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The opioid crisis and us
St. Louis American - 12/14/2017
I have a serious addiction to sweets. I crave sweets. I sometimes sneak and eat them. Generally, I cannot eat just one and I am often ashamed of myself for over-indulging. Admittedly, I have even had so many sugary treats till it made me physically ill.
But for me, my worst consequence from this sugar habit was an upset stomach. However, the fact that I was able to wake up the next day and share my embarrassing story with someone is testament to the difference between a sugar overdose and an opioid overdose.
The current crisis with opioids has been flooding the news cycle for the past few years. In this past year, deaths from opioid overdosage exceeded 60,000. Synthetic opioids such as fentanyl, per the Centers for Disease Control and Prevention, have contributed to the increase.
In many of the death reports from individuals who overdosed, carventanil, an analog of fentanyl, was implicated in the cause of death. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine; carfentanil, a drug used to tranquilize large animals, is estimated to be 10,000 times more potent than morphine.
What is important to understand is that, for the most part, people are not intentionally trying to overdose. When a person uses an opioid medication, this drug can cause respiratory depression. Using this medication repetitively produces drug tolerance: You need more drug to achieve the same effect as in the beginning.
Persons who use the drug to prevent withdrawal are dependent. So those persons found in abandoned squatter houses or in bathroom stalls were probably not trying to kill themselves, but they were trying to get that quick high, relieve pain or stop the horrible effects of withdrawal.
The typical start of this vicious downward spiral is that initial pain-killer prescription. Physicians and legislators must accept our roles in creating this public health crisis. We now know from numerous studies that narcotic prescriptions were often written for conditions that did not require them or patients were given too many tablets with their initial prescription.
Not having an adequate drug registry was also noted to be an issue. In some states, physicians and pharmacists have access to vital information, such as which narcotic was prescribed and by whom, the date and the quantity. This tracking helps to insure that patients are not "doctor hopping" with their medications.
What is interesting about this crisis is that it is not an inner city problem. This situation is affecting the affluent and middle class. The typical profile of a drug overdose victim is a middle-aged, suburban white male. But as with any health problem, this is also hitting minority communities and, if not controlled, will generally cause more chaos and destruction due to the very fragile nature of that population.
Recently, President Donald Trump declared the opioid crisis a public health emergency. Whether or not his statement will be followed by any substantial funds or programs to address the epidemic is unknown.
However, as a community we can all assist by putting in place safeguards and lobbying our state legislators to increase their efforts to provide more drug rehabilitation and detox programs. Any person on pain medications should ensure that their meds are locked away and not easily accessible by others. Providers should insist upon drug contracts with their patients and prescriptions should be prescribed responsibly.
This epidemic will require all hands on deck. A steep rise in unintentional deaths and a rise in crime are both potential results of failure to intervene in this crisis.
Denise Hooks-Anderson, M.D., is assistant professor at SLUCare Family Medicine and medical accuracy editor of The St. Louis American. Email her at firstname.lastname@example.org.