The opioid epidemic
In the last several months, the Block Island community experienced the tragic death of two young people due to opiate overdose. Our hearts go out to their families and loved ones.
As a community, we pause to ask what we can do to prevent similar tragedies in the future. The first step is to acknowledge that Block Island is not exempt from the current nationwide epidemic of prescription and illicit drug abuse. Our community is a microcosm; subject to the same risks found in other places. Unfortunately, this type of tragedy could befall any family, even here on Block Island.
Opiates constitute a class of drugs that are used to treat pain. Opiate substances and medications are derivatives of opium — a naturally occurring substance extracted from various species of poppy plants. Morphine, codeine and hydromorphone are some common examples of opiate medications. Familiar trade names for these medications include Percocet, Norco and Vicodin. Heroin is an illegal, highly addictive opiate derivative.
All opiates relieve pain and anxiety. Many also produce a feeling of euphoria — a powerful sensation of wellbeing or “high.” The pain and anxiety reducing effects of opiates are the reason why they are such a powerful tool in medicine. The euphoria effect is the reason why opiates are prone to abuse. Anyone who uses or abuses opiate medications is at risk of developing an addiction. Addiction is a combination of both physical and psychological dependence that results in a compulsion to use a substance over and over in spite of grave consequences. The degree of risk for addiction depends on the duration and amount of use as well as the person’s individual physiology. Some individuals are more prone to addiction than others.
Similar to alcohol and other drugs, opiates produce a phenomenon called tolerance, which basically means that over time the body adjusts to the substance and higher and higher doses are required to produce the same effect. These substances also cause dependence, which refers to physiological changes in brain chemistry in which sudden removal of the drug will cause a person to become sick—this is called withdrawal. Sometimes withdrawal is so severe that it can lead to seizures and death, although this is more common with alcohol than with opiate withdrawal. While not usually resulting in death, opiate withdrawal can be intensely painful; producing vomiting, abdominal pain and intense psychic pain.
Heroin use poses additional grave dangers. Since heroin may be inhaled or injected, users are at risk of contracting many blood-born diseases and infections from abscesses to heart and blood infections, hepatitis of all forms, and HIV. Heroin is often diluted or “cut” with other toxic or life-threatening substances. Many deaths have occurred accidentally in users who were unaware that their heroin had been cut with either toxic or super-potent formulations. Opiate overdose from any form, pill or heroin, leads to respiratory depression which can result in hypoxia, brain damage, and/or death.
Good people can and do become addicted to opiates, alcohol, and other substances. Opiate addiction may involve using prescribed or illegally obtained medications or using street formulations of opiates such as heroin. Addiction affects people from every walk of life regardless of age, level of education, sex, nationality or religion. Chemical dependence can begin before birth in babies whose mothers are using or dependent. Addiction is a life-threatening medical illness that often destroys the lives of the people suffering from the addiction, as well as the lives of their loved ones. Medical help is available and effective for patients suffering from addiction. While there is no cure for addiction, as there is no cure for diabetes at this time, effective treatment allows a person the possibility to live a healthy, happy, and productive life. Similar to the treatment of many other medical illnesses, treatment for addiction and substance use must be tailored to the individual and must address the physical and psychological components in a holistic way.
If help is available, why then don’t more people seek it? There are many reasons. Denial, the overwhelming craving to use, lack of insight, fear of exposure, and fear of being judged harshly by health care professionals, are just a few of the many factors that may contribute to a person’s unwillingness to seek help. The shame and guilt associated with substance use disorders and addiction often result in secrecy and hiding that interfere with sick people getting the treatment they need. This secrecy and hiding may be shared by a spouse or family members who may deeply desire that their loved ones seek help, but are afraid of exposing them or even confronting them about their substance use. In the end, this is misguided loyalty that contributes to the progression of the disease. The impact on children and the scars left by an actively substance-using parent cannot be overestimated and the tragic scars last a lifetime.
Imagine how many lives would be tragically lost if people with diabetes or any other medical illness felt compelled to hide or deny their condition rather than seek treatment? And imagine if their spouses and family members, who knew of their condition didn’t encourage them to seek treatment because of shame, guilt, or fear of public exposure? We need to shift our thinking to see substance dependence and addiction as we do any other life-threatening illness that needs medical attention and care.
The best thing a spouse, family member, or loved one of an individual with a substance use problem can do is to learn as much as possible about the disease of addiction, while acknowledging that to a large degree they are powerless over the addicted person’s behavior and choices. One way to gain a valuable education and also find support is through an active involvement in Alanon. To be successful, any Alanon group needs members who are committed to the principles of the program, and to supporting one another. It is important for family members to gather support to help them confront their loved one and urge their loved one to get help. It is equally important to realize that in the end it is really up to the addicted person to seek help. This cannot be done for them. And even with the best efforts of family, it is still impossible to control or predict the behavior of a person who suffers from addiction.
Statistics have shown a marked increase in deaths from overdoses caused by opiates in recent years. The increase in cases is due in part to unwitting use of extremely potent heroin circulating on the street. In other cases, addicts who relapse after a period of sobriety are prone to overdose because they use the same dose they had previously used, but their tolerance has diminished during their sobriety. In other cases, users are crushing and inhaling pills of extended release formulations such as OxyContin — a drug intended for slow release in the body. This sudden absorption overwhelms the system and results in overdose.
There is an antidote for acute overdose. Our rescue personnel are trained in the use of Narcan (Naloxone) and carry this with them on rescue calls. This drug can safely reverse the effects of opiate medications but must be given as soon as possible before hypoxia and death occur.
If you or someone you love is suffering from substance dependence or addiction, you can begin to seek help right here at the Medical Center.
We will listen to you without judgment, maintain your confidentiality and help you to find and obtain the most appropriate professional help for your situation. We are here and ready to help. A better life is possible.
We may refer you to an in-patient drug treatment program or connect you with one of the excellent behavioral health counselors we have who are available to see patients on-island.
Thanks to the hard work and advocacy of NAMI-BI, the Tele-Health Program, which is now housed at the Medical Center, is available to provide access to behavioral health specialists at Butler Hospital via the internet.
One thing that we can all do is continue to educate ourselves and our community about substance use and abuse and the opiate epidemic.
We need to continue the conversation
We need to look out for one another. We need to remember that addiction can happen to anyone from any family — even here on Block Island.
Mark Clark, MD, is the Medical Director of the Block Island Medical Center.