Opioid crisis calls for more awareness of risks, alternatives

Opioid crisis calls for more awareness of risks, alternatives

There’s another crisis ongoing during the pandemic, and that’s the opioid crisis that continues. The crisis has been well-established since the 1990s, but only recently has it garnered the attention that it deserves. 

Over 130 people a day die from an opioid-related overdose. This epidemic is defined as 70% of all overdose deaths being the result of opioid abuse.

Within our brains and other parts of the body, there are receptors, opioid receptors, that control pain. When stimulated these same receptors can promote feelings of pleasure via the release of endorphins. 

The receptor trigger also releases dopamine, which creates energy and motivates us.  Unfortunately, these same receptors may also cause lower respiration or heart rates, which can be fatal.

What are opiates?

One may have read or heard the terms narcotic, opiate, or opioid. Opiates are substances found in nature that stimulate the same brain receptors. Many are found within the opium poppy plant and include morphine, heroin, and codeine.  

Synthetic or man-made substances include fentanyl and methadone. There are also semi-synthetic substances that are somewhat organic. These include hydrocodone (aka Vicodin) and oxycodone (aka Oxycontin). 

“Opioid” is a broader term that encompasses both natural and synthetic substances. The term narcotic encompasses opium, opium derivatives, or semisynthetic substances. Opioid is the more modern term that encompasses all of the above substances.

Prescription pain medications include all of the above-listed substances, many typically taken orally. This is the case with codeine, hydrocodone, and oxycodone, all commonly prescribed for pain management.  

Illegal street opioids include heroin and opium, which are more likely to be injected, smoked or inhaled. Any of the above drugs are abused by all socioeconomic classes, races, and genders. 

Morphine, fentanyl, and heroin are used to lower pain perception, but may also elicit a feeling of pleasure and sedation with absorption. Opioids are highly addictive and may also cause cessation of breathing or a very low heart rate.

Morphine is the narcotic found in nature derived from the opium of poppy plants and has been known to man for thousands of years. Heroin is also a potent opiate similar to morphine in structure. It is derived from morphine and is two times as potent as morphine.

Fentanyl is not found in nature and is a synthetic opioid prescribed for acute pain. It is similar to morphine, but it is 50 to 100 times more potent. Due to its extreme potency as well as its addiction potential, misuse is very common. Psychological and physical addictions are very possible, and careful supervision is recommended with its use.

Abuse and addiction

Abuse symptoms appear over time if individuals consume opioids contrary to prescribed instructions. Increasing tolerance, inability to function without consuming opioids and illegal behavior to acquire the drugs can be signs of abuse.  

Eventually, withdrawal symptoms may be noted if any opioid is stopped too abruptly after long-term use. Some withdrawal symptoms include sweating, headache, insomnia, irregular heart rate, and irritability. Abuse and withdrawal symptoms combined may lead to problems in life.

Addiction evolves even though abuse symptoms have negative consequences. Regardless. the individual can not stop consuming. Addiction could be due to overprescribing practices or driven by individuals that seek coping mechanisms during times of distress. The pandemic with loss of jobs and livelihoods further exacerbated opioid abuse.  

Unfortunately, fentanyl is increasingly present in opioid overdose situations and is replacing heroin in abuse. Its increased potency leads to more frequent overdosing. 

Relatively inexpensive, fentanyl is added to create cheap compounds that resemble prescription medications. Fentanyl is even added to cocaine or Xanax. This is very dangerous as people are inadvertently dying due to these potent mixtures. 

The reasons behind the crisis are complex, but the solution involves awareness of what is being prescribed or sold on the streets. We all need to be cognizant that none of the opioids is without risk. 

Improved patient awareness regarding alternative pain management as well as providing education is warranted. More time needs to be spent not only discussing the risks of opioids, but also alternatives for treating pain, depression, anxiety, or any stressor of life.  

Sean J. Ennevor, M.D. graduated with a B.A.S. in biology and economics from Stanford University, and as a Dean’s Scholar from UCLA School of Medicine where he received his MD. He completed his medical residency and fellowship in anesthesiology at Yale University, where he was chief resident and on staff. He practiced medicine in the Twin Cities for over 14 years, and presently serves as an advisor and investor for medical technology companies throughout the country.