In this post, Gwen reviews the rising epidemic of opioid abuse, and what you can do if you suspect you or someone you love may be addicted.

Opium, derived from poppies, has been used for thousands of years to alleviate pain.[1] Prescription drugs like methadone, oxycodone (OxyContin®), hydroxycodone (Vicodin®), and fentanyl (Fentora®), all work through the same basic biochemical pathways as opiates such as heroin. They interact with opioid receptors in the brain that regulate pain perception and that are involved in the brain’s central reward system, which is part of why they’re so addictive.

It’s estimated that 1.9 million Americans had substance abuse issues related to prescription opioid pain medications in 2014, the most recent year for which data are available.[2] According to data released by the Centers for Disease Control – the CDC – deaths from opioid overdose have quadrupled since 1999.[3]

Opioid addiction is a problem that cuts across economic lines – an ongoing investigation by The Guardian reveals how prescription drug addictions have been fueled by pill mills until recent crackdowns that have led to a surge in heroin addiction.[4]

At a hearing before the Senate Judiciary committee earlier this year on heroin and prescription drug abuse, the director of the National Institute of Drug Abuse, Dr. Nora Volkow, called prescription opioid abuse a “public health epidemic,” citing not only deaths from overdose, but also increasing incidence of newborns with health problems resulting from exposure to opiates in utero, and the increases in hepatitis C and HIV infections from dirty needles.[2]

Are Opioids Addictive?
In a word, YES, they’re highly addictive. Almost 1 in 5 people who try heroin will become addicted to it.[5] That bears repeating: almost 20% of people who try heroin become addicts. Initial exposure to opioids causes euphoria and a sense of well being, but after prolonged use, addicts continue using to avoid painful withdrawal symptoms.

Most Americans are familiar with the dangers of heroin from popular culture. But more recently developed and aggressively marketed prescription pharmaceutical opioids can be as addictive, or even more addictive than heroin, which itself was developed over a century ago as an analgesic that was initially believed to be less addictive than opium.[6] Fentanyl, the most recently FDA-approved opioid, came to market a decade ago and is 40-50 times more potent than heroin.[7]

Signs of Addiction
Are you worried that you or someone you love may be addicted to prescription opioids? Here are some warning signs of opioid addiction:[8]

• Taking more than was prescribed, or for a longer time than was intended.
• Desire or craving for opioids, and/or an inability to cut down.
• Inability to fulfill work, school, family or other community obligations due to opioid use.
• Spending a lot of time seeking, using, or recovering from opioid use.
• Continued use despite social repercussions (job loss, personal conflicts, etc.).
• Choosing opioid use to the exclusion of work or recreational activities.
• Choosing opioid use in situations that puts yourself or loved ones in danger of physical harm.
• Continued use despite knowing that physical or psychological problems are caused or worsened by opioid use.
• Need for increasing amounts of opioids to achieve desired effects, or not being able to achieve the desired effect with the same amount of opioids.
• Symptoms of opioid withdrawal when trying to quit. These can include agitation, anxiety, muscle aches, increased tearing, insomnia, runny nose, sweating, yawning, and after longer amounts of time can include abdominal cramping, diarrhea, dilated pupils, goose bumps, nausea, and vomiting.[9] 

Treatment Options for Opioid Addiction
Treatment for opioid addiction usually includes a combination of behavior therapy and medications:[10]

• Therapy/rehab: The most successful drug rehabilitation programs combine individual and group therapies, and also focus on the whole person. There are usually other physical or mental health issues that need to be treated at the same time as the addiction itself, for the greatest chance of success.[8]
• Medication: Treatments for opioid addiction include methadone, buprenorphine, and naltrexone, and new treatments are being developed all the time (an implant was just approved by the FDA in late May that experts hope will decrease opioid dependence).[11]

There are many resources available to help find the right treatment for you or your loved one:

• The Substance Abuse and Mental Health Services Administration (SAMHSA) is a federal agency whose mission is to deal with the impact of substance abuse and mental health issues in communities. The SAMHSA website[12] has many resources understanding addiction, and for getting help. They also have a locator[13] that can find treatment resources in your area.
• Support groups like Narcotics Anonymous or SMART Recovery can be indispensable to long term recovery.
• The SAMHSA National Help Line at 1-800-662-HELP (4357) has live operators providing assistance that can find local resources 24 hours a day, 365 days a year.
• The National Institute on Drug Abuse (NIDA) has the latest information on drug treatment, treatment options, and links to many treatment resources including clinical trials that may be recruiting.
• The Partnership for Drug-Free Kids (drugfree.org) specializes in providing resources and information for parents of teens.
• The National Suicide Prevention Lifeline: Call 24/7 1-800-273-TALK (8255)

 
Dealing with addiction can feel very overwhelming and isolating. If you or someone you love is struggling with an opioid addiction, please know that you’re not alone. Reach out for help today.

Sources
[1] Al-Hasani R, Bruchas MR. Molecular Mechanisms of Opioid Receptor-Dependent Signaling and Behavior. Anesthesiology. 2011 December; 115(6): 1363–1381. [2] Volkow, ND. What Science tells us About Opioid Abuse and Addiction. National Institute on Drug Abuse. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/what-science-tells-us-about-opioid-abuse-addiction. Accessed May 26, 2016.

[3] Injury Prevention & Control: Opioid Overdose, Overview of an Epidemic. Centers for Disease Control and Prevention. http://www.cdc.gov/drugoverdose/data/index.html. Updated March 14, 2016. Accessed May 29, 2016.

[4] America’s Addiction Epidemic. http://www.theguardian.com/us-news/series/americas-addiction-epidemic. Accessed May 29, 2016.

[5] DrugFacts: Heroin. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/heroin. Updated October 2014. Accessed May 29, 2016.

[6] Le Merrer J, Becker JA, Befort K, Kieffer BL. Reward processing by the opioid system in the brain. Physiol Rev. 2009 Oct;89(4):1379-412.

[7] Injury Prevention & Control: Opioid Overdose, Fentanyl Overdose Data. Centers for Disease Control and Prevention. http://www.cdc.gov/drugoverdose/data/fentanyl.html Updated May 10, 2016. Accessed May 29, 2016.

[8] Preda A. Opioid Abuse Clinical Presentation. MedScape. http://emedicine.medscape.com/article/287790-clinical Updated March 16, 2016. Accessed May 29, 2016.

[9] Opiate and opioid withdrawal. National Library of Medicine MedlinePlus. https://www.nlm.nih.gov/medlineplus/ency/article/000949.htm. Updated May 3, 2015. Accessed May 29, 2016.

[10] Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/what-drug-addiction-treatment. Updated December 2012. Accessed May 29, 2016.

[11] FDA approves first buprenorphine implant for treatment of opioid dependence  [FDA news release]. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm503719.htm. Published May 26, 2016. Accessed May 29, 2016.

[12] Substance Abuse and Mental Health Services Administration website. http://www.samhsa.gov. Accessed May 29, 2016.

[13] Behavioral Health Treatment Services Locator. Substance Abuse and Mental Health Services Administration website.  https://findtreatment.samhsa.gov/ Accessed May 29, 2016.

Westminster, CO. Gwen Murphy, PhD, has been elected to the position of Membership Director of the Rocky Mountain Chapter of the American Medical Writers Association (AMWA-RMC) for the 2016-2017 term. The Rocky Mountain chapter includes Colorado, Wyoming, and Utah.
 
“I’m thrilled to be able to give back to this wonderful organization by providing support to new members as membership director of Rocky Mountain AMWA.”
 
AMWA is a nonprofit professional organization that promotes excellence in biomedical communication. For more information, visit: http://www.amwa-rmc.org/

"Structural Racism and the Unfulfilled Promises of Personalized Medicine: Clinical trials in the Age of Colorblindness"

In this roundtable discussion, participants will discuss issues related to race in clinical trials.  Personalized medicine has begun to shine a light on ethnic and racial differences in drug responses, drug metabolism, and disease susceptibility. However, despite long-acknowledged differences, the vast majority of clinical trial participants are still white. We’ll collaboratively address structural barriers, ethical dimensions, and how to write professionally, accurately and sensitively about race issues in medical reporting.

Friday, October 7, 12:15-1:45 PM.  Lunch will be provided. Space is very limited, to give each participant a chance to contribute to this rich topic in a safe, intimate environment. Register today!

2016 AMWA Medical Writing & Communication Conference
Sheraton Denver Downtown Hotel, 1550 Court Place, Denver, CO 80202
October 5, 2016 - October 8, 2016
http://www.amwa.org/calendar_day.asp?date=10/5/2016