Posts Tagged ‘Opioids’

Opioids are a class of medication that include heroin, as well as prescriptions medications such as:

• morphine
• codeine
• methadone
• oxycodone (Oxycontin, Percocet)
• hydrocodone (Vicodin, Norco)
• fentanyl (Duragesic), hydromorphone (Dilaudid)
• buprenorphine (Subutex, Suboxone).

Opioids are extremely effective in controlling pain; however, they also carry risks such as significant constipation, physical dependence, and respiratory depression. Respiratory depression is also known as an “opioid overdose,” and occurs when breathing slows or stops, leading to death. This is why it is important to be careful when using these medications.

What are the risks of an opioid overdose?

You are more likely to experience an opioid overdose if you:

• Take 50 morphine milligram equivalents (MME) or more of prescribed opioids every day

• Take opioid medications together with other sedating drugs, such as benzodiazepines and muscle relaxers

• Have conditions such as lung disease, kidney dysfunction, liver dysfunction, or if you are HIV-positive

• Have a decreased tolerance due to recent abstinence or break in therapy

• Have a history of illicit substance use disorder

• Have a history of overdose from opioids

• Use any illicit drugs or have an opioid use disorder

How can an opioid overdose be prevented/stopped?

Avoid the risk factors listed above at all costs. If you are prescribed opioid medications by a physician, it is important to take them as sparingly as possible, and no more than prescribed. If you have a substance use disorder, talk to your doctor about seeking treatment.

In an overdose, Narcan ® (naloxone) is a medication that rapidly reverses the effects of opioids long enough to call an ambulance. The Centers for Disease Control and Prevention (CDC) recommends that naloxone be provided to all patients who have or know someone with risk factors for opioid overdose. Extensive administration education is provided to all who receive the medication.

Overview of naloxone:

Naloxone (nal-OKS-one) blocks the effects of opioids on the brain and restores breathing. It is safe to give to anyone who is experiencing a known or suspected overdose caused by opioids. It has very few side effects and drug interactions. It will produce withdrawal symptoms. In situations where an overdose was caused by non-opioid drugs, naloxone will not be effective.

Naloxone only lasts 30-60 minutes in the body, but opioid medications typically last much longer. That is why it is so important that if someone receives naloxone, emergency medicine services (9-1-1) are called and that they go to the hospital. As soon as naloxone wears off, the risk of overdosing returns.

Keep naloxone on hand if you or someone you know has risk factors for opioid-related overdose. It’s like having a fire extinguisher – hopefully you will not need to use it, but it can be the difference between life and death.

If you are at risk for opioid overdose, educate your family and others around you on how and when to use naloxone.

How do I get naloxone?

Naloxone can be accessed at many pharmacies and public health agencies. If you believe you or someone you know has risk factors for an opioid overdose, ask your pharmacist or health department about accessing naloxone.

How do I use naloxone and recognize an overdose?

1. The signs of an overdose include:

   1. Slow breathing (less than 1 breath every 5 seconds) or no breathing

   2. Vomiting

   3. Pale and clammy face

   4. Blue lips or nails

   5. Slow heartbeat

   6. Snoring or gurgling noises

   7. Unresponsive

2. Try to wake the person

3. Call 9-1-1

4. Make sure nothing is in the person’s mouth

5. Give rescue breathing

6. Use naloxone and continue rescue breathing

7. Turn the person on their side if the person begins breathing on their own. This is to avoid choking.

8. Stay with the person until EMS arrives

Visit the State of Ohio Board of Pharmacy website for more information on administering naloxone.   https://www.pharmacy.ohio.gov/Pubs/NaloxoneResources.aspx

References:

NARCAN nasal spray. ADAPT Pharma. https://www.narcan.com/. Accessed June 10, 2020.

Naloxone resources: pharmacist dispensing of naloxone. State of Ohio Board of Pharmacy.https://www.pharmacy.ohio.gov/Pubs/NaloxoneResources.aspx. Accessed June 10, 2020.

Prevention of lethal opioid overdose in the community. UpToDate. Wolters Kluwer. Available athttps://www.uptodate.com. Accessed June 9, 2020.

Streamline processes for providing naloxone. Pharmacist’s Letter. 2018.https://pharmacist.therapeuticresearch.com. Accessed June 9, 2020.

Images:

1. https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/ohio-opioid-involved-deaths-related-harms

2. https://www.narcan.com/

3. https://www.narcan.com/

In a statement issued by Ohio Attorney General Mike DeWine, he accused five leading drug manufacturers of providing a dishonest and misleading representation of the true risks of taking opioid painkiller medications.

“We believe the evidence will also show that these companies got thousands and thousands of Ohioans — our friends, our family members, our co-workers, our kids — addicted to opioid pain medications, which has all too often led to use of the cheaper alternatives of heroin and synthetic opioids.  These drug manufacturers led prescribers to believe that opioids were not addictive, that addiction was an easy thing to overcome, or that addiction could actually be treated by taking even more opioids. They knew they were wrong, but they did it anyway — and they continue to do it.  Despite all evidence to the contrary about the addictive nature of these pain medications, they are doing precious little to take responsibility for their actions and to tell the public the truth.” – Mike DeWine

Ohio’s legal action against Janssen Pharmaceuticals, Teva Pharmaceutical Industries, Purdue Pharma, Allergen, and Endo Health Solutions comes shortly after a lawsuit issued by the Attorney General of Mississippi with similar implications. More states are following suit. Missouri announced on June 21 that it will also be suing drug manufacturers of opioid analgesics. Ohio’s lawsuit suggests that these manufacturers misinformed doctors regarding the potential dangers of prescription opioids in order to increase sales.

The lawsuit could result in the drug companies being required to pay a huge sum of money. Aside from the hundreds of millions of dollars spent on prescription opioids in the past decade by state-funded programs like The Ohio Bureau of Workman’s Compensation and Medicaid, there are additional substantial costs associated with the opioid epidemic. For example, about $45 million are spent to transition children of addicted parents into foster care. Even more costly, is the $105 million used to treat babies born with neonatal abstinence syndrome, which occurs when a child is born addicted to opioids due to exposure during gestation. Lastly, about $110 million is spent on treatment centers for those recovering from opioid addiction. Ohio argues that many of these costs would have been preventable if the drug companies had been more upfront about the potential risks of prescription painkillers.

Ohio is considered to be a frontrunner in the opioid epidemic and, according to The Columbus Dispatch, had the most fatal drug overdoses of all 50 states in 2016. Montgomery County in Ohio is among the hardest hit. So far this year, 365 individuals have died due to drug overdoses. Montgomery County’s Sheriff reported that they are on track to have 800 overdose deaths this year, which is more than double the county’s total amount in all of 2016. The majority of the opioid-related overdoses are due to heroin or fentanyl, a synthetic opioid that is 50 to 100 times stronger than morphine. These substances are often snorted or injected to cause a rapid high, and can quickly cause physical and emotional dependence.

Four out of five heroin users began by misusing prescription opioids. The Substance Abuse and Mental Health Services Administration defines medication misuse as “the intentional or unintentional use of medication without a prescription, in a way other than prescribed, or for the experience or feeling it causes.”

Despite many different opinions circulating on the lawsuit, all we can hope for is a brighter tomorrow, with a better balance between adequate pain relief for those who need it and support and recovery for those in the community struggling with addiction.

References:

Ohio Attorney General DeWine Files Lawsuit Against Opioid Manufacturers for Fraudulent Marketing; Fueling Opioid Epidemic. Ohio Attorney General News Releases. May 31, 2017. http://www.ohioattorneygeneral.gov/Media/News-Releases/May-2017/Attorney-General-DeWine-Files-Lawsuit-Against-Opio

Borchardt, J. Ohio’s opioid lawsuit against 5 pharma companies: 6 things to know. Cleveland. com. June 16, 2017. http://www.cleveland.com/metro/index.ssf/2017/05/ohios_opioid_lawsuit_against_5.html

Dwyer, C. Ohio Sues 5 Major Drug Companies For ‘Fueling Opioid Epidemic’. National Public Radio. May 31, 2017. http://www.npr.org/sections/thetwo-way/2017/05/31/530929307/ohio-sues-5-major-drug-companies-for-fueling-opioid-epidemic

Johnson, A., Candisky, C. Overdose Deaths Continue to Soar in Ohio. The Columbus Dispatch. May 28, 2017. http://www.dispatch.com/news/20170528/overdose-deaths-continue-to-soar-in-ohio

Llorente, E. Ohio Drug Overdose Deaths in One County Already Top Last Year’s Total. Fox News. June 5, 2017. http://www.foxnews.com/us/2017/06/05/ohio-drug-overdose-deaths-in-one-county-already-top-last-years-total.html

Opioid Addiction: 2016 Facts and Figures. American Society of Addiction Medicine. https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

Prescription Drug Misuse and Abuse. Substance Abuse and Mental Health Services Administration. October 18, 2015. https://www.samhsa.gov/prescription-drug-misuse-abuse

Soboroff, J., Koss, M., Heikkila, A. ‘Mass-Casualty Event’: Ohio County Now Tops U.S. in Overdose Deaths. NBC News. June 19, 2017. http://www.nbcnews.com/news/us-news/mass-casualty-event-ohio-county-now-tops-u-s-overdose-n773936