Sunday, March 3, 2019

Opioids: The Scourge That Is Comin

I have lived long enough that I have seen various “drug eras” come and go, often decimating families, communities, cities and other institutions, not to mention killing and destroying the lives of millions of individuals in our country.  I was a young child in the ’60’s but was well aware of young people experimenting with weed, LSD, and a variety of other things, and had an extended family member that did a pretty good job of messing up his life due to his addictions.  I remember reading about the horrible experiences people were having with heroin, particularly when they were trying to shake the monkey and get off that drug that controlled their lives.  The cocaine-obsessed party culture of the 1980’s followed by the crack epidemic established some of the most powerful criminal organizations in the world that still have to be reckoned with.  And now, we are seeing parts of our country once again battling a vicious foe.  In March of 2017 the governor of Maryland declared a State of Emergency because of the toll it was taking in that state.  In Maine, New Hampshire, West Virginia, and Ohio the rate of death by overdose is climbing at a never before seen rate.  Nationally, the present epidemic has the highest opioid death rate ever with an average of 10.3 per 100,000 dying because of the drug.  We don’t hear much about it in Iowa, but within the past year, recorded incidents of opioid overdoses have taken place in northeast Iowa and in Fayette County.

The crazy thing about this plague is that in large part most people get addicted to opioids by using it legally.  According to the U.S. Surgeon General, this crisis started with the over-prescription of powerful opioid pain relievers in the 1990’s, and shortly after that, they because the most prescribed class of medications in the United States with over 289 million prescriptions being written in 2016.  The most common of the opioid pain killers are oxycodone (OxyContin and Percocet) and hydrocodone (Vicodin).  These very potent drugs are far more powerful than an opioid that more people have heard of, morphine.  Two other types of opioid that are getting a lot of attention now are fentanyl and the incredibly dangerous carfentanil, the later being 1o,000 times more potent than morphine!  And of course, once addicts cannot afford or get their hands on the pills they want, they can get a much cheaper opioid on the streets, heroin.

The reality is that these drugs are highly addictive.  With doctors diagnosing about a third of the population with chronic pain in the late 1990’s, drug companies went into overdrive to produce these pain killing drugs.  And, they worked, at least for a period of time.  And since they did work, patients wanted and used them, and gave little heed to their addictive nature.  The problem is that some patients continued to take the medication beyond what their doctor prescribed.  Perhaps it was to continue to minimize pain, or maybe for the euphoric rush that it gives.  Just like heroin junkies in the 1960’s that feeling of euphoria after a hit was something their body craved.

As shared by Assistant United States Attorney Patrick Reinhart at a community meeting held at NFVHS in early 2018, this is a United States crisis as 80% of the opioid produced in the world is consumed by Americans.  Not only that, it is a crisis that is currently centered in the northeast and midwest with the number of deaths related to opioid increasing by 4x since 2000.  In Iowa,  while not quite the crisis as it is in states to the east, it is still dramatic as can be seen from the chart below.

In talking with a friend that lives in southeast Ohio, every week there is reference in the newspaper to another opioid related death.  Towns in that region, as well as parts of Pennsylvania, Indiana, and West Virginia have gone broke trying to deal with the economic costs of the crisis.  Medical examiners and coroners in some communities have quit because of the volume of victims that have literally piled up.  In fact, in some areas they have had to resort to commercial refrigerated facilities and even trucks to serve as makeshift morgues.  Just a few weeks ago over 40 people in the same park in Connecticut had to receive medical attention because the synthetic marijuana they had all purchased from a dealer was tainted with fentanyl.

As mentioned above, law enforcement has dealt with opioids in Fayette County.  What is particularly concerning for me is that we have a number of young people in our community that use drugs.  It is a reality, and what I worry about is that someone is going to get something that is tainted with one of these powerful substances and die.  I have heard that different agencies in Iowa are handing out Narcan, a nasal mist used  in emergency situations to block the effects of opioids, so they have it on hand in case they come across someone who overdoses.  It has be pretty serious when steps like this are being taken.

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