A look at the opioid crisis

August 7, 2017  By Michael D. Shaw @ Health News Digest

Let’s start with some definitions (courtesy of NAABT and opium.com):

“Opiates” are drugs derived from opium. Opiate drug types include heroin, opium, morphine, and codeine. The term “opioids” originally referred only to synthetic opiates—drugs created to emulate opium. Opioid drugs sold under brand names include: OxyContin^®, Percocet^®, Vicodin^®, Percodan^®, Tylox^®, and Demerol^® among others. All of these opioids are indicated for the treatment of pain, and can become addictive.

Sufferers of chronic pain may be quite willing to deal with addiction, but with long-term use, patients can develop a tolerance to the drugs. Even worse, users can develop hyperalgesia, whereby they experience an acute sensitization to pain that may be unlike their original pain even though they may, in fact, be stable and functioning on their meds.

In common medical parlance, “opioid” refers to any substance that binds to the body’s opioid receptor sites, so opiate vs. opioid becomes a non-issue in this respect. Technically speaking, not all opioid drugs are opiates, but all opiates are opioids. For example, heroin and morphine qualify as opiates and opioids, whereas Demerol and Percocet only qualify as opioids.

The receptor sites exist to accommodate the body’s naturally-occurring opioids, aka “endorphins,” known in some quarters as “your own private narcotic.” More than 20 types of endorphins have been identified, and those called “beta-endorphins” are said to be stronger than morphine. Many are familiar with the endorphin rush, that tends to block pain, slow breathing, raise our spirits, and calm us down. Moreover, endorphins have been implicated in stress, alcoholism, obesity, diabetes, and psychiatric diseases.

Unfortunately, endorphins are ineffective against chronic or severe pain, as these neurotransmitters are quickly broken down, once they attach to the receptors. Likewise, they cannot produce physical addiction or overdoses. Classic and synthetic drugs of addiction bind those same receptors, but are chemically different enough to resist natural biological breakdown.

As to the crisis, according to the CDC, drug overdose deaths nearly tripled during 1999–2014. Among 47,055 drug overdose deaths that occurred in 2014 in the United States, 28,647 (60.9%) involved an opioid. The draft report—issued July 31—from the President’s Commission on Combating Drug Addiction and the Opioid Crisis, has some disturbing findings:

1. The most recent data estimates that 142 Americans die every day from a drug overdose. Committee chairman Gov. Chris Christie likens this to a “9/11-scale loss every three weeks.”
2. Drug overdoses now kill more people than gun homicides and car crashes combined.
3. In 2015, nearly two-thirds of drug overdoses were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. Americans consume more opioids than any other country in the world. In fact, in 2015, the amount of opioids prescribed in the U.S. was enough for every American to be medicated around the clock for three weeks.

The Commission’s recommendations include:

• Rapidly increase treatment capacity.
• Mandate prescriber education initiatives.
• Immediately establish and fund a federal incentive to enhance access to Medication-Assisted Treatment.

Many authorities tend to blame Big Pharma for over-promoting such drugs as OxyContin, and indeed, lawsuits have been filed. Still, people have their chronic pain, and if they cannot get legit drugs in light of efforts to restrict them being prescribed, they will turn to heroin—originally introduced as a “non-addictive” pain medicine, and alternative to morphine.

Neurologist and pain specialist Aric Hausknecht, MD decries the arbitrary and capricious restriction of opioid pain meds…

“Many doctors have stopped prescribing opioids altogether. I receive phone calls all the time from patients looking for a new pain doctor because their previous physician stopped prescribing. The New York State Department Of Health laws have significantly deterred doctors from prescribing opioids.”
“Requirements include checking the NYS DOH Prescription Monitoring Program every time,
utilizing a cumbersome system to e-prescribe, which involves software and the internet and text messaging simultaneously in order to obtain a one-time passcode (these two steps alone take at least 10 minutes for every prescription), a law that limits the first prescription to a seven-day supply, and a law that requires doctors to take a CME course and attest to it. It is pretty clear that the powers that be in New York State do not want doctors to prescribe opioids.”

Hausknecht continues, “In my practice, I rarely see patients that become addicts. I see human beings who are suffering from pain that is relieved by opioid analgesics.”

This is healthcare? The government, and thus insurance, denies these drugs to suffering patients, who then are forced to go off the grid to obtain wildly unpredictable street drugs. We have an opioid crisis, for sure.