Used legally in semi-synthetic opioid medications primarily for cough suppression and reduction, but sometimes used for pain relief following surgery.
Anthony J. Mele is a licensed psychologist with nearly 25 years of clinical expertise and executive leadership in the behavioral healthcare industry. As Chief Clinical Officer for Sovereign Health, Dr. Mele oversees the development and delivery of state-of the-art behavioral health treatment serving hundreds of patients in a nationwide network of facilities.
Opioid abuse is the major culprit of drug overdoses and overdose deaths in the United States. The numbers have been disturbing for decades, but over the last several years, they’ve been nothing but staggering:
The rate of opioid-involved deaths in 2015 was 10.4 per 100,000 persons. The five states with the highest rates of opioid deaths (per 100,000 persons) that year were:
Opioid use in the U.S. quadrupled between 2000 and 2015, and opioid-related (heroin and prescription opioid) deaths have quadrupled since 1999.
Opioids were involved in over 33,000 deaths in the U.S. in 2015.
A majority of opioid addicts additionally suffer from a mental illness or preexisting personality disorder.
Regarding treatment, a number of respected institutions, including the National Institute on Drug Abuse (NIDA), have concluded that the likely best course of treatment to avoid opioid addiction relapse is the long-term use of medications like methadone, when combined with behavioral treatment and recovery support.
Notwithstanding the positive treatment results, nearly all U.S. states lack sufficient treatment capacity to provide medically-assisted treatment (MAT) to all patients suffering with an opioid use disorder.
In general terms, an opiate is a drug derived from opium, a type of drug that acts upon the brain and nervous system in a way that relieves pain. While the terms opioid and opiates are now somewhat interchangeable, the word opiate once referred specifically to drugs derived naturally while opioids included both natural and synthetic forms, like those found in prescription drugs. Prescription opioids are commonly prescribed to alleviate severe physical pain that cannot be relieved by alternative means – like other, less dangerous medications.
Scientifically speaking, opioids are substances that interact with the brain and body, attaching themselves to parts of nerve cells called opioid receptors. There are three types of opioid receptors: delta, kappa, and mu. When opioids attach to mu receptors, the resulting effects are pain relief and feelings of pleasure. Because the effect is so dramatic- -and potentially dangerous- -opiate detox centers help patients addicted to the drug overcome their physical dependency before proceeding to a more holistic treatment approach.
Opiate detox centers can help someone addicted to opiates — natural or synthetic — overcome his or her physical and mental dependency. This type of treatment prevents serious health complications and, in some cases, death.
The benefits of prescription opioids are real and significant. When used properly, opioid medications can provide safe and effective relief for both acute and chronic pain. The problem, however, is that opioids are also highly addictive and, as a result, all too often misused. Here’s a brief look at the effects, side effects, and dangers of opioid use and abuse:
Immediate opioid use typically produces a “high”, the intensity of which depends on the type and dosage level of the particular opioid. Short-term effects include pain relief, sedation, drowsiness and sleepiness, and feelings of euphoria. Short-term opioid abuse may additionally result in nausea, lethargy, respiratory depression, and paranoia.
Long-term effects include, among other things, constipation, nausea, vomiting, liver damage, and brain damage. Long-term opioid use also invariably leads to higher levels of tolerance to the drug – and dependence.
A number of serious health problems can result from the use of hypodermic needles to inject opioids, such as blood infections, site-related skin infections and gangrene, heart problems, and pulmonary embolisms. Chronic infections, like HIV and hepatitis, can also result from the use of unsterile needles.
Every treatment program is different, each offering its own unique approach and features. There are, however, four basic steps to the treatment provided by most facilities and programs:
Used legally in semi-synthetic opioid medications primarily for cough suppression and reduction, but sometimes used for pain relief following surgery.
Used legally in semi-synthetic opioid medications for pain relief. Also commonly used for recreational purposes.
Commonly used for recreational purposes.
: Derivations of thebaine are used in semi-synthetic opioid medications to treat pain and opiate addiction.
Derived from thebaine. Typically used to treat chronic pain and opiate addiction. Medications containing buprenorphine include Suboxone, Bunavail, Zubsolv, Butrans, Subutex, and others.
Derived from morphine. Typically used to treat dry coughs. Medications containing ethylmorphine include Indalgin, Feco Syrup, Cosylan, and others. Products containing ethylmorphine are not legally available in the United States.
Derived from codeine. Typically used to treat severe pain and to alleviate coughing. Sold under brand names such as Vicodin, Lorcet, Oncet, Hydrocet, Hydrotussin HD, Anexsia, Lortab, and dozens of others.
Derived from thebaine. Typically used to treat moderate to severe pain. Medications containing oxycodone include Oxycontin, Percocet, Percolone, Endocet, Narvox, Roxiprin, and many others.
Derived from morphine. Typically used to treat moderate to severe pain and as a surgery anesthetic. Sold under brand names Opana and Opana ER.
Fentanyl is a very powerful opioid similar to morphine but 50 to 100 times more potent. It is legally used to treat pain following surgery and those with severe and/or chronic pain who have become physically tolerant to other forms of opioids. Illegal use includes swallowing, snorting, and injecting. It is often substituted for or mixed with heroin.
Methadone is used primarily as to relieve pain, and as part of drug addiction detoxification and maintenance treatment. Methadone decreases the symptoms of withdrawal for patients addicted to heroin and other narcotics without producing the “high” normally associated with those drugs.
Commonly known by its brand name, Demerol, meperidine is legitimately used to treat moderate to severe pain.
Heroin, the most well known and infamous of all opioids, is a highly-addictive drug processed from morphine, and is therefore classified as a semi-synthetic opioid. Unlike all of the other opioids listed above (with the exception of opium), there is no legitimate medical use for heroin – it is used strictly for illegal recreational use. Heroin plays a major role in the current opioid epidemic. An individual who begins his or her abuse with prescription opioids – either legally prescribed to them or obtained illicitly – often moves on to heroin once their prescription supply dries up.
Simply put, an overdose is taking too much of a substance, resulting in any number of serious medical complications and possibly death. An overdose may be accidental or intentional. People with a dependence on opioids are the most likely to suffer an overdose, although an overdose can happen to anyone abusing an opioid, even someone using for the first time.
An overdose can sometimes be hard to detect. Signs of overdose to watch for include:
If you suspect that someone you are with may be suffering an overdose, it is crucial to act immediately. Administer naloxone, if available. Then immediately call for help. If breathing is severely impaired, perform rescue breathing or chest compressions. Remember, a quick response can mean the difference between life and death. Once he or she is stable, an opiate rehab can safely oversee the detoxification, or withdrawal, process and create a treatment plan to address the addiction.
Naloxone (sold under the brand name Narcan, among others) is a medication used most notably in emergency situations to quickly reverse the effects of an opioid overdose. Naloxone may be administered through the nose in a spray form, injected into the muscle, or injected intravenously. Naloxone is currently available without a prescription in 41 states and can be purchased at pharmacies nationwide.
Anthony J. Mele is a licensed psychologist with nearly 25 years of clinical expertise and executive leadership in the behavioral healthcare industry. As Chief Clinical Officer for Sovereign Health, Dr. Mele oversees the development and delivery of state-of the-art behavioral health treatment serving hundreds of patients in a nationwide network of facilities.
I was looking at some recent statistics and the current opioid epidemic has killed more Americans than the crack epidemic of the 1980’s and 1990’s. More Americans have died in the current heroin epidemic than during the HIV/AIDS crisis in the mid-90’s, or during the most recent methamphetamine epidemic. And in 2015, we had more opioid-related deaths than from homicides and carjacks combined. Another little factoid is that, with less than five percent of the world’s population, Americans consume 80% of the world’s supply of all opioids, including 99% of all Vicodin. And virtually every statistic is trending upward. So, clearly this is a huge problem in the U.S.
The other thing to call attention to is that opioid abuse is no longer confined to a particular geographic region or demographic category. So, what might have started as a problem perhaps among young white males in Ohio, New Hampshire, Kentucky, and West Virginia, has now spread across the whole country, and includes all genders, all age groups, and all communities of color.
There’s been some attention given to increased government and insurance oversight of prescription opioids. Since about 2000, states have begun creating prescribing databases to help monitor the overuse of prescription opioids. A 2016 study by Vanderbilt University suggested that state monitoring of prescriptions has prevented one death every two hours since its inception. So there is some good evidence that there’s a positive effect by simply curtailing the prescribing by physicians.
There’s been some attention given to increased government and insurance oversight of prescription opioids. Since about 2000, states have begun creating prescribing databases to help monitor the overuse of prescription opioids. A 2016 study by Vanderbilt University suggested that state monitoring of prescriptions has prevented one death every two hours since its inception. So there is some good evidence that there’s a positive effect by simply curtailing the prescribing by physicians.
We try to do as comprehensive a psychological evaluation as we can because we want to know how clear the patient’s cognitive or brain functioning is, and what their emotional/psychological makeup is like. If they are depressed or have a personality disorder, or if they’ve had 20 years of chronic drug and alcohol abuse, we know that’s going to affect the brain. So we have to create a treatment plan that will play to their strengths.
It depends upon their presentation. Typically detox goes anywhere from five to seven days, sometimes a little longer if the detox is complicated. Some folks will have more physical symptoms, some folks will have a lot more psychological symptoms. It’s fairly structured with a lot of oversight. We use medication-assisted treatment on an as-needed basis, but primarily we believe that the best way to address this is to be abstinent.
We tailor our interventions based on the evaluation. No matter what level of care, [the patient] will receive a combination of group therapy – what we would call process group where there’s a lot of talking and sharing – and then individual therapy and family therapy if they agree to participate in family therapy. Then there is a series of activities.
We have what we call “centers of excellence” within each of our sites, and those are specific sub-programs aimed at either specific conditions, like an eating disorder or sexual abuse history, or specific demographics, like men over the age of 40 or women over the age of 40,. We have a program for folks who want a Christian-based recovery program. We have a program that caters to the Orthodox Jewish community. So we try to be as specific as we can with our patients.
If you’re thinking about it, if the thought has come into your consciousness, you’ve got to act on that thought. That action might be calling a buddy, calling a helpline, calling someone. Just call. The thought has emerged from your subconscious, unconscious, whatever you want to call it. It’s now live, so you have to act on that. That’s what I believe.
I think the idea that this is a chronic illness. There’s no such thing, in my view, as a functioning addict. Sooner or later, that house of cards crashes. This needs to be treated as a chronic condition that does get worse. It gets progressive, as we say.
And I think that at some point we’ve got to start saying to ourselves, my God, why do we consume 80% of the world’s painkillers? Is this country in that much pain? What’s going on here? How have we lost the ability to deal with life without painkillers? There’s a lot of pain out there. It’s just astounding to me. When do we ever address that? We are a hurting country, it seems.