Tuesday, July 25, 2017


Leader staff writer

Editor’s note: This is the third in a series.

In 2013, 249,000,000 prescriptions were written for opioids – enough pills for every adult in the U.S., according to turnthetiderx.org.

A letter on the website from then-U.S. Surgeon General Vivek H. Murthy states, “Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed.”

The letter continues to state that abuse of opioids has been connected “to increased heroin use and the spread of HIV and hepatitis C.”

More than 1,000 people are treated in emergency rooms across the country every day for abusing prescription opioids, according to Centers for Disease Control website, www.cdc.gov.

The most common drugs associated with prescription opioid overdose deaths are methadone, oxycodone and hydrocodone. In 2014, nearly 2 million Americans were abusing or dependent on prescription opioids. Heroin- related overdose deaths in 2015 totaled nearly 13,000.

With the numbers skyrocketing, why do people continue to abuse drugs in the opiate family?

“Your body produces opiates – those are called endorphins. Everyone’s body produces opiates in tiny amounts — it’s a slightly different type of opiate. It’s the feel-good chemicals for the body. When you do something good, you feel good because your body is producing those chemicals. They work on the same receptors,” said Dr. Nihit Kumar.

He is an adolescent mental health and child and adolescent psychiatry specialist who works with opiate addicts at the UAMS Psychiatric Research Institute. He also researches addiction.

“When you take external opiates, external chemical version of something your body is already producing. So it works on the same receptors and gives you that feel good feel,” Kumar said.

Kumar works in the Psychiatric Research Institute at UAMS. He works in both the child division and the addiction division.

Prescription opioids alleviate pain by reducing the sending of pain messages to the brain, reducing feelings of pain. “They make you feel good,” he said.

There are many forms of opioids, according to Kumar. Opiates originate from the poppy plant. This would include drugs such as morphine, heroin and codeine.

There are semi-synthetics, when the opium from the poppy plant is modified structurally in a lab. This would include drugs such as oxycodone, hydrocodone, hydromorphone and oxymorphone.

Synthetic opioids are completely manufactured in a lab. This would include drugs such as methadone, tramadol and fentanyl.

Opioids are used to treat pain from injuries such as a broken bones or while recovering from surgery.

“For acute pain, opioids are the best,” Kumar said. “But in the next two or three weeks, you want to start tapering those off and come off opiates completely.”

Opioid users are at a high risk for overdose deaths, according to Kumar. Someone who has taken an opioid may have shallow breathing.

“Opiate is kind of a downer,” he said. “You have shallow breathing, affects memory, focus, concentration, respiratory function, sedation, sleepiness.”

Treating pain is a balancing act. “You have to treat pain effectively. You can’t not treat pain, that would be torture,” Kumar said. “But you also have to be careful of indiscriminately prescribing without having checks in place. That’s the more important issue. It’s very hard to do.”

While opiates work for acute, short-term pain management, they do not work well in the long-term. Information found at www.cdc.gov shows that people abusing opioids will build up a tolerance to the drug, requiring them to take higher doses to feel the same relief.

They will develop a physical dependence, which results in withdrawal symptoms when stopping medication. Other side effects of opiates that may occur even when taking prescription medications properly include nausea, vomiting, sleepiness, confusion, depression, itching and more.

Kumar suggests finding alternative therapies for long-term pain treatment, such as yoga, acupuncture, rehab or physical therapy.

The CDC has extensive data on the opiate epidemic, including data on risk factors.

Those who have a high risk for addiction to opioids are those taking a high daily dosage of the medication, having mental illness or history of alcohol or other substance abuse, living in rural areas and having low income and obtaining overlapping prescriptions from multiple providers and pharmacies.

The rates of inappropriate prescribing practices and opioid prescribing rates are higher with Medicaid patients than those with private insurance.

According to the CDC website, “one in four patients receiving long-term opioid therapy in a primary-care setting struggles with opioid addiction.”

For more information on opioids, visit www.cdc.gov, www.samhsa.gov or turnthetiderx.org.