By Roy Benaroch, M.D., Emory University
In recent times, the number of cases pertaining to an opioid overdose has risen at an alarming rate. And the sad part is that there are many repeat cases, meaning the same patient has to be attended to repeatedly. Are we serious about saving lives? If yes, then what are we doing about it?
Immediately upon reaching someone with an opioid drug overdose, paramedics mostly administer a dose of Naloxone, also known by its traditional brand name, Narcan. This medicine really saves lives because it immediately stops the effect of the opioid drug on the one who has overdosed, so that the victim, if not dead, will start breathing again. But the unfortunate part is that it pushes the victim into full-blown opioid withdrawal.
The feeling, which has been described as the flu on steroids and includes severe body aches, irritability, anxiety, and vomiting is quite miserable. The victims, who are administered Narcan, are generally hostile, angry, and uncontrollable when they wake up, and they have to be given strong sedatives to calm them on their way to the hospital.
This happens, on average, eight times a day in Pittsburgh. The call for an unconscious person, the Narcan, the anger, and withdrawal is routine. In fact, it is easier for paramedics to count days without overdoses than days with them.
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The Chilling Reality of Opioid Usage
Here are some statistics. In the year 2012, paramedics in the city of Pittsburgh answered 900 calls for overdose of the opioid drug. The number increased to 2300 in the year 2016. These huge numbers not only affect the people of Pittsburgh and their families, but also the ones who are the first responders. Paramedics save the same patients so many times that they know their first names, watch fathers perform CPR on sons, and listen to children call out for unconscious, overdosing parents. Among these cases of overdoses in Pittsburgh and the rest of the nation, most are related to the drugs derived from opium, which is extracted from the opium poppy.
Morphine is one of the oldest drugs derived from opium, and it is still widely used as a medication for pain throughout the world. A chemically amended variety of morphine was developed in 1874, and the drug company Bayer sold it as heroin, which was taken from the German word heroic. The name reflected how people felt when they took this drug. Although heroin is banned in the United States and many other countries, it is still used as a part of the healing apparatus in many countries, usually as a remedy for the effects of addiction to an opioid drug. Since then, many other types of this chemical have been developed, but irrespective of their type, all of them have the same impact on the human body. There may be variation in the way it is metabolized in the body and the duration of its effect, but in the end, all of them do the same thing.
On the positive side, they do relieve pain. They can also instill a sense of relaxation, and when taken in such a quantity that it hits the brain quickly, it can give rise to ecstatic high. These may be the positive effects, but there are more negative effects. These include drowsiness, nausea, constipation, and vomiting. They also cause what’s called “respiratory depression”. Simply put, users breathe less, and that effect increases with an increasing dose.
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Opioid Effects
These drugs, with continued use, always cause what’s called “tolerance”, meaning the effect of a certain dose wanes, and you have to use a higher and higher dose to get the same effect. Moreover, these drugs have strong addictive qualities. As a group, they are called opioids. That’s a blanket term for all natural and synthetic versions that have the same pharmacologic effects as opium or morphine. The technical name of the natural derivatives is ‘opiates’, although it is difficult to understand the difference between an opioid drug and an opiate unless you are a chemist.
However, the distinction doesn’t make any difference because the effect is the same. The media uses the opioid drug as the general term for all these drugs, whether used for medical or recreational purposes. An older term, ‘narcotic’, is still used sometimes for these and similar drugs, especially in a law enforcement context.
A story in Post Gazette explains how the drug overdose causes death. It says, “When patients overdose on an opioid drug, their breathing slows down, they fall unconscious, and ultimately stop breathing altogether. Although the heart continues to breathe for a while, the body soon falls short of oxygen, leading to cardiac arrest.” From this point, death is imminent within minutes, unless the victim’s breathing is restored and the heart starts beating again. The patient has to be immediately given Narcan. So the emergency teams are getting used to such calls. They say, “It’s like a drill to us. We can do this even in our sleep.”
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The Sad Reality
Unfortunately, nine times out of 10, patients given Narcan to save their lives aren’t happy to be saved. They’re suddenly torn from their euphoria, their high, and find themselves disoriented and in tremendous physical and mental pain. They vent their anger at paramedics.
How has it got to this stage? Drug overdoses—and most of these overdoses are opioid drugs—are now the leading cause of death of American adults less than 50. The number of people killed due to overdose each year is more than those killed in car accidents, and even more than those killed by HIV when it was at its peak in the 90s. From 52,000 people dying due to overdose in 2015, the number rose to 64,000 in 2016. And this may not be the worst yet. The British newspaper, The Guardian, puts it in perspective. It says, “The US is the epicenter and the origin of the crisis. They consume more than 805 of the opioid drugs although they have less than 5% of the world’s population.” So the situation is serious and its causes need to be looked into.
Common Questions about Opioid Usage
Opioids are drugs that include both legal as well as illegal drugs. Legal drugs include those which are available on prescription, like oxycodone, hydrocodone, and morphine. Illegal drugs include heroin and other synthetic opioids like fentanyl.
The most commonly used legal opioids are oxycodone, hydrocodone, codeine, morphine, etc. The most used illegal opioid is heroin.
Fentanyl is a more powerful and addictive drug than morphine. It is available under the brand names Actiq, Duragesic, and Sublimaze.
In a first time user of cocaine, the drug can produce many physical and psychological effects. It is a stimulant that attacks the brain immediately on use. In rare cases, it can lead to heart attacks and seizures.
