Heroin Epidemic: Treatments and Options

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March 26, 2014


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From rich-and-famous stars to the poor and homeless, heroin overdoses are on the uptick. Earlier this year, for example, actor Philip Seymour Hoffman died on a bathroom floor with a heroin-filled needle in his arm, according to the coroner’s report.

In Florida, heroin-related deaths spiked 89 percent from 2011 to 2012, with a whopping 120 percent increase in Miami-Dade County during that same period, according to new study released by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

“Opiate addiction has been with us for 5,000 years. Our job is to be aware of the problem and to provide counseling and early intervention,” says John Eustace, M.D., medical director of the Addiction Treatment & Recovery Center at South Miami Hospital.

Here are some facts about addiction and treatment options:

Studies have found a link between painkillers and the heroin epidemic. What is the connection?

New pain-management techniques and painkillers have really improved the quality of life for many patients recovering from cancer, major surgery or injury, research shows.

“Narcotics have been tremendously helpful for treating severe pain. But while awareness of pain treatment has gone up, awareness about the other side of pain management — the risk of addiction — has not gone up,” Dr. Eustace says. “So many patients started their addiction on prescription drugs that were given to them for legitimate medical reasons.”

What needs to be done to lower the risk of addiction when a patient is prescribed painkillers?

Painkillers are often necessary before, during and after treatment for many serious conditions, Dr. Eustace says. But patients on painkillers should be carefully monitored for signs of addiction, with the same level of vigilance given to hypertension or diabetes patients during medical crises. For instance, when a patient with diabetes has surgery, the patient’s insulin levels and post-operation food intake are monitored with extra caution to avoid life-threatening episodes.  Likewise, patients prescribed painkillers should receive extra doses of surveillance, Dr. Eustace says.

What are the early warning signs of a possible addiction to painkillers?

He advises people to watch their loved ones for the following:

  • Euphoric moods that exceed the normal boundaries of pain relief.
  • Inappropriate and sudden surges of energy.
  • Obsessive concern about getting more painkillers even after the initial pain has subsided: “Be wary if the patient has full return of functions, but is still seeking renewal of painkillers,” Dr. Eustace says.

Unfortunately, some of these patients  turn to heroin when requests for painkillers are denied.

Why is heroin addictive?

More so than other drugs, opiates have a powerful impact on the body. This class of drugs binds with certain brain receptors, making the patient euphorically happy in the presence of the drug, but equally thrusts them into sadness when the effect of the drug has ended. Opiates also create a biological dependency, and patients become physically ill when they try to stop using the drug.

During withdrawal, many patients also experience anhedonia, a mind-numbing form of clinical depression in which the patient is unable to experience joy. In an effort to escape from their depression, patients will seek relief though painkillers or heroin, Dr. Eustace says.

This cycle of bliss and severe depression – combined with the physical impact of the heroin and opiates — creates a constant loop where the patient craves the drug and becomes further addicted. 

What types of treatments are available?

There are two drugs that have been proven to counteract the effects of opiates:

Naloxone:  Delivered by injection or nasal spray, this drug can instantly reverse drug overdose in some cases. Many rescue workers – police, ambulance crews and emergency room staffs — now carry naloxone, Dr. Eustace says. The Centers for Disease Control and Prevention estimates that more than 10,000 lives have been saved since naloxone has become available.

Suboxone: This drug satisfies the same receptor in the brain that craves heroin, and in a clinical setting, the patient can be gradually weaned from suboxone with fewer of the agonizing side effects that accompany withdrawal from heroin.

 

“Patients addicted to painkillers don’t have to resort to heroin. They can go to an addiction treatment program and be treated with dignity,” Dr. Eustace says. “The hope is to have access to proper medication in conjunction with addiction treatment. Of course, it’s best to prevent addiction to begin with by monitoring patients who have been prescribed painkillers for real medical reasons.

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