The statistics are staggering: Fatalities nationwide due to opioid overdoses numbered 42,000 in 2016 and 71,568 in 2017, according to a 2018 Centers for Disease Control report. That’s between 115 and 196 a day, with estimates suggesting the death rate is likely to rise.
One local addiction specialist who deals with the opioid crisis on a daily basis—she is director of the emergency department at Dignity Health Chandler Regional Medical Center—says the issue has only become more complicated with the entry of international players into the supply side of the American drug market.
“Today we’re seeing newer, more dangerous synthetic forms of opioids on the illicit market, such as Fentanyl,” says Dr. Sandra Indermuhle, a prominent expert in the field of addiction. The synthetic became even more hazardous domestically with the current involvement of criminal drug interests in countries outside the U.S.
“Now, these ever-more-dangerous drugs are being manufactured in China, and the Mexican drug cartels are adding them to their products,” Indermuhle says, noting that an analog of Fentanyl, called Carfentanyl, poses extreme dangers to humans in any amount.
“Carfentanyl is intended for use with very large animals, strictly for veterinary purposes,” Indermuhle warns, “and as such is 100 times more potent than anything we’ve seen so far.”
With the federal government preparing to spend $4.6 billion this year to address the problem, the Chandler Regional ER head says the opioid epidemic has changed its approach to the treatment of pain.
“Even though most opioid overdose deaths have been due to their illicit use in combination with other drugs, the growing epidemic has changed the rules about how doctors routinely treat patients with chronic pain,” she says.
“The state has now put limits on the number and quantity of tablets doctors can prescribe. After that, they must refer the patient to pain management specialists for different treatment modalities.”
The National Institute of Drug Abuse reports the physician prescribing rate decreased annually by 4.9 percent from 2012 to 2016 for high-dose opioids and by 9.3 percent from 2009 to 2016 for lesser dosages.
Indermuhle notes aspects of the brain’s chemistry help to fuel the tendency toward addiction for those susceptible to it.
“We know there is a genetic aspect to addiction,” she says, “and for some, all it takes is a life stressor such as divorce, perhaps, or the loss of a job, to activate this genetic predisposition.”
She reports it is the enhanced production of dopamine (a neurohormone released by the hypothalamus) which makes addiction to opioids so possible with overuse. “Dopamine is involved with the pleasure and reward systems of the brain,” she says, “those ‘feel- good’ responses that the drug gives.”
Indermuhle’s other specialty, emergency medicine, she says came naturally to her as an emergency room technician while she was a pre-med and psychology major at the University of Colorado- Boulder.
“Some people are just better able to cope with the fast-paced and emergent situations in the ER,” she declares. “I think I was just hard-wired for it from the beginning. I like excitement, and I run on adrenaline often—it’s my energy.”
She says an ability to deal successfully in an emergency room scenario depends on repeated exposure to it through training.
“You’ve seen it before, so when faced with an emergency, you don’t put your emotions aside and just forget them—you kind of suspend them and focus intensely on the present circumstance and deal with it—your brain and your training take over.”
A leader in a field heretofore dominated by male physicians, Indermuhle says women working in emergency rooms have a unique contribution to make to the scene.
“I believe women’s natural empathy will help us to connect with patients at a deeply human level. It’s an exciting time to work in this arena.”
Indermuhle earned a bachelor of science degree in psychology at Boulder, graduated from the University of Arizona College of Medicine in 2004, and completed a residency in emergency medicine at the University of Indiana School of Medicine in Indianapolis in 2007.
“My husband and I met in the ER,” she says, “while he was starting to suffer from burnout there,” adding jokingly, “Now, we do great with him taking care of me and our two dogs, while I handle the ER.”
[As soon on Wrangler News]
If you think that someone you love is addicted to drugs, it’s important to handle the situation carefully.
What to Understand Before Talking to a Loved One
Before you talk to your loved one about treatment options, you need to approach them about the problem. It’s important that you don’t confront your loved one in a way that will cause an argument. It’s common for those abusing drugs to get angry and defensive easily, so you need to approach the situation with care.1
It’s natural to be afraid to approach your loved one about drug use, because of the uncertainty of how they will react. However, it could be a life-changing effort for you to overcome your apprehensions and have the conversation. You can approach your loved one with compassion and empathy and ask if they will consider getting the help they need.1
A variety of addiction treatment centers and therapeutic approaches exist to best match the specific needs of each individual. Whether you’re looking for inpatient or outpatient treatment, there are many options out there for anyone looking to take their life back from addiction.
What Do Parents Need to Know?
When you have a child struggling with substance abuse, attempting to handle it on your own can be extremely overwhelming and can eventually become your first and only priority. It may also be difficult to take the first step because addressing the problem is disruptive of school and extracurricular activities.2 However, addiction is far more disruptive to your child’s life in the end, and treatment can work. Taking the time now to get help can save your child’s life.
Signs and Symptoms
People who are addicted to drugs tend to show signs of the disease in every aspect of their lives. The symptoms of addiction are varied, but common signs of a problem with substance abuse include:3,4
[As seen on DrugAbuse.com]
In my new novel “Collusion,” which I co-wrote with Pete Earley, our main character is Brett Garrett, a Navy SEAL who is injured in a helicopter crash.
Due to his injuries and pain, Garrett becomes addicted to opioids. We wrote the story this way because many brave men and women who serve in our armed forces have similar stories.
The latest episode of the “Newt’s World” podcast is “the War at Home.” It takes a closer look at opioid addiction and pain management in the military community.
AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE
It is an important episode because most Americans don’t realize the struggle that some of our veterans face once they return from combat. For many, addiction proves just as dangerous – and as deadly – as warfighting.
In the episode, Earley and I are joined by retired Lt. Gen. Eric B. Schoonmaker, a medical doctor, Ph.D., and Army veteran. Schoonmaker spent four decades as a commissioned officer, and four years as the 42nd Army surgeon general and commanding general of the Army Medical Command.
Schoonmaker shares the challenges of pain management, and about how the military is starting to approach pain treatment differently.
We also speak with retired Army Col. Dr. Chester “Trip” Buckenmaier III, who is the director for the Uniformed Services University’s Defense & Veterans Center for Integrative Pain Management under the department of Military Emergency Medicine.
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This is an important conversation about pain management, opioids, and how we as a society can help combat the tide of addiction that has been tearing lives and families apart in America.
I hope you will listen to “Newt’s World – the War and Home” and join us in trying to understand and solve some of the critical challenges our returning military veterans face.
CLICK HERE TO READ MORE BY NEWT GINGRICH
Tens of thousands of Americans are dying from opioid overdoses, but others need them to treat chronic pain. How do we reconcile both sides?
More than 20 years after the first uptick in opioid overdose deaths in the United States, two groups are pitted in a bitter tug of war around the causes of, and solutions to, the opioid epidemic.
On one side are people pointing to over-prescribing as the reason tens of thousands of Americans die each year from opioid overdose. On the other side are people concerned that efforts to constrain over-prescribing are hurting Americans living with chronic pain.
The tension raises a key question: Are efforts to address addiction and pain fundamentally at odds?
The answer is no. The dueling perspectives on the opioid epidemic and its response both have validity, and there is plenty of room for common ground. A starting point is the recognition that millions of Americans with chronic pain are at risk for opioid addiction, and millions with substance use disorders suffer from chronic pain. It is essential for the nation to advance efforts that address addiction and chronic pain at the same time.
There is no doubt that opioids have been oversupplied in the United States, with enough prescriptions dispensed in 2010 to provide every adult in the U.S. a one-month, round-the-clock supply of pills. While prescribing hasdeclined modestly since then, levels remain far above the pre-epidemic baseline, as well as above levels in every other region of the globe.
The risks of opioid use for pain are well established. Studies indicate that about one in four patients on opioids for extended periods will at some point use them in ways other than as intended, with as many as 10% developing opioid use disorder, or addiction. For many patients, these risks outweigh the benefits that opioids might provide, as there is limited evidence of their long-term effectiveness for chronic pain.
At the same time, chronic pain is a serious public health challenge, affecting millions of Americans and costing the economy hundreds of billions of dollars a year. Disparities in the prevalence and treatment of pain translate into a disproportionate burden on already vulnerable populations, such as the elderly and racial and ethnic minorities. When patients who have been stably maintained on opioids are denied further treatment, the result can be severe pain, increasing desperation, a turn to illicit sources of drugs, or even suicide.
There are three major ways to address opioid addiction and pain at the same time.
►First, the health care system should provide people living with pain access to more than just opioids. Opioids, like all prescription medicines, are just one set of tools in a large toolbox. But there is insufficient access to, or reimbursement for, alternatives to opioids. These include physical therapy, counseling, different classes of medications, and consultation with a diverse team of clinicians who may diagnose other treatable conditions and provide specialized care. It is imperative that insurers and policymakers assure access to a broad range of needed services to as many patients as possible.
►Second, health care practitioners should learn how to diagnose and treat opioid addiction. No group of patients is immune from the risks of addiction, which is a chronic illness, not a moral failure. Yet many clinicians have received little to no training in diagnosing addiction, and fewer than 7% of physicians have the authority to prescribe buprenorphine, a safe and effective treatment. Medical authorities including the Accreditation Council for Graduate Medical Education, which oversees medical training, should close this training gap at once, or Congress should take action.
►Third, insurers and regulators should recognize that the best clinical care is both guided by evidence and tailored to the needs of patients. The recent CDC Guideline on opioid use for chronic pain in primary care embodies this concept; it generally advises limiting dosages for patients but at the same time notes that clinicians must consider the individualized needs of specific patients in their application. The agency should both reinforce its recommendations and caution against one-size-fits-all implementation.
It would be irresponsible to turn the clock back to the peak period of opioid prescribing or to overlook the overwhelming evidence that opioids have been used far beyond the evidence base, at great human and economic cost. It would also be inappropriate to embrace forced tapers of stable patients using opioids for pain, or other policies that prevent access to opioid therapy across the board.
The opioid epidemic challenges the health care system to be adept enough to develop effective approaches that maximize the benefits and minimize the risks of opioid medications. A good first step is to end the tug of war between addiction and pain — and focus on ways to make progress against these twin challenges together.
Dr. Caleb Alexander is a professor of epidemiology and medicine at the Bloomberg School of Public Health, where he co-directs the Johns Hopkins Center for Drug Safety and Effectiveness. Dr. Joshua Sharfstein is vice dean for public health practice and community engagement at the Bloomberg School of Public Health, and the co-author of The Opioid Epidemic: What Everyone Needs to Know from Oxford University Press.