Become Aware

Ignorance is no longer bliss when it comes to the misuse and dependency of opioids.

In America, this crisis has reached epidemic proportions, which according to the CDC, claimed 63,632 lives in 2016 and is generating an economic burden of $78.5 Billion in terms of healthcare costs, lost productivity, addiction treatment and criminal justice costs.

It’s time to become aware of the substances posing great health risks to our loved ones so that we can help them continue to make SMART choices when it comes to interacting with opioid pain relievers after surgeries, injuries and among their spheres of influence.

Let’s begin with acquiring some knowledge about opioids.

What is an Opioid?

An “Opioid” is a narcotic substance with a chemical structure derived from the poppy plant, which is grown in mountainous regions in Southeast and Southwest Asia, Mexico and Columbia. The plant contains chemicals that can be processed into other drug like morphine, which then can be changed into many types of stronger opioids that are patented by pharmaceutical companies for sale or used in laboratories for research purposes.

Common Opioids

Opioids can be divided into common types: natural or semi-synthetic opioids such as prescription opioids, morphine, and heroin; or full-synthetic opioids and their many analogs like fentanyl and carfentanil.

At some point on life’s journey, each of us will face the challenges of an illness or an injury and may eventually require pain relief.

Prescription opioids are powerful pain medications commonly referred to as “heroin in a pill,” by people who misuse them for the euphoric and sedating feeling they cause.

Technically, prescription opioids are narcotics. Most have the potential for abuse and can create dependency in the user. Many name brand opioids have Abuse-Deterrent Formulations and have existed for years. These formulations attempt to reduce the likelihood of users being able to crush, snort or shoot up the extended release medication to achieve a stronger and faster high.

Abuse Deterrent Formulation is one side of the multi-faceted action necessary to reduce the misuse and the diversion of prescription opioids to the black market. If you are in a position to help shape the public health landscape of your city or state, and are looking for action steps to add to your policy reform plans, consider advocating for policies that require the following:

  • All patient rooms display opioid prescribing guidelines and basic awareness information.
  • Emergency Department, Urgent Care and Primary Care Patients receive no more than a seven-day supply for an initial, new prescription and the duration should be at the discretion of the prescriber.
  • All patients requesting refills of opioids be switched to an abuse-deterrent formulation accepted by the patient’s insurance.
  • All opioid prescribers provide patients or their caregivers with “take home” information on where and how to safely dispose of their unused prescription opioids once their pain has become manageable with other treatment modalities.
  • Increase awareness and access to naloxone by having the purchase price built into the patient’s medical bill, so there is no upfront cost to getting it at the same time they fill their opioid prescription.

The most common types of prescription opioids are:

  • Hydrocodone based
    • Lortab
    • Vicodin
  • Oxycodone based
    • Percocet
    • Percodan
    • Oxy Contin

The risk of overdose for misusers of prescription opioids is high. Naloxone containing medications like Narcan®, reverse prescription opioid overdose if given in time. Click here to learn how.

Over the last hundred or so years, heroin has gone from being accepted as an everyday over the counter cough suppressant, to one of the most addictive drugs known to man.

Heroin can be taken many ways, most commonly it is injected intravenously, but can also be snorted nasally or smoked.

Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin. Heroin enters the brain quickly and binds to opioid receptors on many types of cells, including those that are involved with the perception of pain and pleasure.

Heroin use greatly increases the risk of death from cardiac arrest due to its impact on the autonomic nervous system; the system that regulates normal breathing, heart rate and sleep. Simply put, when users are heavily sedated, they can fall asleep and stop thinking about breathing and then die from cardiac arrest. The same risk exists for prescription opioids.

Those who become addicted to heroin and abruptly stop using it can experience severe withdrawal symptoms within a few hours. According to NIDA, These symptoms include:

  • Restlessness
  • Severe muscle and bone pain
  • Sleep problems
  • Diarrhea and vomiting
  • Cold flashes with goose bumps (“cold turkey”)
  • Uncontrollable leg movements (“kicking the habit”)
  • Severe heroin cravings

Heroin overdose can happen suddenly without warning. Because heroin is an opioid, Naloxone containing medications like Narcan® have the ability to also reverse a heroin overdose, if given in time by whoever is present first on the scene. Though, multiple doses may be needed before emergency medical help arrives. Check out “where to find naloxone“ on the Restoring Life page to find a naloxone provider near you.

According to the CDC, in 2016, there were 19,413 drug poisoning deaths involving synthetic opioids—an increase of 110% from 2015 and this class of drug was present in approximately a third of all drug-involved poisoning deaths in 2016.

The CDC has reported fentanyl as the drug responsible for most of the synthetic opioid deaths. In addition, in 2016, there were more deaths involving synthetic opioids than involving natural and semi-synthetic opioids for the first time ever.

Fentanyl is the generic name for a class of Schedule II narcotics reported to be 50-100 times stronger than morphine. Fentanyl was created for patients suffering from severe pain due to cancer and/or an exceedingly invasive surgery whom were not receiving adequate relief from their current opioid regimen. It was intended to be administered only by doctors in a medical setting. Nowadays, it is sold over the counter at pharmacies or neighborhood drugstores in the form of lollipops, lozenges, and time-release gel patches. Fentanyl sold on the streets is extremely efficient at causing overdose because a minute difference between a medical, professionally administered dose, and one performed by an amateur, can result in immediate and often fatal cardiac arrest.

DEA Info on Fentanyl

Fentanyl is More Than One Drug

Carfentanil is a Schedule II drug and is an analog synthetic version of Fentanyl, created to be more potent, and also less expensive.

Carfentanil is reported to be 10,000 times stronger than morphine, 4,000 times stronger than heroin, and 1,000 times stronger than Fentanyl. It is marketed as a horse and elephant tranquilizer; however, drug traffickers are shipping it into the US from China for other purposes.

Fentanyl and carfentanil are used as additives to make heroin and other drugs stronger, thereby generating more profit for drug dealers. Because of the profit potential, fentanyl and Carfentanil is silently slipping into small towns and cities across the US.

Some cities have seen their overdose rates shoot up to new, disturbing heights. During a single weekend, Cincinnati Ohio recorded 30 overdoses. The most elusive aspect of the drug is that it looks like regular table salt, however, only a few small granules are enough to prove fatal.

As if Carfentanil were not disturbing enough, there is a substance very similar but more potent, known as “Lofentanil,” which can be over 100,000 times stronger than the standard dose of morphine.

For more information on the comparative strength of various opioids, please click here.

Why Sharing is NOT Caring

Opioids are prescribed with a one specific person in mind: the patient. If you require medicine for pain management, your medical history, current health issues, and weight were considered when your provider wrote the prescription. No matter how good your intention, handing pain medication to someone else can be a fatal choice. Even if both parties believe it’s safe, or have done it before, it’s not a SMART idea to push your luck when over 50,000 people die each year from prescription drug overdose.

But sharing still happens. A lot.

In a drug use and health survey, more than half of the people who misused pain relievers got them from a friend or family member.

  • 40.4% Free form A Friend or Relative
  • 8.9% Bought from A Friend or Relative
  • 3.7% Stole from A Friend or Relative
  • 6% Bought from A Drug Dealer or Stranger
  • 35.4% Other
  • 1.4% Prescribed by A Doctor
  • 0.7% Prescribed by Multiple Doctors
  • 3.4% Stolen from Doctor, Clinc, Hospital or Pharmacy

Source: 2016 National Survey on Drug Use and Health

HARD TRUTH: Taking from or sharing prescribed medication with anyone means you are committing a felony. Specific laws vary state by state, but if you are caught with illegal prescription drugs (meaning any medications that are not prescribed for you), you can be imprisoned and/or fined among other serious consequences.

Community Action Network recommends patients ask their doctor to prescribe fewer pain pills for the initial prescription. Doctors should educate their patients on the legal consequences of sharing opioids, which generate higher rates of dependence and overdose than any other class of prescription drug.

Preventing Opioid Misuse Among Student Athletes

Thinking SMART means using the experiences of teachers and those who have gone before you to avoid danger.

The State of Massachusetts is a great example, having pioneered many aspects of the prevention effort. The Massachusetts Department of Public Health (MDPH), Massachusetts Interscholastic Athletic Association (MIAA), and Massachusetts Technical Assistance Partnership for Prevention (MassTAPP) have joined forces to provide direction for student athletes, coaches, and parents who work through the pain and challenges of sport injury.

The action steps designed by these organizations help prevent opioid misuse and overdose among student athletes.

Resources for Injured Athletes

Athletes, Opioids and Addiction

Path to Rx Drug Dependency

They way opioids achieve pain relief also causes the release of brain chemicals that make the user feel euphoric, or “high.” Overtime opioid users can develop a tolerance to their current dose and must take stronger and stronger doses to achieve the desired effects. This also makes opioids an equal opportunity destroyer, because the intense need to take more to fend off the symptoms of withdrawal can lead most anyone to engage in drug seeking behaviors.

Learn the Path to Dependency below to help intervene when you or a loved one find yourselves on it.

This is the therapeutic use of a prescribed drug by a user under the care of a license health care provider, or the self-treatment of conditions using over-the-counter (OTC) medicine as directed by product labeling. Users in this stage typically do not experience many negative side effects or consequences from their use. Those who do speak to their health care provider to make adjustments or stop taking them altogether.

Misuse is defined as taking a prescribed drug in ways unintended by the license health care provider who originally prescribed it. This includes taking the medicine for the feeling it causes, taking it for other medical reasons not properly diagnosed, sharing the same medicine with others, or diverting prescribed medicine to others illegally, whether as a gift or for financial purposes. Users in this stage begin to experience negative side effects and consequences of taking prescribed medicine in a non-medical way. These can be of a legal, social, health, or financial nature.

Abuse means the continued non-medical use of medicine despite experiencing serious legal, social, health and/or financial consequences. Users in this stage often report that the negative costs experienced far outweigh the positive benefits received from their continued consumption of the Rx drug. By performing simple and effective screeners, medical providers can identify users with an Rx Drug abuse problem before they become chemically dependent.

Opioid Risk Assessment

Dependent users are unable to stop taking a drug due to the chemical dependency the brain has developed for a particular substance. When the user enters this stage, their brain’s ability to regulate urges and cravings diminishes. Vital brain chemicals and instinctual behaviors become hijacked by the drug, making the user believe that without achieving their next dose, they will not survive. The user becomes willing to do almost anything to acquire and consume their next dose, which includes drug-seeking behaviors such as:

  • Obtaining multiple provider prescriptions
  • Medicine theft from family or friends
  • Reporting false medicine theft to police in order to get refills
  • Inflicting injury on themselves, relatives and pets to obtain their next dose

These users are not stereotypical “mindless zombies,” but in fact are brilliant at devising schemes and means to their end, which according to their brain, is their own survival.

Dependent users experience the strongest withdrawal, which is the state when their drug of choice has not been active in their system for a period of time. Dependent users in withdrawal are at a high risk for overdose due to medicine tolerance that requires stronger doses over time. Also, due to the common presence of related illegal activities, dependent users often become incarcerated, cutting them off from their supply of medicine. This reduced use drastically lowers tolerance. Upon being released, however, many dependent users resume taking drugs at the same frequency and dose strength, which too often proves to be a lethal decision.

These individuals are often clinically diagnosed with Opioid Use Disorder(OUD) and can strongly benefit from Medication Assisted Treatment using bupdrenophine, or other medicines.

Medication-Assisted Treatment MAT can reduce the urge to habitually use, prevent withdrawal symptoms, and allow patients time for their internal brain chemicals to become more stabilized and receptive to cognitive behavioral therapies (CBT) by partner providers in the behavioral health field. Cognitive behavioral therapies can help restore further balance in live derailed by substance use disorder.

What Parents Need to Know:A Prescription Drug Abuse Documentary

If you are a parent or guardian, you naturally take preventative steps to protect your child from illness or harm.

Sometimes when children grow up and become teenagers, it’s sometimes easier to think they no longer need “the pain pill” talk, or you may feel uncomfortable or ill equipped to start the conversation. Think SMART Oklahoma is here to provide you with the tools to speak confidently to your child about medicine safety before they have reached the wrong end of the dependency path.

Have the “pain pill” talk before “the friends” do. Listen to other parents’ experiences and become more aware by watching the video below.

The Consequences

Community Action Network believes that opioid dependency is best treated as a disease and not a moral failing on the part of the host. It is a mental illness that, with treatment and support, can be overcome. This does not mean, however, that users should overlook responsibility for their own actions.

If you or someone you know engages in risky drug related behaviors, there are natural consequences that can be expected along the path to recovery.

Abusing any drug, whether to enhance your mental or physical performance, cope with stress or pain, or simply for the feeling it causes, (known as recreational use), will eventually contribute to the loss of non-using friends and healthy relationships.

Drug misuse also can get you in trouble financially. You will make more mistakes on the job, effecting both you and your team's outcomes. If you lose your job, you’ll be less able to support yourself or your family. Drug use is also a leading cause of chronic and acute homelessness.

Opioids can affect your heart rate, oxygenation of muscles, appetite, digestive functions, ability to concentrate, eye-hand coordination, senses, pain level and depth perception, interfere with your body’s normal brain and chemical process and response systems, affect judgment, decision-making, and ability to regulate body temperature. All these things can produce serious negative health outcomes, but the greatest threat to health involves breathing.

During an overdose, opioids interfere with the part of the nervous system that allows you to breathe automatically. Opioids also have strong sedative properties and can make you drowsy. If you fall asleep and lose your ability to breathe without thinking, the heart goes into cardiac arrest and you can die.

Furthermore, opioids impair your ability to drive a motor vehicle or perform other mechanical functions. All opioid users, especially chronic pain sufferers who take daily opioid regimen, should use extreme caution when operating a motor vehicle, as the concentration of opioids in the body result in a user often being behind the wheel under the influence. Driving under the influence is a crime.

Pledge Your Support

Now that you have become aware of the problem, understand the social, legal and health consequences that come with opioid misuse, will you take a stand with us and pledge to Think SMART when it comes to prescription drugs?

Download the pledge card today and display it in your home, office, business storefront or other places to show your sphere of influence that you care about the health and safety of Oklahoma and promise to do your part to put an end to the opioid epidemic!

Download Pledge Card