"International Overdose Awareness Day (IOAD) is a global event held on August 31st each year and aims to raise awareness of overdose and reduce the stigma of a drug-related death. It also acknowledges the grief felt by families and friends remembering those who have met with death or permanent injury as a result of drug overdose."[1]
What is Addiction?
I doubt there's a person who hasn't heard about the "epidemic" of opioid addiction. Unfortunately, this is an epidemic with a high mortality rate, with limited research or resources dedicated to its control. What is addiction? "Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences." [2]
Who is Susceptible to Addiction?
Unlike some misconceptions, addiction is not due to a lack of will or weakness. Addiction knows no boundaries, and can happen to people of any socioeconomic group, as well as any gender or race. It truly is a disease without a face. It's often repeated: Look to the left or to the right.
That's what a heroin addict looks like.
A person doesn't want to be an addict. Initiation into use of drugs can start innocently, frequently, with the legitimate use of prescription pain medicine, most often, opiates. Unfortunately, opiates have a surreptitious, cumulative effect on the human brain. When a drug reaches an opiate receptor, it releases dopamine, the neurotransmitter that produces a sense of pleasure. With repeated use, the need for this 'high' becomes paramount, overtaking all other aspects of life. To reach the anticipated high, ever increasing doses of the drug are needed, as the brain has reduced its production of dopamine, in a feedback loop due to the overproduction from the drug.
People can source drugs from seemingly innocent places: family, friends, and physicians, in addition to drug dealers. If a teenager starts using drugs or alcohol, the chances of their becoming addicted rises exponentially. The immaturity of the teenage brain makes it particularly susceptible to the effects of drugs and alcohol.Why do some people become addicts and not others? Ultimately, it's an unpredictable combination of biology, environment, and development. There are complex and multifaceted components of a risk for addiction. Parents take a lot of blame for an addicted child, or one who dies from an overdose; however, that's a judgment without scientific merit.
An Epidemic
Addicts and addiction have been part of society forever, why the current interest and concern? Certainly, the increased incidence is the catalyst. According to an article by the New York Times, deaths from opioid use reached 59,000 in 2016, and is now the leading cause of death of Americans under 50. Their research indicated that approximately 76% of deaths during the time studied were from overdoses.[3] Substances most often found in overdoses include cocaine, non-opioid analgesics (i.e., NSAIDS) and opioids. Opioids include heroin, morphine, methadone, codeine, and oxycodone.
The New Dangers of Heroin
So why the surge in overdoses? Previously, cocaine and meth were the drugs associated with overdoses. With the increase in prescriptions of opiates for pain, however, they soon became the drug of choice. Use of prescription opioids has become too costly for many; however, heroin is cheap. Drug dealers are always looking for a way to increase profits, and heroin can be 'cut' with a cheaper, visually undetectable substance; thus, enters Fentanyl, the eye of the tiger.
Fentanyl is a manufactured opioid now frequently used to stretch the content of, or replace, heroin. Carfentanil is a form of Fentanyl, an elephant tranquilizer, 5.000 times stronger than heroin. In a statement by Captain Michael Shearer, commander of the Narcotics Unit for the Akron Police Department.: "July 5th, 2016 - that's the day carfentanil hit the streets of Akron. On that day, 17 people overdosed and one person died in a span of nine hours." In the Dayton area, out of 100 overdoses in a two-month period, only 3 tested positive for heroin. Ninety-nine tested positive for Fentanyl or a derivative.[4]
Fentanyl/Carfentanil can be so powerful, that Narcan, a drug used to counter the effects of an opiate overdose, often has to be given in multiple doses to work. It's been reported that as many as 14 doses have been given without effect.
Prognosis
Addiction is a complex, chronic disease that has no cure. That doesn't mean that it cannot be treated; however, treatment is complicated and ongoing follow-up is required, as relapses are to be expected. Essentially, it's not very different from diabetes or heart disease, except for the stigma associated with it. Prevention is the ultimate goal. Programs by schools, conversations with parents, and media have been proven to reduce the use of substances. For those with an existing addiction, behavioral therapy combined with addiction treatment produces the best outcomes. With the availability of Narcan in certain states in the hands of EMS, with early intervention, the effects of opiates can be reversed. (See above about complications of Fentanyl derviatives) Please remember that persons with a dual diagnosis, like bipolar disorder, require interventions targeted to their specific challenges.
New Perspectives
Because of the failure of the war on drugs, other, sometimes controversial approaches are being tried, e.g. clinics that allow safe use of drugs while reducing doses, simultaneously providing behavioral support. Buffalo has introduced the nation's first Opiate Crisis Intervention Court. Judge Craig Hannah, a recovering addict, offers an option to the punishment imposed by the legal system, recognizing that addiction is a medical issue. The only requisite for his court is opiate drug abuse. "Everyone who comes through the court is essentially offered a deal: complete addiction treatment, and prosecutors may look favorably at reducing the charges against them." Erie County averaged one death from opiates daily. The Opiate Crisis Court has not suffered the death of one person who's gone through the court.[5]
Addiction to any substance is now recognized as a serious social problem with a medical cause. It effects all of us in some way, either by loss of a friend or loved one, or through the costs to our medical system, etc. It's important to learn all that you can about addiction, evaluate your own habits, and be part of a cure, be it through donations, advocacy, or fighting stigma.
There are multiple sources of detailed information, including SAMSHA (https://www.samhsa.gov/), and NIMH (https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health/index.shtml).
An excellent reference for determining if your child is abusing a substance is: (https://www.health.ny.gov/publications/1089.pdf)
The September 2017 edition of National Geographic presents new discoveries and how they can affect the addicted brain.
Remember
ADDICTION IS A DISEASE
TALK ABOUT ADDICTION AND OVERDOSE
THERE IS NO ROOM FOR STIGMA
AN OVERDOSE CAN HAPPEN TO ANYONE
IT COULD BE SOMEONE YOU KNOW
OVERDOSES ARE PREVENTABLE
WHAT AN OVERDOSE LOOKS LIKE:WON'T WAKE UP? GET HELP
UNUSUAL SNORING AND CANNOT BE AWAKENED? GET HELP
NARCAN (NALOXONE) SAVES LIVES, ADVOCATE FOR EMS AVAILABILITY
LEARN RESCUE BREATHING... IT COULD SAVE A LIFE
Suggestions from International Overdose Awareness Day website.
(https://www.overdoseday.com/)[1]
(https://www.overdoseday.com)[2]
www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction[3]
(https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?mcubz=0)[4]
(https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?mcubz=0 )[5]
(https://www.theguardian.com/us-news/2017/aug/20/opioid-crisis-america-buffalo-new-york-trump-national-emergency?[6])