How do we prevent opioid-related deaths?

Opioid-related overdose deaths continue to rise. But the public doesn’t want to deal with the problem in their city. Data from the Centers for Disease Control and Prevention show that overdose deaths rose nearly 30 percent in 2021.

The pandemic has only exacerbated the opioid crisis. And the crisis doesn’t have an end in sight, as newer, more potent opioids hit the street.

Public health officials are scrambling for solutions and agencies are increasing access to medication-assisted treatment. Communities are still largely opposed to methadone clinics in their town or city. This line of thinking is called “Not In My Neighborhood,” which is known by its acronym: NIMBY.

The only thing it’s doing is creating barriers to public health harm reduction efforts for the opioid epidemic.

Harm Reduction Helps Prevent Opioid-Related Deaths

Harm reduction services like methadone clinics, safety syringe exchanges, and even safe consumption sites are resisted in almost every city.

Sophia lives in New York City. She believes that the implementation of a safe consumption site is a disaster to the city.

“New York is already rife with addiction,” she says. “Bringing a ‘safe consumption site’ will only encourage addicts to swarm neighborhoods to use drugs, bringing crime, violence, and antisocial behavior to the city. I don’t want anything like that in my neighborhood!”

Those concerns are valid, and public safety concerns are important. However, Sophia does not get the full picture. However, medical professionals and researchers are working to shed light on the issue.

The Real Help of Harm Reduction

Dr. C. Debra M. Furr-Holden is an associate professor in the Bloomberg School of Public Health’s Department of Mental Health. She studies the effects of treatment centers on crime. Her Johns Hopkins Bloomberg School of Public Health research suggests there may actually be less serious crime near clinics than other community businesses. In fact, the research shows that drug treatment centers actually attract less crime than liquor stores and convenience stores.

Kathryn Stadeli is a surgical resident at the University of Washington. She is acutely aware of the effects of opioid-related overdoses in the state of Washington. She tells the Seattle Times that overdose-related deaths from fentanyl rose 70 percent in 2018 compared to the previous year.

Stadeli sees many of these deaths firsthand. She feels powerless over them.

“Unfortunately, opioid use disorder (commonly known as addiction) is not a disease I can cut away with a scalpel,” she says.

She suggests, however, that the use of certain medications can reduce the rate of opioid-related deaths by a staggering 50 percent. This method of treating opioid addiction is known as — known as medication-assisted treatment.

The problem: access.

Seattle, like many other cities, needs more medication-assisted treatment centers, like methadone clinics.

Stadeli talks about “Sarah,” whom she treated for a potentially deadly skin infection from injecting opioids. She explains that Sarah developed opioid use disorder after taking oxycodone for a sports injury. Like millions of other Americans who weren’t able to refill their prescription, Sarah turned to injecting heroin and fentanyl.

“I held her trembling hand as we wheeled her to the operating room; the fear invading her beautiful brown eyes when she asked me if she was going to die still haunts me,” Stadeli recalls.

Sarah had struggled to quit using on her own. Despite desperately wanting help, her situation and lack of housing meant that she wasn’t able to access the treatment she needed. Tragically, Sarah died from that infection shortly after her encounter with Stradeli.

“She was 22, and opioids killed her. Deaths like hers are preventable and unacceptable,” says the surgical resident.

The Benefits of Harm Reduction Services

Stadeli underscores the already substantial empirical evidence that that MAT is a far more successful treatment of opioid use disorder than alternatives, like rehab, resulting in less likelihood of overdoses. Those aren’t the only benefits.

The Substance Abuse and Mental Health Services Administration (SAMHSA) demonstrated that medication-assisted treatment:

• Improves patient survival
• Increases retention in treatment
• Decreases illicit opioid use and other criminal activities among people with substance use disorders
• Improves birth outcomes among pregnant women with substance use disorders
• Increases patients’ ability to gain and maintain employment

Yet, stereotypes about people who need medication, like methadone, persist. This stigma is a major barrier to treatment. This is why less than 10 percent of those with substance use disorder get the help they need.

In fact, research from the Recovery Research Institute shows that this stigma impacts the quality of care and how people with substance use disorders are treated.

Reducing Stigma to Prevent Opioid-Related Deaths

Given that level of stigma, it’s understandable why folks don’t seek help. And trying to quit on their own is an uphill battle with low rates of success. Added to that stigma is the public perception of bringing medication-assisted treatment centers to their communities, like Sophia mentioned.

Yet the evidence, like in Furr-Holden’s study shows the opposite to be true. Harm reduction facilities, like syringe exchange programs, methadone clinics, and other treatment facilities actually reduce the burden on the local economy by:

• Lowering rates of transmissible diseases, like HIV and hepatitis B and hepatitis C
• Reduce emergency department admissions
• Increased life expectancy and reduces overdose
• Improved access to treatment facilities and subsequently recovery
• Provided access to other critical services like housing and medical care
• Decreased the likelihood of engaging in criminal activities
• Reduced use of opioids
• Improved the likelihood of obtaining housing and employment
• Improves birth outcomes

Despite these overwhelmingly positive outcomes, being treated with methadone is still highly stigmatized. Most patients feel like they’re “dirty” for accessing this help.

How Can Destigmatizing Harm Reduction Services Prevent Opioid-Related Deaths?

Sarah Church, PhD, is the executive director of the division of substance abuse at the Albert Einstein College of Medicine. She mentions a quote from her colleagues, Murphy and Irwin, in a recent training:

After ten years of interviewing women and men in various stages of their methadone maintenance careers, recurring themes emerged, one of which was that being a methadone patient is a marginal identity; not quite junkie, not quite conventional. Clients’ efforts to manage this stigmatized identity were often shrouded in anguish and secrecy. Methadone patients were in a kind of identity limbo; a holding pattern between two extremely different social worlds. They were trying to affect an identity transformation; however, in many circumstances they were still associated with and defined by their ‘dirty secret.’

Prevent Deaths by Preventing NIMBY-ism

So, why we are still stigmatizing and resisting the very solutions to the opioid crisis because we don’t want it in our neighborhood?

Many would argue that, perhaps the solution to the opioid crisis isn’t only an increase in treatment facilities, particularly medication-assisted treatment facilities, but also the critical work of destigmatizing people with mental health disorders? What are your thoughts on the issue?

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-407-7195(Who Answers?) today to speak with a treatment specialist.

You may know him as a young John Conner in Terminator 3: Rise of the Machines. Or you may recognize him as the child actor who co-starred with Mel Gibson in Man Without a Face in 1993.

Nick Stahl began performing at age 4 and was recruited by Hollywood at age 10. He was just 11 when Gibson discovered Nick’s talent, and his career took off from there.

And it was just two years later, at age 13, that Stahl discovered alcohol.

But let’s back up a bit.

Looking back at his childhood, Stahl gains some insight into why the stage was so appealing – and why alcohol was so appealing at a young age, too.

A Blanket of Fear

Stahl was raised by a single mom who worked two jobs to make ends meet.

Stahl recalls, “From a very young age, I was always under this blanket of fear, financial fear. There was this idea that if we didn’t come up with enough money for that month, we would end up on the street. That colored my outlook growing up. My default mode was untrusting, with this mentality of waiting for the other shoe to drop.”

“I don’t look back on my childhood with real fond memories,” he says. “But for some reason, when I did plays, that stuff shut off and I had this ability to just be very comfortable.”

And when he had his first drink at 13, he discovered a way to “shut stuff off” when he wasn’t on stage. The tense feelings disappeared.

“Suddenly, I had a freedom from thinking, from uncomfortability,” he explains. “I felt okay in my skin — and I hadn’t really felt that before.”

Full Steam Ahead

By age 16, Stahl’s career was in full gear, and he and his mother moved to Los Angeles. There, he discovered the party scene.

He recalls, “I was going to bars. I had a very easy time getting into these places. A lot of my friends were older, and I had a great time.”

“That became what I chased,” he says. For Stahl, the drugs alleviated anxiety. He wasn’t partying for fun, but for release. He explains, “Very early on, it was not ‘I want this,’ but ‘I need this.’”

Falling Apart

In 2001, Stahl starred in Bully, a true-crime drama. Brad Renfro, his co-star, also battled addiction at the time.

Stahl recalls, “He was more severe in his addiction than I was. He just progressed to a point where he had to have someone on set with him to keep him sober.”

Stahl knew he was headed in the same direction. He tried to stop the deadly addiction train he was on.

But none of that worked.

“Things started to get awful pretty quickly,” Stahl recalls. “I started to miss appointments. I put on a good front. The extent of my illness stayed hidden even from me. It’s common to justify, rationalize things. I looked around and said, ‘Everyone is partying the way I am.’ In retrospect, there were far less people going as hard as I did.”

In 2007, at age 27, Stahl entered rehab for the first time. In 2009, he tried again.

But Stahl couldn’t stay away from Hollywood for long. He went back – and was arrested multiple times. The charges included disorderly conduct and possession of meth.

Picking Up the Pieces in Recovering from Addiction

Despite his struggles, Stahl never lost an acting job. He was able to hold it together enough that he never got fired. But he knew he would soon, if something didn’t change. In 2012, he knew it was time to step away from acting for a while.

“I was physically there, but I was checked out,” he admits, “and I certainly wasn’t feeling any real enthusiasm for acting anymore. I knew that I had to step away, for self-preservation, but also for the preservation of my career, if I was going to have one again.”

Stahl spent the next five years in Dallas, “diving into his recovery” as he puts it.

Once he achieved sobriety, Stahl was able to give his life new direction. “It proved to be reconstructive for me,” he says. “That’s when I really started to piece together that I had neglected building a real life outside of the business. For many years, I had everything — but I didn’t have anything resembling a satisfying life. I didn’t have outside interests, I lost touch with friends and family. The film world made up too much of my identity.”

A New Life While Recovering from Addiction

When Stahl stepped away from Hollywood while recovering from addiction, he didn’t leave with millions in the bank. That meant he had to get a job like any other Joe. “So, I started working for a friend’s moving company,” he says.

“I tried other things. I worked at a coffee shop in New York for a little bit. Not only did I learn how to live as a sober person, which I didn’t know how to do, but I learned how to have a life outside the business.”

And this fresh perspective has allowed Stahl to re-enter show business with a healthy, sober outlook. “That passion inside me that burned for film and acting, it had dulled progressively over time,” he explains.

“But once I was separated from Hollywood, all of that started to come back. Over the past few years, whether I’m working on a film or auditioning, I don’t take it for granted, ever. I work much harder at it now. I just feel a renewed love for it.”

Clean for four years now, Stahl, age 41, is back in action with a full line-up of acting roles on his calendar.

But recovering from addiction comes first. “Recovery has to be the most important thing for me,” he says. “I put it first in my life. But I’m grateful for it, and it’s given me the opportunity to try to help people in the same situation I was [in]. It’s more important to me than making films. I search out people who have had similar struggles and show them how I got well. I speak from my experience and show them what worked for me.”

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-407-7195(Who Answers?) today to speak with a treatment specialist.

80 members of Temple Sinai gathered for a Zoom call to hear their spiritual leader’s announcement.

They thought Rabbi Perice might have called the meeting to share that he and his wife were having a baby. Or that they were buying a home.

Or maybe that he was leaving his post.

Instead, he disclosed to his congregation that he’d been in recovery from opioid addiction for 10 years.

Perice explained that he shared this “because they trust me every day with the most vulnerable parts of their lives. What would it mean if I couldn’t trust them the way they trust me?”

Tearing Down the Stigma in Talking about Opioid Addiction

“When the rabbi told me in advance what he wanted to say, I thought it was a great idea,” said Johanna Schoss, president of the Temple Sinai board.

“For someone like the leader of our community, for whom people already have a lot of respect, to admit to having gone through a situation like this, it means that other people don’t have to be afraid to talk about it.”

“Addiction is still something that is thought of as taboo, but if our rabbi and our community can help in any way, it’s huge,” said past board president Stacey Blacker.

With this support and encouragement from leadership, Perice moved forward with his announcement. And the positive response has been overwhelming.

“I was overwhelmed by the support that this community showed me,” Perice said. “I’ve heard from probably 50 people, sharing personal stories, congratulations, all the nice things you would hope to hear after sharing something like this.”

Perice hopes Temple Sinai can get involved in addiction and recovery efforts through education and advocacy–like talking about opioid addiction. He knows firsthand how important the right support can be.

A Fateful Collision

It started in 2007, with a simple car accident. Perice was rear-ended and suffered shoulder, neck, and lower back injuries. His doctor prescribed pain pills, which Perice took as directed – at first.

“It didn’t just seemingly fix the pain at first. I had been dealing with anxiety and depression, and [the drug] gave me almost a sense of peace. It took away the angst about college and jobs. And something in my brain said, ‘I need more of this.’”

Perice upped his dosage. But the physical pain worsened and his addiction grew. When his doctor refused to prescribe any more painkillers, he began doctor shopping. And that’s when his life began to revolve around fending off withdrawal.

“I told myself, ‘I can’t be an addict,’” he said. “I was getting it from a doctor. I had legitimate pain. How can I be an addict? But after two years went by, doctors were no longer close to prescribing what I needed.”

“I needed to find other ways — calling friends and acquaintances, going into medicine cabinets and checking wherever I could get it. That’s when I was introduced to OxyContin, which is a very powerful opiate. That was the medication I was most actively using until the end.”

A Fateful Moment of Clarity in Talking about Opioid Addiction

In 2011, Perice’s life took a turn. One day in early spring, he ran out of OxyContin. He couldn’t find anyone who had the drug.

He was desperate to relieve his withdrawal. So, he called a known drug source and told him “I need something, anything.”

An hour later, the man brought Perice a bag of heroin.

Perice had never done heroin before. He sat in his bathroom, staring at the bag.

“It was a moment I can only describe as a moment of clarity. I was able to see that if I did this, I might die. I just flushed it down the toilet, called my parents, and said, ‘I need help.’”

He got treatment, which included a long-term medically assisted outpatient treatment, counseling, and physical therapy.

A New Path

Perice admitted, “Treatment saved me, but it didn’t give my life purpose. Re-finding my faith gave me purpose.”

Once he was “liberated from opioids” as he put it, Perice began considering the rabbinate. He entered Reconstructionist Rabbinical College in 2014 and was ordained in 2020.

He became the religious leader at Temple Sinai within a month of ordination.

After serving there for several months, Perice decided to share his secret with his congregation. And he’s glad he did. He described it as “a very powerful moment for me, and for my community.”

He added:

“But there are a lot of feelings about the issue [of addiction] in the world. Many people have dealt with this in their families. Addiction causes pain for everyone around [the person living in addiction].”

“So, it’s important to help people move through that pain. By removing the stigma and getting people help early, we can help them, and their families, heal.”

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-407-7195(Who Answers?) today to speak with a treatment specialist.

10.1 million. That’s the estimated number of Americans aged 12 or older who misused opioids in 2019.

There were an estimated 75,673 opioid overdose deaths that occurred from April 2020 through April 2021.

What are we doing about these alarming statistics? The FDA has approved three drugs to treat opioid dependence. Buprenorphine – sold under the brand name Suboxone – is one of them.

Here’s how it works and what researchers have discovered.

Suboxone 101

Suboxone is an opioid partial agonist. An agonist is a chemical that triggers a response in the body. This drug only partly activates rather than fully. So its effects are weaker than substances like heroin or morphine (which are full agonists).

The drug also has a ceiling effect. This means higher doses don’t increase its effects. And, it’s long-acting, so people don’t have to take it every day.

This makes Suboxone a go-to drug for medication-assisted treatment (MAT) for opioid use disorder.

This medication can:

• Diminish the effects of physical dependency on opioids, such as withdrawal symptoms and cravings
• Increase safety (reduce the chances of overdose)
• Lower the potential for drug abuse

Ultimately, this can help people withdraw from opioids like heroin and reduce people’s use.

How long someone takes buprenorphine varies with each case. Treatment can range from short-term to indefinite.

MAT 101

The US Department of Health and Human Services reports that 1.27 million Americans are now receiving medication-assisted treatment for opioid use disorder (OUD). This combines medication like buprenorphine with counseling and behavioral therapies. This creates a comprehensive treatment plan that treats the whole person.

Research has shown that this combination can successfully treat opioid use disorders and help sustain recovery.

Does It Work?

Researchers recently dug into results from drug tests to find out.

Brendan Saloner, PhD, is an associate professor at Johns Hopkins Bloomberg School of Public Health. Together with researchers from Millennium Health, he published their findings in JAMA Network Open.

These investigators analyzed 150,000 urine drug test results for OUD patients. The patients were prescribed Suboxone between 2013 and 2019. Researchers wanted to find out if the presence of Suboxone made it less likely for a person to misuse opioids.

Of their 150,000 results, 85.49 percent were positive for buprenorphine. Just under half (47.58 percent) were positive for at least one non-prescribed substance.

Specifically, they found:

• Those who tested negative for buprenorphine were 10 times more likely to test positive for heroin.
• Those who tested negative for buprenorphine were seven times more likely to test positive for fentanyl.

In other words, the results indicate that if the patients stuck with their treatment, they were less likely to abuse other drugs. And, that if they stopped taking their medication, they were much more likely to turn to other drugs.

More Good News for Suboxone

Other research supports the theory that Suboxone can be an effective treatment for addiction. One meta-analysis of buprenorphine use found that doses of this medication improved retention in treatment and that high doses reduced opioid use.

And through other research, MAT has been shown to:

• Increase treatment retention
• Increase patients’ ability to remain employed
• Decrease illicit opioid use and other criminal activity among those with SUDs
• Improve patient survival

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Call 800-407-7195(Who Answers?) today to speak with a specialist who can talk with you about treatment options.

You say tomato. I say tomahto.

You say oxycodone. I say Percocet. Same difference, right?

Actually, no. The two drugs do have some similarities, but when comparing opioids, the terms are not interchangeable.

Let’s talk about how they differ.

Chemical Makeup

Both of these drugs are opioid pain medications. Oxycodone is a synthetic drug made from opium. Percocet is made of oxycodone and acetaminophen. (Acetaminophen is another painkiller, which you probably know by its brand name: Tylenol.)

If you take either of these drugs, you’re taking oxycodone. But when you take Percocet, you’re also getting the second medication, acetaminophen. This is one of the primary reasons oxycodone and Percocet get confused when comparing opioids.

Oxycodone and Percocet Use

Oxycodone is available in three different forms, which are used for different types of treatment:

• Immediate-release tablets enter the bloodstream right away
• Extended-release tablets gradually release the drug into the bloodstream
• An oral solution, often given through a gastric tube, is available for patients who can’t swallow tablets

Oxycodone is used for treating moderate to severe pain. The extended-release form is often prescribed for patients who have ongoing pain, such as cancer-related issues. 

Percocet is also prescribed to treat moderate to severe pain. But it is used for treating conditions that also cause a fever because acetaminophen is a fever reducer. It may also be used to treat patients who experience pain while on another long-acting painkiller. 

Percocet is not recommended for long-term use, since the acetaminophen in it can wreak havoc on the liver and cause serious damage over time.

Effectiveness

Both drugs are proven to effectively relieve pain. When you take Percocet or immediate-release oxycodone, you start to feel relief within half an hour, and the effects usually last for three to six hours. 

Extended-release oxycodone starts to work within two hours and continues to relieve pain for up to 12 hours. The brand name drug OxyContin is a type of extended-release oxycodone.

Over time, patients can develop tolerance to these drugs. This means they need higher doses to get the same pain relief. Tolerance can begin to develop within just one week of taking regular doses of either drug.

Side Effects

Since we’re comparing opioids with the same primary ingredient, both oxycodone and Percocet naturally have similar side effects.

Both commonly cause:

• Constipation
• Sleepiness
• Calmness
• Nausea
• Dizziness
• Loss of appetite
• Headache
• Impaired motor skills

There are two main differences in their side effects:

• Oxycodone is more likely to cause feelings of euphoria
• Percocet can cause abdominal pain, black stools, and yellowing of the skin (jaundice) because of its effect on the liver

One of the biggest potential side effects of either drug is addiction. Tolerance can happen quickly and lead to physical and psychological dependence, so “>both drugs are considered highly addictive. 

Drug Classification

Here’s an area where the two drugs don’t differ. The Drug Enforcement Administration (DEA) classifies drugs into five categories or “schedules.” A drug’s class is determined by its potential for dependency and its accepted medical use. 

Both oxycodone and Percocet are Schedule II drugs.

Schedule II substances have “a high potential for abuse, with use potentially leading to severe psychological or physical dependence.” They are considered dangerous.

Other examples of Schedule II drugs include methamphetamine, cocaine, fentanyl, and Ritalin.

Pop Quiz

Here’s a quick quiz comparing oxycodone and Percocet. Don’t worry – you won’t be graded!

Match the following descriptions with the correct drug. (Hint: Some are true for both substances.)

1. An opioid
2. Contains acetaminophen
3. Relieves pain
4. Is considered addictive
5. Comes in an extended-release form
6. Can cause drowsiness
7. Reduces fever
8. Is not recommended for long-term use
9. Tolerance can develop in 7 days
10. A Schedule II narcotic

How’d you do? You can check your answers below.

And remember, if you’re trying to decide which medication is best for your situation, always consult with a doctor and use the drug only as prescribed.

If you need help for prescription drug misuse or addiction, call 800-407-7195(Who Answers?) to speak with our specialists about comparing opioid addiction treatment options.

Pop Quiz Answers:

1. Both
2. Percocet
3. Both
4. Both
5. Oxycodone
6. Both
7. Percocet
8. Percocet
9. Both
10. Both

Tina and Melinda are both addicted to opioids. Both of these women are paying for suboxone treatment for their opioid use disorder.

Tina has private insurance. Melinda has Medicaid coverage.

Which of these two women is more likely to get an appointment? Will providers discriminate when it comes to the method for paying for suboxone treatment?

That’s what researchers wanted to find out. So, they used “secret shoppers” to get answers.

Investigators from Baylor University’s Hankamer School of Business, RAND Corporation, and Vanderbilt University Medical Center’s Departments of Pediatrics and Health Policy collaborated on the study.

Here’s what they discovered.

It’s Hard for Anyone to Get an Appointment

Researchers made 3,420 simulated patient calls for the study. The callers identified themselves as women with Medicaid coverage or private insurance coverage. All were requesting appointments with buprenorphine providers.

Guess how many successfully landed an insurance-covered appointment? Less than half. Even with Medicaid or private insurance.

Only 45 percent of women with private insurance coverage were able to get an appointment. And just 38 percent of women with Medicaid insurance were as well.

According to the study’s lead author Michael Richards, MD, PhD, MPH, and associate professor at Baylor University in Waco:

The most striking finding is — for both callers that had private insurance and callers that had Medicaid — just how infrequently they’re able to actually leverage those insurance benefits when it comes to getting an appointment for opioid use disorder. That really speaks to the many serious and substantive access hurdles these individuals have to clear.

It’s Harder for Medicaid Patients…in Certain Areas

Previous research has shown significant differences in access to opioid use disorder treatment between patients with Medicaid versus private insurance. And this study was no different.

However, researchers discovered that these results varied based on one key factor.

But, as the percentage of Medicaid coverage in the local community went up, so did the number of Medicaid patients getting appointments.

In areas where Medicaid coverage was prevalent enough, the difference in access to care was insignificant.

Causes of Discrimination in Paying for Suboxone Treatment 

Investigators can’t say for sure what is causing this disparity. They suspect it might be as simple as paperwork issues.

According to the study findings, providers in areas with a higher rate of Medicaid coverage may be more familiar with business processes needed to obtain payment from Medicaid for buprenorphine treatment.

But the problem is most likely multifaceted, they admit.

Whatever the issues are, researchers suggest that these findings guide future efforts. They advise, “Efforts to improve access to treatment may be best targeted to areas where Medicaid prevalence is lower.”

MAT Numbers Remain Low

In 2020, nearly 70,000 people in the United States died from opioid overdoses. Currently, buprenorphine is one of three medication-assisted treatments (MAT) approved by the World Health Organization and the FDA to treat opioid use disorder. This medication can help diminish withdrawal symptoms and cravings.

This, in turn, lowers the potential for opioid misuse.

The number of clinicians who can prescribe buprenorphine has increased 300 percent. But less than 33 percent of individuals with opioid use disorder receive any kind of MAT. Researchers hope their efforts can make a change in these numbers.

“Making it through the structural barriers to just getting into treatment for opioid use disorder is extraordinarily hard, even if you’re the most motivated person on the planet,” says study principal investigator Stephen Patrick, MD, MPH. He’s from the department of health policy at Vanderbilt University Medical Center in Nashville, Tennessee.

“We are seeing record-setting rates of overdose death, and for every overdose death, there are a slew of other hospitalizations and additional family members affected. I hope our continued research garners the attention of the public and policymakers and more clearly communicates that we must put solutions in place to break down these barriers.”

Call 800-407-7195(Who Answers?) today to speak with a specialist who can talk with you about treatment options.

Images Courtesy of Shutterstock.

Over 93,000 Americans died from an opioid overdose in 2020, which is a 30 percent increase from the previous year. The effects of fentanyl are the root cause behind this increase. It is a powerful synthetic opioid that is infiltrating the drug supply.

Americans are buying other drugs, like cocaine or benzodiazepines, that have been laced with fentanyl. Because the effects of fentanyl are so powerful, it is killing record numbers of unsuspecting Americans.

Fentanyl is not only potent but also difficult to identify. Given the social restrictions and heightened stress during the pandemic, more and more people had been susceptible to this deadly drug.

In this blog, we’ll explain why fentanyl is so dangerous, how to spot it in your drugs, and what to do if you suspect someone is having an opioid-related overdose.

What Is Fentanyl?

Fentanyl is a powerful synthetic opioid that is 50 times stronger than heroin and 100 times stronger than morphine. It has been used medicinally to treat chronic pain following surgery or in patients with cancer since 1968. Fentanyl is also illicitly manufactured for the drug market for those seeking a more powerful high than heroin.

Street fentanyl is either injected in its liquid form, smoked, or inhaled. Street names for fentanyl include:

• Murder 8
• Apache
• Dance Fever
• Jackpot
• Friend
• Goodfellas
• Tango and Cash

The typical effects of fentanyl are similar to heroin, and include:

• Euphoria
• Relaxation
• Pain relief
• Sedation
• Confusion
• Nausea and/or vomiting
• Dizziness
• Drowsiness
• Pupil constriction
• Risk of overdose and death

What Does Fentanyl Look Like?

Prescription fentanyl is usually a patch worn on the skin. Illicitly manufactured fentanyl is available in a powder or liquid form. The powder is either white, gray, or tan-colored.

Unfortunately, when fentanyl is powdered, it’s difficult to differentiate it from other powdered drugs, like cocaine. And the liquid can be hidden in unassuming everyday items like nasal sprays, eye drops, and even candy.

Why Is Fentanyl So Dangerous?

According to the CDC, fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths.

The problem with fentanyl is two-fold: Its potency and the incentive of illicit drug manufacturers to cut other drugs with fentanyl to make more money.

People are buying illicit drugs like methamphetamine, cocaine, heroin, and pills (like opioids and benzodiazepines) completely unaware that their drugs are contaminated with fentanyl. What’s more, the amount of fentanyl in the drug could be a lethal dose that you can’t taste, smell, or see.

To make matters worse, rates of fentanyl infiltrating the drug supply continue to rise.

Fentanyl was involved in a staggering 62 percent of opioid deaths in 2020. Illicit manufacturers have been able to achieve exponential distribution across the country.

Previously, fentanyl was common in the northeast, midwest, and mid-Atlantic and now it is showing up in other parts of the country.

Why Did Overdose Deaths Surge During the Pandemic?

Fentanyl-related deaths have also been exacerbated by the pandemic. People struggled to access harm reduction programs that enabled them to test their drugs and access recovery resources.

This led many to return to using to cope with the stress, anxiety, and social isolation of the pandemic.

While the pandemic is beginning to wane, many people are burned out and struggling to cope with the economic burdens and the loss of loved ones that the pandemic left in its wake. These factors alone are a risk for overdose but taken together, they reflect one of the many tragedies of COVID-19 — the staggering rise of overdose deaths.

How Much Fentanyl Is Fatal?

It takes just two milligrams of fentanyl to kill, according to the Drug Enforcement Administration (DEA). You may think you’re safe because you don’t take opioids, but you’d be mistaken.

Fentanyl is usually distributed by drug organizations by the kilogram. This amount could kill a staggering 500,000 Americans.

What Are the Signs of an Overdose?

Whether you’re taking a prescribed opioid, or an illicit substance, you should be aware of the signs of overdose because you could save someone’s life.

The common signs of overdose the CDC advises to look out for include:

• Shallow, weak, or no breathing
• Small pinpoint pupils
• Falling asleep or losing consciousness
• Limp body
• Choking or gurgling sounds
• Cold and/or clammy skin
• Discolored skin, especially on the lips and nails

What to Do If You Think Someone Is Overdosing

If you suspect someone is overdosing you should act quickly, by:

• Calling 911 immediately
• Administering the overdose reversal drug, naloxone
• Try to keep the person awake and breaking
• Lay the person on their side to prevent choking
• Stay with the person until the emergency services arrive

It is very simple to use and will save a life.

How Can I Check My Drugs for Fentanyl?

It is possible to test your drugs for fentanyl and other potent opioids like carfentanil by using fentanyl test strips. You can either buy or find it at your nearest harm reduction service center. The test takes just 5 minutes and could save you from the harmful effects of fentanyl.

Fentanyl Myths

On TV dramas, cops come out in hazmat suits because they fear they’ll die from touching fentanyl. However, much of the media has misrepresented what happens when you come into contact with fentanyl.

The Harm Reduction Coalition has dispelled many of these myths, such as:

• You cannot overdose by simply touching powdered fentanyl. It must either enter your bloodstream or mucus membrane — body cavities like the nose, mouth, lungs, and stomach — for you to feel any of the effects of fentanyl.
• Fentanyl and its analogues, such as carfentanil, are not resistant to naloxone. Fentanyl is an opioid and therefore naloxone will respond to a fentanyl-related overdose. When people don’t respond to naloxone, it is because you haven’t waited long enough. (Fact: You need to wait two to three minutes. After, if still unresponsive, the person needs more than one dose).
• Fentanyl patches are not the same formulation as illicitly manufactured fentanyl. They are specially formulated for pain management — it takes 12 to 24 hours to receive adequate pain relief.

Ways to Reduce the Risk of Overdose from the Effects of Fentanyl

While treatment is the preferred course of action for addiction, you may not be ready for recovery. Or, you may be concerned for a loved one who uses alone.

This is where harm reduction practices apply. The following precautions can reduce the risk of overdose:

• Always carry naloxone
• Eat, drink, rest, and hydrate as best you can
• Make an overdose plan with a friend
• Use less and more slowly because fentanyl is very powerful
• Test your drugs
• Use one drug at a time
• Avoid taking alcohol with opioids
• If you do use alone, ensure someone knows where you are
• Be cautious of your tolerance, especially if you have recently taken a break from drug use. If in doubt, try a tester amount
• Use a different method of ingestion, such as snorting instead of injecting

If you or someone you love is experiencing a substance use disorder, help is available. Call 800-407-7195(Who Answers?) today to speak with a treatment specialist.

Images Courtesy of Shutterstock.

A lot has changed when it comes to prescription opioids and how they’re prescribed.

It’s been six years. Six years since the CDC released its Guideline for Prescribing Opioids for Chronic Pain. So, why did the CDC decide to propose an update this year? What compelled the organization to take action now?

Let’s take a trip back to 2016 to find out.

Headed Toward Disaster

Over the course of two decades, use of prescription opioids in the U.S. drastically increased. The result? A full-blown opioid epidemic.

Thousands of people became addicted to painkillers. And when they grew desperate to feed their addiction, many of them progressed from prescription painkillers to illicit drugs like heroin.

Realizing the dangers, healthcare providers began to cut back on opioid prescriptions by 2012. But the damage was already done.

Opioid addiction and opioid overdose numbers skyrocketed. And what’s worse, the numbers kept climbing.

In 2016, the officials finally decided something had to change. The CDC stepped in with official prescribing guidelines, which later became known as the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. These guidelines were designed to reduce dependence on opioids and lower the risk of overdose.

After releasing the CDC guidelines, opioid laws began to change. Many states limited opioid prescriptions for acute pain to no more than seven days. Some states also limited prescriptions for Medicaid patients.

Insurance companies and pharmacies also set their own limits. Doctors began to taper long-term patients off opioids. Medical boards sanctioned doctors who didn’t adhere to the guidelines. Opioid prescriptions decreased.

Were all these actions helpful? That depends on who you ask.

Prescription Opioids: Too Strict or Too Misunderstood?

Some doctors, patients, and drug manufacturers were upset by the guidelines. They said chronic pain patients were being denied relief.

They were also concerned that doctors might be cutting patients off opioid pain relievers too quickly or failing to give prescription opioids to patients who could benefit from them.

Dr. Bobby Makkumala, head and neck surgeon in Michigan, said the guidelines

“…have been a barrier to patient care, with some pharmacists pointing to the CDC’s suggested limits and refusing to fill prescriptions as doctors wrote them.”

Keith Humphreys, Stanford University psychiatry and behavioral sciences professor, noted:

“It’s important to tailor policies to a patient’s individual circumstances rather than adopt a blanket approach for all.”

One survey found that 84 percent of patients reported having more pain and poorer quality of life after the opioid prescribing guidelines were released.

But others didn’t see a problem with the overall guidelines – just with how they were interpreted.

The CDC published a paper in 2019 stating that many physicians “were guilty of a misapplication of the 2016 guideline that clamped down on the use of opioids.”

Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control noted that the 2016 guidelines “were essentially taken out of context beyond (their) intent and applied as rigid laws, regulations and policies.”

The guidelines were voluntary. They offered suggestions to help curb the opioid epidemic. They encouraged doctors to try other medications or nondrug options to treat pain rather than turning to opioids as the first treatment option.

Doctors were also urged to limit prescription opioids to three days when treating acute pain. And to prescribe the lowest dose possible.

But in many cases, these suggestions quickly became strict regulations. And the CDC felt the backlash. Many experts say the guidelines are too strict, and they’ve been calling for change ever since.

That change is happening now.

Threading the Needle

The CDC released an update and expansion of the 2016 guidelines. The 229-page document is open for public comment through April 11, 2022.

The update does not include “hard thresholds” from the previous version. Jones noted, “We’ve built in flexibility so that there’s not a one-size-fits-all approach.”

Dr. Joshua Sharfstein is the vice dean for public health practice and community engagement at Johns Hopkins Bloomberg School of Public Health. He explained:

The new recommendations are still voluntary. The document clarifies that these are not prescriptive standards. And that healthcare providers should consider unique circumstances and needs of each patient when prescribing treatments.

The update also avoids language that puts precise limits on dosages and lengths of prescriptions.

So, what do the new guidelines recommend?

New Guidelines for Prescription Opioids: Changes in Store

The updated guidelines provide recommendations for primary care physicians, outpatient clinicians, and other specialty clinicians who are treating three categories of patients:

• Adults with acute pain (lasting less than one month)
• Adults with subacute pain (lasting one to three months)
• Adults with chronic pain (lasting three months or longer)

The guidelines do not apply to patients being treated for cancer or sickle cell disease or receiving palliative or end-of-life care.

The main issues addressed in the guidelines are:

• When to initiate or continue opioids for pain treatment
• Opioid selection, dosage, duration, follow-up, and discontinuation
• Risk assessment/addressing harms of opioid use

Changes made to the previous guidelines include:

• Removal of the suggestion to limit opioid treatment for acute pain to three days.
• Removal of the recommendation that doctors avoid increasing dosage to the equivalent of 90 milligrams of morphine per day.
• Removal of the suggestion to have patients undergo urine testing annually. (But the guidelines still say doctors should consider having patients get tested to see if they are using other drugs.)
• The CDC urges doctors to avoid abruptly halting treatment unless the situation appears life threatening. The agency offers suggestions for tapering patients off the drugs instead.

The main prescribing guideline change is the removal of specific limits on treatment with opioid painkillers. The CDC hopes to avoid any misinterpretation that could prevent patients from receiving needed care.

The new guidelines still emphasize that opioids should not be the first-line option to treat chronic pain. And they advise physicians to start with a low dose of immediate-release pills.

Millions of Lives on the Line

Between spring 2020 and spring 2021, the U.S. saw an astounding 100,306 drug overdose deaths.

An additional study published in February 2020 projected “1.2 million people will die from overdose deaths in the U.S. and Canada through 2029 unless leaders enact evidence-based public health policies.”

Will the changes to the CDC opioid prescribing guidelines improve or worsen these numbers? Are we headed for better pain treatment or an increase in prescriptions that lead to addiction?

Time will tell.

For information about treatment options for you or a loved one, call 800-407-7195(Who Answers?) today.

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It was a day she would never forget. Tammy came home from work and found her husband slouched in the recliner. She thought he was dozing, but then he didn’t respond when she tried to wake him.

She tried again. Then she noticed his lips had a blue tint to them, and his breathing was extremely slow. She put her hand to his cheek, and his face felt clammy.

He was taking painkillers for a back injury, and Tammy knew he had been taking extra pills here and there – more than the doc had recommended. Recognizing the signs of an opioid overdose, Tammy quickly grabbed the naloxone from her purse and sprayed it into her husband’s nose. She then called 911.

The paramedics told her later that her husband wouldn’t have made it if Tammy hadn’t given him the naloxone.

What is Naloxone and Who Can Administer It?

Nearly 80 percent of opioid overdose deaths happen in a non-medical setting. Settings where there are no doctors, emergency techs, or medical supplies. But one thing is available – naloxone.

Also known by the brand name Narcan, naloxone is a medication that can reverse an opioid overdose. An overdose occurs when opioids fully block the brain’s receptors. This blockage causes breathing to slow down and then stop.

Naloxone clears the brain’s receptors of the opioids so breathing can return to normal. It can literally save the person’s life.

A prescription is not required to purchase naloxone. It is available at most pharmacies, and anyone can carry it. It’s easy to use, so anyone can administer it when someone is experiencing an opioid overdose.

Who Should Carry Naloxone?

You may want to consider keeping naloxone on hand if any of these situations apply to you:

• You or a loved one is taking an opioid pain medication such as Vicodin, OxyContin, Codeine, or Percocet.
• You suspect your loved one may be struggling with opioid addiction or is misusing a prescription or other opioids.
• A loved one has recently received treatment for an opioid addiction.
• You want to be prepared to help save a life in your community if the situation arises.

When Should You Use Naloxone?

If you suspect someone is overdosing from opioid use, give them naloxone. The medication is not known to cause any harm if it turns out the person was not overdosing, so it’s best to go ahead and administer it.

Look for the following symptoms of overdose:

• Slow or erratic breathing, or breathing has stopped
• Non-responsive to their name or firm knuckle-rub to the chest
• Blue lips and fingertips
• Clammy face
• Paleness
• Deep snoring or gurgling sound
• Slow heartbeat or no heartbeat

How to Save a Life With Naloxone

If you suspect an overdose, take the following steps immediately:

1. Call 911: If the person is unresponsive, call 911. Try to get their attention by calling their name and telling them you’re going to call 911. Rub their chest firmly with your knuckles to try to wake them. If they are unresponsive to these attempts, call 911.

Put the person on their side with their legs bent and their head resting on the arm that is on the floor. This position will prevent them from choking if they vomit.

2. Administer Naloxone: Depending on the delivery method used, you will administer naloxone in one of the following two ways.

• Spray bottle: Insert the spray nozzle into either nostril and spray the medication into the person’s nose.
• Auto-injector: Remove the injector from its outer case. Remove the safety guard. Place the injector against their outer thigh, through clothing if needed. Press firmly and hold for 5 seconds.

3. Apply Rescue Breathing

If the person is not breathing or is struggling to breathe, conduct rescue breathing. Place them on their back. Tilt their head back, pinch their nose, and breathe one slow breath into their mouth every 5 seconds. Their chest should rise and fall with each breath.

4. Provide Support

When the person starts breathing on their own, roll them back onto their side and wait for paramedics to arrive. Keep in mind the person may feel sick, confused, and upset. Offer comfort and reassurance while you wait with them for emergency responders. And do not let them use any drugs.

5. Follow Up

After they have recovered from the overdose, have an honest but loving conversation with them about the situation. This may be a good opportunity to suggest getting treatment for opioid abuse or addiction.

Ready to talk to a treatment specialist? Contact us today at 800-407-7195(Who Answers?) to learn about our flexible treatment programs for drug and alcohol addiction.

Eight days ago, Angela was in rehab. Now she’s completely off heroin and has an impressive five weeks of sobriety under her belt. She has a new job and a new apartment. But things are starting to get a little more stressful than she thought they’d be — so many changes, so many new responsibilities.

One night after work, Angela’s stress became too much to handle. She could feel herself slipping. Her mind was overcome by cravings.

In an instant, that familiar voice in her head reappeared. “You just need a little something to take the edge off — something to help you relax. It’s just this one time. No big deal. You can go back to being sober tomorrow.”

Three hours later, Angela woke up in a hospital bed. She’d overdosed on heroin. Fortunately for Angela, she was saved when a neighbor found her unconscious and barely breathing in their apartment complex hallway. EMTs were able to revive her from the overdose.

Many others aren’t so lucky.

The Heightened Risk of an Overdose After Rehab

When Angela entered rehab, she stopped using opioids. Before rehab, she had been using drugs for two years. During those two years, her body built up a tolerance for opioids. Eventually, she needed a much bigger dose to keep getting the same effect from the drugs.

Fresh out of rehab, Angela had been drug-free for weeks. Her body had returned to a normal, healthy state. And that can be dangerous.

Angela’s systems weren’t constantly interacting with and reacting to the effects of opioids. That means she no longer had the same tolerance she’d built up before entering treatment.

But Angela wasn’t thinking about detox, tolerance levels, or the potential of an overdose. So, she took the same dose of heroin she was using right before rehab. And her body went into shock.

She hit her body with an amount of heroin it was no longer used to, and her system couldn’t handle it. So, it started shutting down.

The result: an overdose that nearly killed her.

The Common Story of Overdosing After Rehab

Angela’s situation isn’t unusual. After leaving rehab, many people return to their old habits. And while their habits haven’t changed, their bodies and tolerance levels have.

When people relapse after treatment, they often make the mistake of thinking they can take the same dose they used pre-rehab. They don’t realize that dose could now be fatal, and they end up overdosing.

Some people get lucky and survive the overdose. But many don’t.

Top Reasons for a Post-Rehab Overdose

Angela looked to opioids to help her cope with stress. This is a common reason for overdose after rehab. Whether at home or work, stress builds up, and the person who is addicted feels they can’t cope with everything without using substances.

Here are five other common mindsets that can lead to a post-rehab overdose:

• Just One More Time:

Jeff wanted to take his life in a new direction. He hadn’t taken any pills in weeks.

But, when he ran into an old friend who invited him over, he knew what they would end up doing. “Why not?” he thought. “I might never see him again. One last time can’t hurt.”

But, yes, it can. Jeff no longer has the tolerance for the level of drugs he and his friend used to use. If he takes that amount tonight, there’s a very good chance he’ll overdose.

• Feeling the pain 

Devan’s old shoulder injury was flaring up again. After battling with a painkiller addiction, he had been drug-free for six months. But the pain was back.

And he didn’t think he could manage it without those pills.

The problem: If Devan took the same dose of painkillers today that he was taking when he quit six months ago, the amount would kill him.

• Too Strong for Triggers

Sam used to get high every time he went to his cousin’s house. Now, he’s been out of rehab for three weeks and has stayed clean.

But just walking by his cousin’s place makes him want to use. He doesn’t try to avoid the neighborhood — or his cousin.

And the cravings are getting more intense.

If Sam doesn’t find a way to address his triggers and cravings, and gives in to them, he’ll be in danger of an overdose.

• Something Completely Different

Kelly went to rehab to deal with her alcohol addiction. Three months sober, Kelly starts using heroin instead of drinking. But her body isn’t used to this drug.

Because she substitutes one drug for another, Kelly is at high risk for an overdose.

• Feeling Despair

Sobriety has just become too much. Brian is in a deep well of depression and sees no hope.

He decides to take every pill he can find to escape it all with an intentional overdose to end his life.

And the Leading Cause for an Overdose After Rehab…

Of all the reasons for post-rehab overdose, one of the most common is self-deception. Here’s what that looks like:

“Sure, I had a drug addiction before, but I have control now. This time, I won’t let things get out of hand.”

But this line of thinking shows that things are already out of hand. And a relapse could be (and often is) fatal — especially after rehab.

For information about treatment options for you or a loved one, call 800-407-7195(Who Answers?) today.

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