The Opioid Crisis

By: Anne M. Perry, AEMT-P, CET, CPT

Opiates have been used by humans for thousands of years. Their recreational and medicinal uses have been recorded for millennia. Opiates mimic endorphins, which are produced in the pituitary gland and secreted in response to stress and pain.

The Opioid Crisis, is not new to America or the world.  It is believed that Neanderthals used opium over thirty thousand years ago.  Egyptian Pharoahs were buried with opium plant renderings.

There was a time, that when you were in need of medical intervention, you were hospitalized and your pain control was handled in-patient, as your admission lasted over several days to weeks.  Today, admission duration for a cholecystectomy is only six hours.  A Cesarean Section is discharged within four days, whereas thirty years ago, your hospital admission lasted almost ten days. Pain control now, needs to be managed at home. It was more cost effective to prescribe sixty Vicodin, for home administration, than to keep the patient in the hospital for five or six extra days, just for pain control.

Pharmaceutical companies either did not understand the true action of their opiate medications or they lied to the prescribing physicians.  Physicians were told that medications like oxycontin, oxycodone and hydromorphone were not addicting. They believed it was safe to prescribe opiate pain relievers to their patients for a month or more. Physicians were led to believe that these medications were not addictive.

In truth, a patient taking an opiate, whether it be codeine, hydromorphone or oxycodone; for fourteen days, as prescribed (one to two tablets every four to six hours as needed for pain), would become physiologically dependent on the drug.  The body would suffer withdrawal symptoms of rhinorrhea, piloerection, diarrhea, joint and muscle pain, sneezing, abdominal cramping and an overall feeling of malaise.  What alleviated these symptoms?  Another dose of their pain medication.

Physiological dependence is not addiction. They are two different medical issues.  Dependence is an issue that can be easily managed by reducing the medication dosage amount and frequency.  Addiction is a psychological issue that is complex and will need ongoing, multidisciplinary treatment.  Addiction is the continued usage of the medication beyond its therapeutic need.

Beginning in the 1990s, doctors began to prescribe pain medication, liberally to their patients. Patients had myriad reasons for needing pain medication and doctors now believed that a patient who is pain free, heals faster and has fewer complications during the recovery process. This only reinforced the prescribing of more opiates. A generation of potential addicts were introduced to a group of drugs that made addiction easy. These medications were easy to obtain, in fairly large quantities.

Along with patients who truly were suffering and in need of pain management, there were those who understood that they could divert these medications and generate income or even trade favors.  Doctors had no way to monitor whether their patients were in fact the consumers of the 360 pills a month they were prescribing.  A new revenue stream was made and those who were abusing had a supplier.

This went on for decades.  Until the incidence of overdose began to rise and a few celebrities accidentally died from multiple drug intoxication.  This brought the epidemic to the forefront.  Authorities were desperate to stem the flood of overdoses from opiate derived prescription medications and illicit drugs.

We now have restrictions on how often and how many pills a patient can receive, along with reduced dosing guidelines. These changes have been made abruptly, with the intent to halt the diversion of the medications and overdoses. What these new laws have not addressed, are all the patients who have been taking these meds religiously for chronic pain, who do not abuse the medications and truly need them. These patients need a program to allow for reduction of dose over time.  They have not received any such program.

What does this mean? Those that were able to get their hands on black market opiates, have had their supply dry up, those that were always abiding the law are now victims in this new opiate reduced era.  This leaves both groups scrambling for supply.  This has been a boon for the Heroin trade. Former law-abiding citizens, have now turned to illegal activity just for pain control measures.

The poor planning on behalf of the authorities, has now created a revenue stream for dealers and a large number of fatal overdoses from heroin, laced with fentanyl and carfentanil. Pre-hospital care providers, now use more naloxone than ever before.  We are seeing patients from every single age, socio-economic and geographic group, overdosing on heroin and prescription opiates.

The crisis today, is a multifaceted problem, that has yet to receive a multifaceted solution.  Until a plan is put in place to address every facet of the problem, our response to overdoses will continue to rise, as will the death toll.

 

Anne began her career in EMS in 1992 as a Basic EMT.  The next logical step for her was teaching, which began in 1994 with CPR and Lab Instructing. Anne went on to achieve her Paramedic in 1998. She has worked in both Career/Commercial EMS and Volunteer Organizations. Most of her time today is spent educating Medical Professionals from Basic EMTs, to Phlebotomy and EKG Technicians at a local private college and is a Lead EMS Instructor for Medic-CE, teaching Paramedic and EMT refresher coursework.  EMS has taught her that she is a life long learner and to that end, has returned to school, pursuing her BSN, while completing multiple Teaching Certifications for EMS Educating.

 

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