Drugs - Opioids & Prescription

  • Opiods are both heroin and a narcotic medication prescribed to alleviate pain or induce sleep. 

    Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and other areas of the body.  They reduce the sending of pain messages to the brain and reduce feelings of pain. 

    Opioids are used to treat moderate to severe pain that may not respond well to other pain medications.  Some types of opioid drugs include:
    • codeine (only available in generic form)
    • fentanyl (Actiq, Duragesic, Fentora - available in a patch that allows the medication to be absorbed through the skin)
    • hydrocodone (Hysingla ER, Sohydro ER)
    • hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
    • hydromorphone (Dilaudid, Exalgo)
    • meperidine (Demerol)
    • methadone (Dolophine, Methadose)
    • morphine (Astramorph, Avinza, Kadian, MS contin, Ora-Morph SR)
    • oxycodone (OxyContin, Oxecta, Roxicodone)
    • oxycodone and acetaminophen (Percocet, Endocet, Roxicet)
    • oxycodone and naloxone (Targiniq ER)  
For more information about Opioid drugs:  Dosage, side effects, tolerance and addiction, see the source of this information at WebMD, Pain Management, 2017.   http://www.webmd.com/pain-management/guide/narcotic-pain-medications#1
  • WARNING!  Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States.  Drug overdoses are now the leading cause of death among Americans under 50.  All evidence suggests the problem has continued to worsen in 2017.

    Many people start using prescription painkillers at parties, just for fun.  By the time it stopped being fun, it was too late.  People are also turning from heroin to fentanyl or an analogues.  Fentanyl is sold on the street as heroin, or drug traffickers use it to make cheap counterfeit prescription opioids. Fentanyls are showing up in cocaine as well, contributing to an increase in cocaine-related overdoses.  The most deadly of the fentanyl analogues is carfentanil, an elephant tranquilizer 5,000 times stronger than heroin.  An amount smaller than a few grains of salt can be a lethal dose.

    The severity of opioid withdrawal means users rarely get clean unless they are determined and have treatment readily available. “No one wants their family to find them face down with a needle in their arm…but no one stops until they’re ready.”  (Source:  Drug Deaths in America Are Rising Faster Than Ever," by Josh Katz, The New York Times, June 5, 2017) 

  • Opioid deaths is a disaster in the U.S.  Most people don’t realize the magnitude of the problem.  During the entire Vietnam War, 53,000 people died.  In 2016, from overdoses of opiates, 53,000 people died.  Essentially, we have a Vietnam War taking place in our country every year.  Some of these powerful drugs are disastrously strong.  The introduction of the powerful opioids fentanyl and carfentanil – an elephant tranquilizer – into the drug supply has only exacerbated the epidemic.

    80% of heroin addicts started with a prescription drug, so clearly the medical community is now reducing the number of opiates they prescribe for control of pain. 

    Pharmaceutical companies, the medical community, and patients can all play a role in reducing the damage of the opioid epidemic.  “This goes across all segments of society and I think the big problem is that society does not recognize the magnitude of the problem,” he said.  (“The Doctor is In,” Dr. Toby Cosgrove, Cleveland Clinic President & CEO, CBS This Morning, March 31, 2017)

  • The Painkiller Crisis.  Substance abuse is one of America's most pressing public health problems.  The problem is still growing and growing fast.  "The U.S. is 5% of the world's population, and we consume in one way or another 99% of the world's hydrocodone.  That's crazy, that's crazy," says the DEA chief. 

    Each year -
    30,000 people die each year from gun violence.
    About 33,000 people die each year from car accidents.  (2014)
    53,000 people die from opioid-related overdose (2016)

    On an average day in the U.S.: 
    650,000+ opioid prescriptions are dispensed
    580 people start using heroin
    78 people die from opioid-related overdose (more than from car accidents or gun violence)

    In 2014, 14 billion opioid pills were manufactured and dispensed in the U.S. with DEA approval.  (The DEA sets the limits on how many pills can be manufactured, but they don't regulate the practice of medicine.  The DEA is cutting production of prescription opioids by 25% in 2017.) 

    Why is the problem growing?  Four out of 5 new heroin users started on prescription pills, and most of the people who start on prescription pills get them out of someone's medicine cabinet, get it 'legitimately.'  In 2014 there were 18,893 opioid painkiller poisoning deaths, and 10,574 heroin poisoning deaths.  (CDC) 

    DEA Chief Chuck Rosenberg says that
    1. People need to recognize the signs of opioid addiction.
    2. We need to continue the national take-back (In 2015 they took in 1.6 million pounds of unwanted and expired prescription drugs.  People dropped them off anonymously with no questions asked, and the drugs are incinerated. Only an estimated 10% of the drugs taken in were opioids, but that is still 160,000 lbs. of opioids out of medicine cabinets and off the streets.  
    3. We need to teach, rehabilitate and treat this addiction.
    4. We need to teach teachers, parents and kids the signs of opioid addiction. 
    5. We need help from doctors, pharmacies, manufacturers and Congress. 
    ("The Painkiller Crisis," DEA chief Chuck Rosenberg on America's "growing" opioid epidemic, CBS News, November 17, 2016; U.S. Dept. of Health and Human Services statistics)

  • What are Opioids?  Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus. Medications that fall within this class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs. Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injury-related pain. Morphine is often used before and after surgical procedures to alleviate severe pain. Codeine, on the other hand, is often prescribed for mild pain. In addition to their painrelieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for example—can be used to relieve coughs and severe diarrhea.  (National Institute on Drug Ab use, August 2016)

  • The Deception.  Prescription drugs are deceiving.  People feel they are safer with prescription drugs because you get them from a pharmacy and they are prescribed by a doctor.  Younger people believe they are safer because they see their parents taking them.  It doesn’t have the same stigma as using street narcotics. 

  • Drug Danger.  Non-prescribed prescription drugs are dangerous.  The prescription drugs (pain killers and sleeping pills) which teens are abusing and sharing at school are just as dangerous as street heroine.

  • We have an epidemic of abuse and death tied to prescription drugs like Vicodin and Percocet.  A wave of overdoses is being fueled by the over-prescribing of medications and a steady supply of cheap heroin.  Deaths linked to misuse and abuse of prescription opioids climbed to 19,000 in 2014, the highest figure on record, according to the CDC.  Opioids are a class of powerful and highly addictive drugs that include both prescription drugs, like codeine and hydrocodone, as well as illegal narcotics, like heroin.  Congress has been asked to provide $1.1 billion to combat opioid addiction.  All 50 governors have been asked by the White House to reduce opioid over-prescribing and enhance addiction treatment.  (Centers for Disease Control and Prevention; "FDA adds firmest warning to widely used painkillers," Associated Press, March 23, 2016) 

  • Drug Market.  There is a huge market for illegal prescription drugs in Spokane.  Young people are abusing legal drugs and getting many of them directly from the family medicine cabinets, which is extremely dangerous.   They use pain killers to change their moods.  
  • Medicine Cabinets.  The problem is in our medicine cabinets.  OxyContin, Vicodin, Xanax and Soma are the most commonly abused prescription drugs.  Other potentially addictive prescription pain killers include Hydrocodone, Percocet, and Demerol.  OxyContin, an opiate-based painkiller, is so potent and addictive that it's sometimes referred to as synthetic heroin.  Fentanyl patches are 100 times more powerful than morphine.  Such drugs now cause more deaths than heroin and cocaine combined.  
  • Hydrocodone.  The most commonly abused prescription drug, hydrocodone, is also the most widely prescribed drug in America.  Sold under the brand names Vicodin, Norco and Lortab, hydrocodone-based medications are some of the most potent and addictive narcotics on the market.  The pain reliever Vicodin is prescribed more often than the top cholesterol drug and the top antibiotic. 

    Hydrocodone is a key contributor to the nation's prescription drug death epidemic.  Prescription drugs, primarily narcotic painkillers such as hydrocodone, cause or contribute to more deaths than  heroin and cocaine combined.  As a result, drug fatalities have surpassed deaths from motor vehicle crashes, long the leading cause of accidental death in the United States.  The United States consumes 99% of the hydrocodone produced worldwide, and doctors write more prescriptions for it than for the leading antibiotic and hypertension medications.  Doctors have prescribed hydrocodone with few restrictions since it was introduced four decades ago.  Because of the perception that it is less risky than other narcotic painkillers, it is widely prescribed by general practitioners and dentists.  ("Legislation targets hydrocodone," by Scott Glover and Lisa Girion, Los Angeles Times, March 21, 2013) 

  • Methadone.  The people dying from methadone are not hard-core drug users.  In our society, people think prescription medications are simply safe.  Methadone is especially dangerous in unskilled hands.  Because it takes longer to have an effect, people overdose, hoping to relieve pain or achieve a high.  By the time it takes full effect, the accumulated drug has slowed respiration, overriding the body’s instinct to breathe. 
  • Addicts.  Addicts range from teenagers to middle-aged working men and women who take medications prescribed for pain and anti-anxiety, and become addicted.  
  • Drug Deaths.  Deaths from prescription medication overdoses are far outpacing deaths from illegal drugs in Spokane County.   Lethal prescription drug overdoses have soared 84% over the past 5 years.  Today, more people die from prescription drug overdoses than cocaine and heroine combined.  
  • Deaths of Children.  Accidental poisoning deaths among young children have spiked due to prescription drugs.  Parents and guardians are advised to store drugs in locked cabinets and rid the home of unused medications.  (Dr. Randall Bond, Cincinnati Children’s Hospital Medical Center)  
  • Secrecy.  Both prescription pain killers and heroin can be snorted, avoiding needle marks.  

Statistics
  • In 2015, 718 people died from opioid overdoses in Washington.  More people die in accidental deaths from heroin and prescription painkiller overdoses than from vehicle or firearm-related deaths.  Prescription opioid drug deaths have gone down, but fatalities from heroin overdoses are rising, particularly among young people.   ("Inslee executive action targets opioid addiction," Governor Jay Inslee, AP, October 9, 2016)

  • Addiction in America. 12.5 million people report misusing prescription painkillers in 2015.  78 Americans die every day from opioid overdoses.  (U.S. Dept. of Health and Human Services, 2016) 

  • Deaths linked to misuse and abuse of prescription opioids climbed to 19,000 in 2014, the highest figure on record, according to the CDC.  In 2014, more people died from drug overdoses than car accidents or gun violence.  (Centers for Disease Control and Prevention; "FDA adds firmest warning to widely used painkillers," Associated Press, March 23, 2016) 

  • Availability of prescription drugs.  Nearly l in 5 teenagers says it is easier to buy prescription drugs than it is to buy marijuana, beer or cigarettes.

    Overdose Deaths from Painkillers.
      Prescription painkillers such as OxyContin, Vicodin and methadone led to the deaths of almost 15,000 people in 2008—more than 3 times the 4,000 deaths from narcotics in 1999.  Painkillers “are meant to help people who have severe pain,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, which issued the November 2011 report.  “They are, however, highly addictive.” 

    Nearly 5% of Americans ages 12 and older
    said they have abused painkillers in the past year—using them without a prescription or just for the high.  There are enough narcotic painkillers prescribed every year to give every American a one-month supply.  For chronic pain, narcotics should be the last resort.

    Overall, there were 36,450 fatal overdoses in 2008,
    including accidental cases and suicides involving illegal drugs like heroin and cocaine along with prescription medicines.  About ¾ of the deaths from prescriptions involved narcotic painkillers.  (end of the CDC report)  
  • Drug Deaths.  Deaths from prescription drugs now outnumber traffic fatalities in the U.S.  (Sept. 2011 L.A. Times analysis)  
  • Dirty Needles.  More than a half million dirty hypodermic needles were exchanged for clean ones in 2006 to help prevent the spread of disease in Spokane County.   
  • Internet Purchases.  Prescription drugs are traded on Internet chat rooms for $10 to $80 a pill.  They are also sold on street corners along with heroin, marijuana and crack.  
  • College Students.  Nearly half of America’s 5.4 million full-time college students abuse drugs or binge drink.  (National Center on Drug Addiction and Substance Abuse)
  • National Problem.  Nearly 7 million Americans abused prescription drugs in 2007, more than marijuana, cocaine, heroin and Ecstasy combined -- an 80 percent increase since 2000. 
What You Can Do
  • Parents and Grandparents.  Lock up your medicine cabinets!  
  • Deadliest Drugs - An Epidemic.  Get the facts about drugs and death caused by drugs. 
    (Source:  CBS News, 2016)
    http://www.cbsnews.com/pictures/deadliest-drugs/

  • Organize a Prescription Drug Take-back program for people to safely dispose of old and unused prescription medicine. 

  • Set a Good Example.  Parental example is the greatest teacher for children in all things, including substance abuse.  Parents in turmoil look for ways to numb their pain; but unfortunately, sometimes it is drugs and alcohol—an example viewed by their children.  Do your children watch you take a pill or a drink to deal with stress, anxiety, and depression?  What messages are you sending and teaching your children?  
  • Addicted Parents Neglect Children.  Children who are neglected by parents abusing substances will never trust that they will have food, comfort, and unconditional love.  They will be thwarted in their ability to concentrate, interact socially, and develop physically.  If you are addicted to any drugs, get professional counseling or therapy.  Contact a drug rehabilitation/treatment program.
  • Have the Conversation.  Parents— Talk to your children about the danger of all drug abuse, including prescription drugs.  Explain that even a small dose can take someone’s life.  For help talking to your children about the risks of drugs and alcohol, visit http://starttalkingnow.org.

  • 17,000 people die every year from prescription painkiller abuse (opiate-based prescription drugs like Vicodin, Oxycontin, Percocet (contains oxycodone), Zohydro ER, Targiniq ER). 

    Consumer Reports recommends to those with pain killer addiction:
    - Try alternative pain relief methods
    - Use low-dose, short-acting opioids
    - Limit duration of use.  
As the body builds up a tolerance for the drug, users increase the dose for pain relief resulting in physical and psychological dependence.  Taking these drugs long-term can make it difficult to stop.   ("Consumer Reports:  Legal pain pills can be deadly," CBS Morning News, July 31, 2014)
  • Outstanding Resource.  For pictures and detailed information on hundreds of drugs which are sold on the street, contact local law enforcement for a copy of “Street Drugs—a Drug Identification Guide,” or request a copy from Publishers Group, LLC, 2805 Alvarado Lane N, Plymouth, MN  55447, (763) 473-0646, mailto:sdinfo@streetdrugs.org, ISBN 0-942677-02-1.   
Local Organizations
Additional Resources
  • Greater Spokane Substance Abuse Council.   Call to learn more about the dangers of prescription drugs and other substances, or to share your story of recovery in an effort to help others.
    (509) 922-8383
    http://www.gssac.org 
    http://drugfree.org     

  • New Vision @ Holy Family Hospital
    (509) 252-6488

  • Spokane Treatment and Recovery Services
    (formerly Community Detox Services of Spokane)
    312 W. 8th Avenue
    Spokane, WA
    (509) 477-4631
  • “Street Drugs—a Drug Identification Guide,” is an outstanding resource book containing hundreds of pictures of drugs which are sold on the street.  Contact our local law enforcement for a copy, or request a copy from Publishers Group, LLC, 2805 Alvarado Lane N, Plymouth, MN  55447, (763) 473-0646, mailto:sdinfo@streetdrugs.org, ISBN 0-942677-02-1.  

  • Drug Rehab
    http://www.drugrehab.com/addiction/
    Addiction to drugs, alcohol and prescription drugs.  Their mission is to equip patients and families with the best information, resources and tools to overcome addition and lead a lifelong recovery.