity and strength of the drug itself.

As drugs like cocaine and heroin are cut with other substances, the actual volume of the drug can vary. Think of it in the same way as proof in alcohol terminology. A 4% ABV will have a different effect on your body than a 90% grain alcohol. Similarly, heroin of low purity will break down in your body faster than a higher concentration.

Health Factors

One individual may process heroin in a different way depending on personal health issues. A diabetic, for example, will break things down in the body in different ways and at different rates. A person with blood and circulation issues may also take longer to clear the drug from their body.

Use History

The effect of a particular drug can have a lot to do with a person’s history of use. Consider that a dose for a first-time user may have a much stronger impact than the same dose for someone who has dealt with addiction for many years. One component of drug abuse is the perceived need for more and more as time goes on. Unfortunately, this is what leads to many overdoses.

While a lifelong user may process the drug differently, the bigger issue is their likely increased dosage. If a person is consuming higher and higher amounts to try and get a certain high, the volume in their body will likely take longer to process through the system.

How Long Does Heroin Stay in Your System?

Taking all of the above into account, we are talking about a drug with a very short half-life. In most cases, it will be undetectable in urine after only a couple of days. Blood and saliva tests are especially poor testing methods for heroin. In fact, testing blood and oral fluids may yield a negative result within only five to six hours of taking the drug. The most effective test available for detecting drug use over time is hair follicle testing, which has been reported to detect heroin in the body for up to three months after the last use.

So, when considering how long the drug stays in your system, the answer really depends on the test. You can think of two days and up to three months as the two extremes. However, most tests will only be able to detect heroin in your system for a period of two to seven days.

Opioids & Heroin Epidemic

opioid and heroin epidemicThe opioid epidemic is a serious problem in America today. In the late 1990s and early 2000s, prescription opioid drugs were touted as low-risk solutions for chronic pain and other conditions. Thousands upon thousands of people all across the country were led to assume that opioid drugs were relatively safe solutions to temporary or chronic pain, and these days, almost everyone in America knows somebody whose life has been negatively affected by these dangerous drugs.

As the use of prescription opioid drugs became more and more widespread, another equally destructive problem continued to simmer in the background: heroin abuse. In recent years, these two disparate issues have combined into a maelstrom that is ravaging the country. By learning more about the origins of the opioid epidemic, you can insulate yourself against the dangers that this mounting trend poses.

What Are Opioids?

Opioids are a class of drugs that block pain by directly interacting with pain circuits in the brain. In addition to reducing the sensation of pain, these drugs also produce a euphoric high that quickly becomes addictive. When opioid drugs are used in their prescribed concentrations, they can be effective short-term tools for fighting pain, but abusing these drugs quickly results in addiction.

The original opioid was opium, which was used in the ancient world for analgesic and recreational purposes. Opium is extracted from the bud of the poppy flower, and it is also known as the “milk of the poppy.” While opium itself isn’t widely used in the West anymore, every type of synthetic opioid is in some way derived from the substance. For instance, morphine was one of the first isolate opioids to be extracted from opium, and it is still widely used in medical settings today.

Morphine is much more powerful than normal opium, and the first signs of opioid abuse in America began with cases of morphine addiction in the mid-20th century. However, another synthetic opioid known as oxycodone rapidly supplanted morphine as the go-to drug for cases of pain that were moderate to severe. Today, oxycodone is widely known by its brand names OxyContin and Percocet, and it is one of the main drivers of the opioid epidemic.

As medical drugs like morphine and oxycodone gained popularity in the mainstream, another type of opioid steadily crept into American homes from the shadows. Known as heroin, this morphine derivative is of much lower quality than other types of opioid drugs, and since it is made by criminal drug gangs, there is no way for end users to guarantee that their supply is safe. This drug is usually cut with cheaper substances, and long-term users often inject it into their bodies with needles that may or may not be safe.

Heroin powder is white in its pure form, but most types of street heroin are brown due to additives. An even more insidious type of this drug is also available to street users: black tar heroin. It is either gummy or hard as a rock and derives its name from its black color. This type of heroin is the cheapest, but it is also more likely to be filled with pollutants than any other form of this street drug.

In recent years, however, a street drug that’s even more dangerous than heroin has made its debut. While fentanyl is used in hospitals under extreme circumstances, this drug is also manufactured in China and other countries and smuggled into the United States for illicit use. If fentanyl were just another opioid like oxycodone or morphine, it would be easier to lump this drug into the existing opioid crisis. However, fentanyl is a synthetic opioid that is much stronger than others traditionally manufactured in the pharmaceutical industry.

The Centers for Disease Control and Prevention (CDC) has estimated that fentanyl is 50 to 100 times stronger than morphine. As an abused substance, fentanyl had its debut as an incredibly potent designer drug that was mainly used by wealthy coastal elites. As prices of fentanyl have dropped, however, it has been much more widely used.

These days, it’s common to find fentanyl included in bags of street heroin. Many users are unaware of the presence of this drug in their supply, and they may choose to use their regular dose immediately upon receiving a new bag of drugs that has fentanyl in it. The results of this choice can be disastrous. Because fentanyl is so much stronger than normal heroin, it’s far easier to overdose on heroin that has been spiked with this highly potent synthetic drug.

What Is Fueling the Epidemic?

There are a number of factors that are contributing to the ongoing prevalence of the opioid epidemic in the United States. It’s possible to trace the origins of this pressing social issue back to earlier days of heroin abuse in the United States. During the waning decades of the 20th century, heroin became more and more popular throughout the country. When opium production spiked in Afghanistan in the years following 9/11, this problem only became worse.

Today, it appears that a significant amount of heroin is still coming into the U.S. from foreign countries. While cocaine and marijuana seizures on the country’s borders have decreased in recent years, heroin seizures have increased in some areas. Additionally, although there is no statistical information yet available on fentanyl seizures along the border, a U.S. citizen was recently arrested while attempting to smuggle nearly 11,500 fentanyl pills across the San Ysidro Port of Entry. Fentanyl is so powerful that a batch of pills of that size could easily poison a sizeable town.

Despite the fact that fentanyl poses such a danger to users, companies in China and other countries continue to produce this drug. In many cases, these companies often sell fentanyl directly to American citizens over the dark web. In other situations, fentanyl is smuggled into the country for illicit use. However, increased awareness of the dangers of this drug is minimizing the domestic market for fentanyl.

Historically, one of the biggest impediments to halting the opioid crisis has been domestic opioid manufacturers. For instance, the manufacturers of OxyContin, Purdue Pharma, once claimed in their official materials that their prescription opioids were safer than morphine and other types of opioid drugs. These types of misguided marketing campaigns led many doctors to believe that some opioids were safer than others. In many parts of the country, prescriptions for these drugs increased. For example, in the state of West Virginia, 110 opioid prescriptions were written for every 100 people in 2013 at the height of the opioid crisis. While certainly not all of these prescriptions were illegitimate, the sheer number of pills being prescribed made the drugs much more widely available for use.

The rise of prescription painkillers has even had a bleed-over effect into heroin abuse. According to the National Institute on Drug Abuse (NIDA), using prescription opioid drugs increases the likelihood that you will use heroin. This phenomenon is partially fueled by the fact that this drug is generally cheaper than prescription opioids, and it’s easy to find a supply of heroin even when your doctor refuses to prescribe you any more opioids.

To briefly recap, here are the most prominent reasons why the opioid crisis is still a significant problem in the United States:

  • Medical: Doctors have prescribed much higher doses of opioids than are safe for extended periods of time.
  • Smuggling: Many tons of opioids have come over the U.S. border in recent decades. These drugs continue to be smuggled into the country.
  • Plentiful supply: The dangers of opioids are becoming better known, but these drugs are still widely produced and prescribed.
  • Prescription and illicit overlap: Since both heroin and prescription opioid drugs are widely available, it’s easy for addicts to remain addicted.

What Is Being Done

In recent years, greater attention has been paid to the problems that have arisen from increased opioid drug use in the United States. The Trump Administration declared that the opioid epidemic is a Public Health Emergency in 2017. This declaration has brought more attention to the blight of opioid drugs in American communities, and members of the Trump administration have begun coordinating with local officials around the country. Alongside the highest office in the land, policymakers and medical professionals across the United States are leading a national conversation focused on how to best combat this issue in local communities that each face their own unique problems.

The greater emphasis on border security has also helped decrease the supply of opioids entering our country illegally. While keeping illicit opioids from passing through our points of entry will ultimately require the help of other nations, every border seizure of heroin or fentanyl is another batch of drugs that won’t make it into the hands of Americans who suffer from opioid addiction. The incoming Obrador administration in Mexico has promised to work with the U.S. government to fight the power of the cartels in Central and South America. In addition, better diplomatic relations with China will inevitably lead to decreased fentanyl production.

An increased public awareness of the danger that opioids pose has been the most effective measure in curbing the spread of this epidemic. While stopping the drug supply is one half of the equation when it comes to stamping out the opioid menace, education is another critical part of this initiative. An informed populace will be less likely to make decisions that are harmful, and adults who have been educated regarding the dangers of opioids will pass their knowledge down to their children. In decades past, Americans were largely unaware of the dangers that opioids posed to themselves and their communities. However, the American people have woken up to the problem and many are actively working to find a solution.

Increased prevalence of abuse-deterrent formulations (ADFs) in prescription pills has made it harder for people to abuse drugs like OxyContin and Percocet. However, ADFs aren’t present in the majority of prescription opioids, and they aren’t present in any illicit drugs like fentanyl or heroin.

If more people become aware of the dangers of opioid drugs, and if fewer opioids are made available to the populace, this fire will naturally extinguish itself. In the raging blaze that is opioid addiction, the drugs themselves are the wood and ignorance about the dangers of opiates is the oxygen. When starved of these vital components, any fire has no choice but to go out. By surrounding this problem from all sides, we are making the gradual destruction of this danger to our well-being a guaranteed inevitability.

Vermont Opioid Epidemic

On June 6th, 2017 Dutchess County of New York State filed a lawsuit against 11 pharmaceutical companies on several allegations regarding their production and distribution of prescription opioid painkillers. The lawsuit alleges that pharmaceutical companies have used deceitful tactics to market prescription opioid painkillers, an epidemic that has swept across the nation resulting in several deaths that only continue to increase by the year. Keep in mind, considering the date of the lawsuit, that nothing has come of the it and Dutchess County is not necessarily setting a precedent as 5 other New York State counties have filed similar lawsuits against pharmaceutical companies and individual providers. There are 62 counties in New York State.

vermont opioid epidemicAs has become the norm in a capitalist society like the United States, money is a powerful and nearly undefeated entity. How often do you see money being the driving force behind evil and selfish acts? It’s safe to assume money is the driving force behind the companies and providers turning their back on a public health crisis, even if it didn’t start that way. Addiction is a disease, as is cancer, and the former is much easier to turn your back on.

In addition to the lawsuit against pharmaceutical companies, Dutchess County has named a handful of prescribing providers alleging that they were responsible for promoting opioids for sale and distribution locally and nationally. Dutchess County Legislator, Jerry Landisi, is quoted saying “We have been fighting this war on drugs and addiction, but the enemy has been supplied by these pharmaceutical companies who have chosen to put profit ahead of patient safety.”

The problem is spreading and there does not seem to be an end in sight. Several states are seeing the devastating effects of the opioid epidemic, including Vermont. In fact, Vermont ranks ninth among the National Safety Council’s top 10 states with the highest heroin fatality rates per capita.

So, what gives them a right to blame the companies and prescribers? Is it pure ignorance? As it is for many professionally licensed providers, there are annual continuing education requirements. Any responsible doctor would take note of the rise in deaths due to prescription opioid use.

Let’s look at the numbers

National Heroin/Opioid Statistics

  • In 1999 there were 7,523 deaths due to prescription opioids
  • In 2015 there were 29,728 deaths due to prescription opioids
  • In 1999 there were 2,675 deaths due to illicit opioids
  • In 2015 there were 19,884 deaths due to illicit opioids

If you’re wondering why pharmaceutical companies and individual providers are being held accountable, the above statistics should be telling. Not only have patients become addicted to pain management medications prescribed by their doctors, they seem to be seeking out the drug after the prescription has lapsed.

To the naysayers that may point to our population growth in America, which has grown 14% between 1999 and 2015. The population growth of 14% pales in comparison to the 295% increase in prescription opioid deaths over the same time frame. If we’re aiming for population control then we have the answer.

There are some states that are considered to be doing it “right”, most notably, the state of Vermont, which is just a mere ninety miles from the center of Dutchess County, NY.

Now that we’re shifting away from the most recent lawsuit in New York, let’s see what their neighbors are up to, besides filing lawsuits.

Vermont Opioid Statistics

  • In 2010 there were 38 deaths in Vermont due to prescription opioids
  • In 2016 there were 38 deaths in Vermont due to prescription opioids

Wait, the opioid deaths did not increase 295% in Vermont? Yes, the same number of people died at the hands of prescription drugs but they must be doing something “right” in Vermont.

Before we dive into the treatment programs and legislation associated with Vermont’s success let’s widen the spectrum again briefly. On a national level, for those addicted to opioids the people closest to them are the most dangerous enablers. In 2015, a survey determined that 36% of people that misused a prescription pain reliever received the drug directly from their doctor. Another 54% of misuses were taken, bought or given to the person by a friend or relative. The remaining 10% fell into the following categories:

  • 9% bought from a drug dealer or stranger
  • 9% obtained the prescription pain reliever “some other way”

It’s not the dark alley dealer we have to worry about. It’s the people that are supposed to care about our health and well-being.

How is Vermont Preventing Prescription Opioid Misuse?

While the following list is seemingly vague, we get an idea of what programs and prevention tactics are being employed and we’ll take a close look at a couple of the programs and the elements that make them successful. Vermont reportedly has the following prevention and treatment programs in place:

  • Mandatory Prescriber Education
  • Opioid Prescribing Guidelines
  • Eliminating Pill Mills (VT doesn’t have them but also doesn’t have legislation to eliminate/prevent them)
  • Prescription Drug Monitoring Programs
  • Increased Access to Naloxone
  • Availability of Opioid Use Disorder Treatment

Particular to mandatory prescriber education and opioid prescribing guidelines, at first glance, it could seem like just more charting in an attempt to decrease liability with a smoke screen of caring for the patient. However, it seems the amount of charting that needs to occur cannot be fudged or faked as there are too many stipulations in place that call upon the doctor to be, well, a responsible doctor! For example, when prescribing an opioid painkiller the prescriber must evaluate the benefits and risks, including risk of misuse. Additionally, the provider will need to produce a diagnosis that supports prescription opioids and consider and document the possibility of a non-opioid alternative as well as a non-pharmacological treatment.

These doctor and patient education attempts will help prevent the patients from confusing the drowsy eye warning on the bottle as a “wink, wink” suggestion, much like Lucille Bluth, of the cult television show, Arrested Development.

Beyond the Initiation Point

If you’re looking for a hole in Vermont’s approach, you must read on to determine if you feel it’s a credible approach. What’s been described in the preceding section is a small part of the process, the opioid initiation stage. How should we expect doctors, especially ones that see dozens of people on weekly basis, monitor opioid use after the initial prescription?

For general practitioners that aren’t seeing improvement in their patient’s condition they must be comfortable with a referral to a pain management specialist and/or a substance abuse specialist. Mainly, don’t be so damn arrogant! Some of the risk indicators are listed below:

  • Treatment goals are not met despite escalating doses.
  • The patient’s history and/or a screening indicate high risk for misuse, abuse, diversion, addiction, or overdose.
  • The prescriber knows or suspects based upon reasonable grounds that the patient has engaged in misuse of opioids or other substances.
  • The patient obtains prescriptions from multiple prescribers and/or multiple pharmacies.
  • The patient has been prescribed multiple controlled substances

Relating back to the more charting phenomenon, it seems that a common theme within Vermont’s model is documenting their treatment of the patient. Vermont’s laws indicate that the patient must be seen within 365 days of the initial prescription, otherwise the provider will be held accountable for being in violation of a state law. The annual review of a patient’s prescription mirrors the initiation stage and what’s important about the annual requirement is that patients that are misusing or are addicted have to come back and evaluate their use themselves. That way the provider and patient are being held accountable. The annual reevaluation period has the following salient elements:

  • Reevaluation of effectiveness and safety of the pain management plan and the patient’s adherence to the treatment regimen.
  • Potential for non-opioid/non-pharmacological treatments.
  • Functional status examination of the patient.
  • Review of the Controlled Substance Treatment Agreement and Informed Consent, and any revisions to the conditions.
  • Assessment of co-morbid conditions.
  • Related actions that may prompt adjustments to treatment, including aberrant behavior, early refills, or other factors reasonably suggesting risks associated with misuse, abuse, diversion, addiction, or overdose.

Of the aforementioned elements, especially within the one year mark, what sticks out the most the requirement to assess for comorbidity. Yes, the patient may have come with back pain due to recent surgery however, he or she may have developed an addiction over time, especially due to the vulnerability a physical ailment can create. Those suffering from an injury or that are in recovery cannot always participate in regular activities, may be bed ridden at times and feel alienated from their social group. All of those elements could result in depressive symptoms, which put someone at much higher risk to misuse or abuse drugs.

As indicated earlier, addiction is a disease and must be recognized and treated as such. While Vermont is seeing their most significant decrease in prescription opioid misuse in the 18 to 25 age range, the Substance Use and Mental Health Services Administration found that the rates for mental illness and substance use disorders were the highest (35.1%) for people in the same age range.

Conclusion

While the opioid epidemic is alive and well, it’s a welcome sight to see Vermont attempting to increase their treatment capacity to deter the effects to their residents. Much like the tobacco industry’s settlement with 46 states in 1998, the wave of lawsuits may force the pharmaceutical companies to take more responsibility for ignoring or downplaying the addictive nature of opioids. In the tobacco settlement the tobacco industry agreed to make ongoing payments to the 46 states involved to fund anti-smoking campaigns and public health programs. With the current climate of healthcare and the increasing cost, a similar settlement could be applied to the opioid epidemic. In the meantime, other states should be following in the footsteps of Vermont because, just like tobacco, much of the damage is already done. The patients are hooked. What makes this even worse is that many of those hooked started with trying to get help. We’ve learned quite a bit since the time period of doctors recommending smoking. Let’s not be so naive again.

Fentanyl & Carfentanil Deadly for Law Enforcement

It’s a well-established fact that fentanyl and carfentanil, two of the most deadly opioids known to man, are killing people by the thousands. Fentanyl is an opioid medication used for surgery and chronic pain, and it is 50-100 times more powerful than morphine. Carfentanil, its stronger cousin, is up to 100 times more powerful than fentanyl, and is used to tranquilize large mammals such as elephants.

Both substances are being masked as prescription pills or heroin by drug dealers on the street, and both substances are so deadly that even a few grains can kill. Overdoses from the substances have risen as much as 500% over the last few years according to the CDC. No part of the country is safe. From Alaska to Maine, Hawaii to Florida and all states in between, America is in the midst of a fentanyl/carfentanil crisis.

“Fentanyl is being sold as heroin in virtually every corner of our country… a very small amount ingested or absorbed through your skin can kill you,” said DEA Deputy Administrator Jack Riley to Law Enforcement Product News. Riley said this as part of a warning from the DEA to all US law enforcement, a warning about the dangers of being exposed to fentanyl or carfentanil during drug busts.

Near Deadly Exposure for Law Enforcement

These two drugs are so deadly, that as part of the warning issued by the DEA, a video was released, and it is available to view here.

Deputy Administrator Riley is the spokesperson, and his message is clear. Fentanyl exposure can be deadly. Riley urges all officers to “transport it directly to a laboratory, where it can be safely handled and tested.” He says not to field test it, and to never bring it back to the office. Here’s why:

  • Recently in New Jersey, two officers survived a powder blast of fentanyl to their faces. Investigator Kallen and Detective Price of the Atlantic County Task Force were sealing a bag of confiscated fentanyl when a cloud of the powder came out of the bag and the officers inhaled it. “I felt like my body was shutting down,” said Det. Price. “I thought that was it. I thought I was dying.” Inv. Kallen added, “You actually felt like you were dying. It was the most bizarre feeling that I never ever would want to feel again.”
  • In Hartford, CT last month, eleven SWAT team officers were exposed to a cloud of fentanyl being blown about the crime scene. Several of the officers experienced lightheadedness, nausea, sore throats and/or headaches. The entire team was taken to the hospital.
  • All over the country, law enforcement officers as well as firefighters are now carrying Naloxone, an anti-overdose drug. Well, now, because of the fentanyl crisis, officers in places such as Vancouver, Canada and St. Louis, MO, are carrying it for themselves. Exposure to the drug can be so deadly so quick, that the anti-overdose drug may have to be administered to an exposed officer.

Conclusion (or lack thereof)

As if it’s not bad enough fentanyl is killing drug users and putting law enforcement at risk, police dogs sniffing for drugs are being exposed as well. The invasion of fentanyl (and carfentanil – even deadlier but less commonly found) has made being a cop even harder and riskier of a job.

Fentanyl and carfentanil are so hazardous, officers must wear the same suits worn by scientists avoiding the Ebola virus when handling them. These are full-body, level A hazmat suits. Imagine what damage these drugs do to the human body, able to kill in less than three minutes.

130 people die every day from opioid overdoses in this country. Remove fentanyl and carfentanil from the equation and that number goes down.

The American Opioid Epidemic

 

Between 2000 and 2014, American rates of death from opioid overdose have tripled from three deaths per 100,000 people to nine per 100,000. That adds up to 28,647 deaths in 2014. While the number of heroin overdoses has made a rapid climb, the majority of the lethal overdoses involve prescription opioids  –  and the heroin crisis is closely tied to prescription drugs, since many users become addicted to a prescription opioid before switching to the street drug. In March 2015, U.S. Department of Health & Human Services Secretary Sylvia M. Burwell announced an initiative targeting three priority areas to tackle the opioid epidemic and help save lives. These include: improving prescribing practices, expanding access to and the use of medication-assisted treatment, and expanding the use of naloxone.

The abuse of opioids, a group of drugs that  includes heroin and prescription painkillers has had a devastating impact on public health in this country. According to the CDC approximately 100 Americans died from drug overdose every day in 2010. Prescription drugs were involved in well over half of the 38,300 recorded fatal overdoses and opioid pain relievers were involved in 16,600 of those deaths.

Overdose Deaths Involving Opioid Analgesics

Research shows that many non-medical users obtain prescription medications from family and friends.

How Different Misusers of Pain Relievers Get Their Drugs

Today, more Americans die from drug overdoses than car crashes or gun fatalities. In total, drug overdoses killed 47,000 people in the United States in 2014, the latest year for which data is available. That’s 130 deaths per day, on average.

 

The majority of those deaths – 29,000, or 80 per day – involved an opioid.

Between 1999 and 2014, the overdose epidemic spread from a few concentrated pockets in Appalachia and northern New Mexico to nearly every corner of America. The opioid overdose crisis began early in central Appalachia, a region encompassing much of West Virginia and eastern Kentucky. The largely rural area – dominated by physically taxing industries, including coal mining, agriculture and timbering – was susceptible to the pain-relief promise of prescription opioids such as OxyContin and Vicodin. These painkillers were aggressively marketed throughout the 1990s and early 2000s. As prescriptions proliferated, so did misuse and abuse. In central Appalachia, as in many parts of the country, the prescription painkiller epidemic also fuelled the influx of a cheap, alternative opioid: heroin. As painkiller-related deaths began to fall in the early 2010s following federal and state crackdowns on prescription opioids, heroin-related deaths began to rise.

In the west, New Mexico showed earliest signs of the looming overdose crisis, but Utah was not far behind. The state’s overdose death rate climbed steadily during the early 2000s, driven by growing prescription opioid dependence. But Utah lawmakers took action early. In 2007, they established a two-year public health-based program to combat painkiller misuse. Over the next three years, prescription opioid-related overdose deaths dropped more than 25%, but the success was short lived. After funding ran out in 2010, deaths began to climb again. Drug overdose deaths in Utah continue to be fueled by prescription painkiller misuse, often in combination with other depressant drugs . Though heroin deaths have made a smaller impact in the state, they are also on the rise. Now, six years after the Prescription Pain Medication Program program ended, the Utah house of representatives declared drug overdose deaths to be a public health emergency, and passed a slate of new public health measures, including the legalization of needle-exchange programs.

New England Opioid Overdose RatesNew England is grappling with a more recent scourge. Since 2013, New Hampshire, Massachusetts, and other north-eastern states have seen large spikes in overdose deaths attributed to increasing heroin use and the introduction of a new deadly drug: Fentanyl. Fentanyl, a synthetic opioid 50 times more potent than heroin, first appeared in the region around 2012, making its way down from Canada. Suppliers often cut the drug into heroin or other substances before selling it to users who may not know exactly what they’re buying. Because of its strength – and users’ unfamiliarity with it – fentanyl has proven particularly deadly.

In the face of these new challenges, Massachusetts and other north-eastern states have begun to expand prevention efforts and access to treatment programs. Naloxone, a drug that can reverse opioid overdoses, has become more widely available throughout the region and local harm-reduction initiatives are being tested.

 

Meanwhile, Fentanyl has surfaced in several more states, including Ohio and Florida.

Florida, once known as the prescription drug capital of America. began cracking down on “pills mill” clinics in 2010. Soon after, the state’s drug overdose death rate took a downward turn, declining through 2013.But by 2014, deaths were inching back up in Florida too.

Florida did a good job of cracking down on the supply side, but at the same time they actually cut treatment funding. Not addressing the demand side of the problem has contributed to the continuing of the epidemic.

Though postponed for a few years, Florida’s overdose crisis has progressed along a familiar pattern: a wave of prescription opioid abuse followed by heroin and, soon after, fentanyl.

More recently, fentanyl has cropped up in a previously unseen form: fake Xanax pills. The “death pills”, as they have become known, have also been found in California, Indiana and other parts of the mid-west.

Opioid Overdose DeathsIn October 2015, the President issued a Memorandum to Federal Departments and Agencies directing important steps to combat the prescription drug abuse and heroin epidemic. You can find it here.

In March 2016 HHS awarded $94 million to health centers in Affordable Care Act funding to help treat the prescription opioid abuse and heroin epidemic in America. This funding covers 271 health centers in 45 states, the District of Columbia, and Puerto Rico to improve and expand the delivery of substance abuse services in health centers, with a specific focus on treatment of opioid use disorders in underserved populations.

Administered by the HHS Health Resources and Services Administration (HRSA), these awards to health centers across the country will increase the number of patients screened for substance use disorders and connected to treatment, increase the number of patients with access to MAT for substance use disorders and opioid treatment, and provide training and educational resources to help health professionals make informed prescribing decisions. This $94 million investment is expected to help awardees hire approximately 800 providers to treat nearly 124,000 new patients.

Research demonstrates that a whole-patient approach to treatment through a combination of medication and counseling and behavioral therapies is most successful in treating opioid use disorders. In 2014, over 1.3 million people received behavioral health services at health centers, This represents a 75 percent increase since 2008 and was made possible with support from the Affordable Care Act (ACA) and the Recovery Act.

 

Opioid Treatment Options are Available

If you can’t stop taking a drug even if you want to, or if the urge to use drugs is too strong to control, even if you know the drug is causing harm, you might be addicted to opiates. Are you thinking about opioid treatment? Here are some questions to ask yourself:

  1. Do you think about drugs a lot?
  2. Did you ever try to stop or cut down on your drug usage but couldn’t?
  3. Have you ever thought you couldn’t fit in or have a good time without the use of drugs?
  4. Do you ever use drugs because you are upset or angry at other people?
  5. Have you ever used a drug without knowing what it was or what it would do to you?
  6. Have you ever taken one drug to get over the effects of another?
  7. Have you ever made mistakes at a job or at school because you were using drugs?
  8. Does the thought of running out of drugs really scare you?
  9. Have you ever stolen drugs or stolen to pay for drugs?
  10. Have you ever been arrested or in the hospital because of your drug use?
  11. Have you experienced an opioid overdose?
  12. Has using drugs hurt your relationships with other people?

If the answer to some or all of these questions is yes, you might have an addiction. People from all backgrounds can get an addiction. Asking for help is the first important step. Visiting your doctor for a possible referral to opioid treatment is one way to do it. You can ask if he or she is comfortable discussing drug abuse screening and opioid treatment. If not, ask for a referral to another doctor. You can also contact an addiction specialist about opioid rehab. There are 3,500 board-certified physicians who specialize in addiction and opioid treatment in the United States.

Pharmaceutical Incentive Programs: Feeding Addictions

 

Plenty of companies offer incentive programs, or what are essentially performance-based payments. Realtors receive bonuses for closing deals on expensive homes. Journalists receive bonuses for winning a Pulitzer Prize. Heck, even the NFL doled out more than $121 million last year through its incentive program! But nothing has the impact like Pharmaceutical Incentive Programs.

 

Let’s switch gears for a moment.

The National Institute on Drug Abuse reported in 2011 that 52,000,000 Americans over age 12 had abused prescription pills at least once, and the number of reported prescription pill addicts was 8,760,000. Where are all of these pills coming from? Over 80% of them come right from the doctor’s office. A major role of pharmaceutical company representatives is to visit doctor’s offices in hopes of convincing the office to buy their pills from whatever brand they represent. Long sentence shorter, big pharma competes for business, from big hospitals to your local family practice.

Now let’s combine the two ideas from the two previous paragraphs.

 

Pharmaceutical incentive programs offer large incentives.

The incentive is usually monetary, but can even include a trips around the world. With such stakes, surely pharma reps are pushing their companies to the max. One very vicious side effect of all this pill-pushing is the rampant addiction and abuse of prescription pills in the US.

 

The Pain Pill Epidemic

From 1999 to 2010, sales of opioid-based pain medications such as Vicodin, Percocet and OxyContin quadrupled. The United States consumes 99% of the world’s hydrocodone (Vicodin), 80% of the world’s oxycodone (Percocet & OxyContin), and 65% of the world’s hydromorphone (Dilaudid). Either we are all in excruciating pain or there exists some serious discrepancies.

Something else happened to quadruple during the time period of 1999 to 2010. Opioid overdoses rose from 4,000 annually to 17,000 annually. In 2014, more people died from opioid overdoses than ever before. The more pain medication prescribed the more overdoses that occur; this seems to be a direct relationship.

Pharmaceutical-Incentive-Programs-lead-to-opioid-abuse

 

Purdue Pharma is the manufacturer of OxyContin, a powerful opioid painkiller. OxyContin was released to the market in 1996, and in its first year garnered $45 million in sales. Not bad. In 2000, the drug garnered $1.1 billion. That’s a 2,000% increase. Then, ten years later in 2010, OxyContin garnered $3.1 billion! These are incredible sales, and account for approximately one third of the entire painkiller market.

In 2007, Purdue Pharma was brought up on a criminal charge of misleading the “FDA, clinicians, and patients about the risks of OxyContin addiction and abuse by aggressively marketing the drug to providers and patients…” It took three years after the charges were filed for Purdue Pharma to make OxyContin less susceptible to abuse.

 

The Struggle Continues

The case of Purdue Pharma is one of many that exemplify the desire for profit being greater than the desire for healing. Take Insys Therapeutics, for another example. They manufacture a product called Subsys Fentanyl, a painkiller spray ingested orally. Now subject to investigations, Insys Therapeutics has been peddling this extremely strong opioid (100x stronger than morphine) for fifteen years, and makes approximately $300 million annually. Meanwhile, well over 1,000 deaths from overdoses of Fentanyl have occurred, including the death of Prince.

Talk at length with your doctor(s) about any prescriptions recommended or given to you, or to your loved ones. It might even be a good idea to get a second or third opinion, given how many medical companies are under the sway of big pharma.