In recent years, the United States has seen an alarming spike in opioid overdoses. From prescription painkillers to street drugs like heroin, opioid abuse has led to widespread addiction and all too often, death. Today, development of the counterdrug Narcan is serving to combat the growing problem and save the lives of those affected.
To find out more about this epidemic and what’s being done about it, “Take Care” spoke with emergency medicine physician and Baltimore Health Commissioner, Dr. Leana Wen. Later, we'll also speak to a survivor who overdosed twice and is now living his life (drug-free), thanks to Narcan.
Opioids, Wen explains, are derived from the opium found in poppies. Heroin, for example – an illegal, schedule I narcotic -- is an opioid. But you can also find opioids behind the pharmacy counter, in prescription drugs such as Oxycodone, OxyContin, Percocet, and morphine. And despite their legality, these drugs have similar effects to heroin, including euphoria … and addiction. Prescription painkillers are meant to treat severe pain, but when abused, yield disastrous results.
Medical professionals are trained to minimize patients’ pain as much as possible, and this often means prescribing opioids. For example, Wen can recall “routinely prescribing” these painkillers for people who did not necessarily need them. In our culture, she explains, it is essentially expected to prescribe something – anything – even for moderate pain. And in order to feel completely pain free many people need a strong prescription, thus increasing the risk of abuse.
According to Wen, there are enough opioid prescriptions written annually that every American adult could have a bottle. Aggressive marketing by the pharmaceutical industry, as well as the nonchalance of physicians’ prescriptions have made it all too easy for patients to receive these drugs. And further, says Wen, patients themselves frequently request painkillers before considering rest, physical therapy, or simply waiting it out.
Sometimes, the drugs serve their purpose and the patient is fine. But other times, perhaps the individual doesn’t finish their entire bottle. Those pills are then available at a later date for them, or someone else. In fact, says Wen, many cases she’s seen were the result of someone taking someone else’s prescription.
In 2015, she says, there were 390 lives lost to overdose in Baltimore alone. That’s roughly one person per day. This number outweighs homicide, car accidents, and suicide.
Addiction, Wen stresses, has no face; it is an epidemic -- a public health emergency -- and needs to be treated as such.
And, in Baltimore, it is. As the problem persists, so have the efforts to solve it. The counteractive drug Naloxone (commonly known as Narcan), which can completely reverse an overdose, is becoming increasingly available to health professionals everywhere, especially in Baltimore.
In October 2015, legislation was passed in Baltimore in which Wen became the single prescriber of Narcan to every resident of Baltimore. It was, she says, a blanket prescription issued to everyone, and resulted in more than 18,000 trainings throughout the city.
Training is required in order to receive Narcan, as it is administered through an intermuscular needle (similar to an EpiPen) or a nasal spray. The Baltimore Health Department negotiated with Medicaid so residents on the program can receive it for just a dollar, sometimes less. Prices for Narcan have skyrocketed. One dose can be roughly $100, and it’s recommended to have two doses available in case one isn’t enough.
Wen spearheaded the Narcan campaign just over a year ago, and she says since then, 620 Baltimore citizens have been saved.
This is so important, she says, because in an overdose, passing minutes can be a matter of life and death. To have Narcan readily available is literally a life saver. But still, unprecedented numbers of people are dying from overdoses, and Narcan does not treat addiction. It is only meant to counteract the overdose, and does not address the root of the problem.
There is a tremendous amount of stigma and misunderstanding surrounding addiction, leading many to believe it is some sort of moral failing. But addiction, Wen stresses, does not discriminate. Science tells us for certain that addiction is a chronic brain disease, and further, opioids are some of the most addictive substances out there. Treatment works and recovery is possible, but it is an investment that takes patience and time, according to Wen.
Baltimore residents, she says, are experiencing a shift in thinking regarding addiction, through education, understanding, and compassion for their neighbors. Virtually everyone knows someone affected, and after all, you wouldn’t tell someone with a peanut allergy not to have an EpiPen, or a person with cancer not to receive chemotherapy. Addiction is a disease, and addicts deserve proper treatment.
So, what is there to do? According to Wen, we need to start with the understanding that addiction is a disease, and a public health approach is important. And what’s more, treatment does work, but availability is minimal. In fact, only 1 in 10 opioid users seeking addiction treatment is able to receive the help they need. Treating addiction as a crime, Wen says, is unscientific, inhumane, and doesn’t solve anything, and all of us must treat it with the urgency and compassion we would with any other disease.
Painkillers: prescription or affliction?
When a water heater fell on him one fateful day at work, John Dias’ life was forever changed. He awoke in the hospital, partially paralyzed, and when he left, he had a prescription for OxyContin. But like so many others, his prescription became his affliction, resulting in a severe addiction and eventual overdoses.
In recent years, this occurrence has become all too common, leading to the development of the antidote naloxone – the very medicine which revived Dias on two separate occasions. To find out more about his story, “Take Care” spoke with Dias, who opened up about his experience and the importance of naloxone, also known by the brand name Narcan.
After the initial injury, Dias had three surgeries on his neck and back -- two on his shoulders, and one on his elbow. With each surgery, his doctors and pain management team continued to refill his prescription. He had a written prescription for OxyContin for almost two years.
For the first year or so, Dias says, he took the painkillers as advised, but soon realized he was developing a dependence. He had a brief stint with pain medications following an injury in his early 20s, he explains, but he stopped taking them once the prescription was finished. He could recognize the same dependence developing, but when he told his doctor he didn’t want any more surgeries because he was addicted to the painkillers, his doctor and pain management team “kicked me out of their office and told me I was a liability,” he says.
Dias says he was escorted out of the building without any mention of addiction services. He had hoped that expressing his concerns to his doctor would merit a referral to a rehabilitation center, but he says that is far from what he says he got.
With no more access to the written prescription, Dias turned to the streets to find painkillers. And at this point, he says, it was no longer about the pain. He was addicted. And when he couldn’t afford the price of pills, heroin became a cheaper alternative. For the cost of one pill, he could get an entire day’s worth of heroin. And this went on for 6 months.
He overdosed twice, and was revived by Narcan administered by paramedics in both instances.
“My face was blue and my lips were white when they found me. I had vomit all over me and I was choking on it,” he says.
After the second overdose, Dias was able to get clean. And what needs to be understood, according to him, is that people of all walks of life can become addicts.
“When you are addicted, you are a different person,” he says.
Were it not for Narcan, Dias says he would have died. Since its development, it has saved countless lives, but not everyone is so lucky. In fact, Dias says his own brother might still be alive had there been Narcan available at the time of his overdose. But unfortunately, says Dias, there wasn’t.
As the number of overdoses continues to soar, accessibility to Narcan is becoming increasingly important. Those in the public health sector, like Baltimore Health Commissioner, Dr. Leana Wen, are pushing for Narcan training in their cities, to reduce the number of lives cut short as a result of drug abuse. Addiction is a disease, but through proper education, training, and availability to Narcan, health officials hope to prevent people from overdosing and revive those who do.