Opioid Epidemic (no humor here)

     We are reading and hearing more frequently that this country is in crisis regarding opioid use. What are opioids?

     "Opioid" is a "blanket term used for any drug which binds to the opioid receptors in the central nerous system or gastrointestinal tract" (Yahoo Answers:  difference between opioids, opiates, and benzodiazepines).
Opioids are used primarily to relieve pain.

Natural opiates are Morphine, Codiene, and Thebaine.
Semi-synthetic opioids are Heroin, Oxycodone, Hydrocodone, Dihydrocodene, Hydromorphone, Oxymorphone, Buprenorphine, Etorphine, Naloxone, and Nicomorphine.
Synthetic opioids include Methadone, Pethidine (Demerol), Fentanyl Alfentanil, Sufentanil, Remifentanil, Carfentanyl, Pentazocine, Phenazocine, Tramadol, and Loperamide.

     Before there were pain relievers, humans relied on the natural world to ease suffering.  The Sumerians used opium from the poppy by 3400 B..C.  They shared the pain-relieving potential of this plant with the Assyrians, who passed it to the Egyptians.  Alexander the Great took it to India, and from there opiates spread around the world.

     Opium, opiates, and opioids all produce similar effects.  At low doses they make effective painkillers.  At medium to high doses they produce euphoria, nausea, sleepiness, a sense of peace. They can be extremely addictive mentally and physically, the body craving more and more to reach the same state of euphoria over time. All are depressants.

     On August 31, 2016, the FDA announced it would require boxed warnings on prescription opioid analgesics, opioid-containing cough products, and a class of drugs called benzodiazepines regarding the serious risks when these medications are used together.  Overdose deaths tripled involving concomitant use of these drugs between 2004-2011 (AmericanAssociationFamilyPhysicians.org/news/health-of-the-public). For patients taking both classes of medications, there are non-sedating anti-depressants that can be used in place of benzodiazepines.

     What are benzodiazepines?  Benzodiazepines are among the most commonly prescribed depressant medications in the U.S. today.  More than fifteen different types exist to treat a wide array of psychological and physical maladies, whose treatment might be used for:  anxiety relief; hypnotic; muscle relaxant; anti-convulsant; or amnesiatic (mild memory-loss inducer).  These drugs affect a key neurotransmitter in the brain, slowing or stopping neuronal (nerve) impulses throughout the body. A short-acting benzodiazepine is cleaned from the body in a short time, whereas long-acting benzodiazepines may either accumulate in the bloodstream or take a much longer time to leave the body.

     The DEA has cracked down on the medical use of synthetic narcotics such as OxyContin and Lorcet, Lortab, Norco, and Vicodin.  Therefore, many physicians have been scared to prescribe such medications.  However, opioids play a key role in easing pain for people at the end of life.

     The controversy focuses on the treatment of chronic non-cancer pain.  The Center for Medicare and Medicaid Services has drafted a policy that would make it difficult or impossible for these patients to get prescriptions for such medications. Many of the chronic-pain patients are now suffering withdrawal symptoms because they can no longer access medications that allowed them to function (Palm Beach Post, "Health and Beauty," March 19, 2017, pg. F5).

     Palm Beach County, Florida, is in the midst of an opioid crisis. A person died every other day of a heroin-related overdose in 2015 - more than all fatal car crashes and double the number of homicides. In 2016, there were more than 500 deaths in the County from heroin (Palm Beach Post, "Opioid Crisis Puts County in Spotlight," pgs. 1 & 5, February 27, 2017).  At a recent conference in Washington, D.C., community leaders from across the nation shared horror stories and solutions. The most common recommendation was for all first-responders, including police and deputies, to carry and use the overdose antidote naloxone.

     In Palm Beach County, a few police departments use naloxone, but P.B.C. Sheriff Bradshaw refuses to let his deputies carry it, citing liability issues.

     "It still shocks me when I hear of jurisdictions that don't have a Narcan or naloxone program. There's no downside to it," said Assistant Police Chief Russ Hamill from Montgomery County, Md. "You're not going to hurt anybody."