Focus On Prevention – Spokane Regional Opioid Task Force
What is Addiction?
The American Society of Addiction Medicine (ASAM) defines addiction as, “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or involvement in recovery activities, addiction is progressive and can result in disability or premature death.
Dependance vs. Addiction?
Opioid dependence is the need to keep taking drugs to avoid a withdrawal syndrome. Addiction is intense drug craving and compulsive use. Dependence is when a person’s body has begun to develop a tolerance to a drug, and more of that drug is needed to get the same effect. A person who uses opioids on a regular basis can develop a tolerance, feeling like they need to take more in order to feel “normal.” If the drug were to be stopped, the body would begin to go through withdrawal. This can happen even if the drug is taken as directed by a doctor. The abnormalities that produce dependence appear to resolve after detoxification, within days or weeks after opioid use stops.
The abnormalities that produce addiction, however, are more wide-ranging, complex, and long-lasting. Addiction is when an individual becomes physically unable to stop taking a drug even after detox and even though drug use is causing negative consequences. The drivers of addiction may involve an interaction of environmental effects—for example, stress, the social context of initial opiate use, and psychological conditioning—and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent.
Risk Factors for Addiction
Opioid addiction is not a moral failing, but a chronic disease. Just as like a heart condition or cancer, who becomes addicted cannot be predicted based on the moral character of the individual. There are risk factors: family history of substance use disorder, trauma, a person’s ACEs (adverse childhood experiences) score, and mental health. For some, there were adverse experiences in child- or adulthood that caused emotional or physical trauma. These events lead to an increased risk of any substance use disorder. For some, opioids have become a means of self-medicating a mental health issue. For others, they were born and genetically predisposed to addict. The challenge is that people do not necessarily know whether they are predisposed or not until they try an opioid for the first time. Approximately 1 in four people using opioids, prescription or heroin, are likely to become addicted.
What are Co-occurring Disorders?
Co-occurring disorders: refers to someone who is suffering from substance use disorder in addition to another mental health disorder. Substance abuse often worsens the symptoms of the mental health disorder, and likewise, the mental health issue can lead to worsened substance abuse.
What are Opioids?
Opioids, also called opiates, are a class of drug. The class includes drugs derived from the opium poppy, such as morphine and codeine. It also includes synthetic or partially synthetic formulas, such as hydrocodone (Vicodin), oxycodone (OxyContin or Percocet), oxymorphone (Opana), morphine (Kadian or Avinza), codeine and fentanyl. Many opioids are used to treat pain. Some opioids, such as oxycodone, codeine, and morphine, are prescription pain medications. Using these medications for recreation or in a way not prescribed by a doctor can be considered abuse. Heroin is an illegal form of opioid, and very similar to prescription opioids but a lot more affordable. A recent study conducted by the University of Washington’s Alcohol & Drug Abuse Institute found that of those drug injectors who had used heroin within the past 3 months, 57% reported being “hooked on” prescription opioids before trying heroin.
Opioids increase the amount of dopamine in a part of the brain called the limbic reward system. Dopamine causes intense feelings of pleasure, which drives users to seek out the drug again and again. They trigger the release of dopamine, which is a neurotransmitter that causes intense pleasure in parts of the brain that include the limbic system. It links brain areas that control and regulate emotions. Limbic reward system can hijack other systems in the brain — systems that drive judgment, planning and organization — driving them all to seek that pleasure of getting high. This process can go on during years of sobriety.
What is Fentanyl?
Fentanyl is becoming a larger part of the opioid epidemic conversation, as overdoses from fentanyl are on the rise. Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the United States. However, most recent cases of fentanyl-related harm, overdose, and death in the U.S. are linked to illegally made fentanyl. It is sold through illegal drug markets for its heroin-like effect. It is often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge—to increase its euphoric effects, which can also lead to overdose.
Treatment for Opioid Use Disorder and Overdose Reversal Drugs
Opioid use disorder is 100 percent preventable, but it’s also 100 percent treatable. The first and most effective is medication assisted treatment (MAT) with buprenorphine and methadone. People can be on those medications and in recovery, with an added bonus of reducing death by 50 percent.
What is Medication Assisted
MAT is Medication Assisted Treatment. Methadone, buprenorphine, and naltrexone are Food and Drug Administration (FDA) approved medications often combined with behavioral therapies to treat Opioid Use Disorder. They are used to treat those who have an addiction to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. Medications used in this type of treatment normalizes brain chemistry and body functions without the negative effect. This stability allows MAT patients to achieve healthy social, psychological and lifestyle changes. It decreases overdoses, increases the likelihood that someone will stay in treatment even through relapse, is more effective in reducing illicit opioid drug use than non-pharmacological treatments, and improves health treatment in other areas as well. For example, a person using MAT is more likely to enroll in HIV treatment and keep up their HIV treatments. People may safely take medications used in MAT for months, years, several years, or even a lifetime. Plans to stop a medication must always be discussed with a doctor.
A common misconception associated with MAT is that it substitutes one drug for another. Instead, these medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability.
Treating Opioid Overdoses with Narcan
Naloxone, also known as Narcan, is the life-saving drug that can reverse an overdose. It is not addictive, nor can it cause harm if administered. Some people have expressed concern that using Naloxone will only encourage more drug abuse. However, a recent study done at Harborview showed that there is no evidence that providing naloxone increases overdose or opioid use risk behaviors. One reason cited is that Naloxone puts the person experiencing an overdose in sudden, acute withdrawal, the symptoms which can include tremors and seizures.
Anyone who is currently using, has a loved one using opioids, or is working with people who are using prescription or illicit opioids should consider carrying Naloxone. Naloxone is available for purchase at most pharmacies. Some pharmacies require a prescription from a provider. There are a few pharmacy chains—Walmart, Walgreens and Yolks—in the Spokane area that can prescribe Naloxone directly.
Health Risks of Drug Use
Injecting opioids increases its side effects. The body is not, for example, designed to cope with a load of powder floating around in the bloodstream, but a number of addicts grind up tablets, mix them with water or alcohol, and inject them. This can lead to heart problems, including long-term heart infections, as well as pulmonary embolisms. If the injection site gets infected, it can cause gangrene in the local area – the flesh dies and then rots. If the wound gets infected, it can cause a massive blood infection, which can be life-threatening. A number of chronic infections such as viral hepatitis and HIV can be contracted as a result of unsterile needle techniques in conjunction with intravenous use of several opiates. Compared to the general population, intravenous drug users have a much higher rate of contraction of HIV and other blood borne illnesses. Needle exchange programs help to lower the risk of HIV and hepatitis B and C transmission. Spokane Regional Health District Needle Exchange services provide one-for-one exchange of used syringes for new ones. https://srhd.org/programs-and-services/hiv-std-services/needle-exchange-services
Pregnant and Using?
Pregnancy can be a wonderful, yet stressful time for any expecting mother. Yet, for someone struggling with substance use disorder, it can be particularly stressful. But there is information, and programs, to help.
If you are pregnant and using opioids or other drugs, it’s important to get help for yourself and your unborn baby. Medication-assisted treatment (methadone or Subutex(R) is the current recommendation for pregnant women using opioids. Treatment is available in our community. Your path to a healthier pregnancy can begin with these five steps:
- See a healthcare provider as soon as you learn/suspect you are pregnant and keep scheduled appointments.
- Be honest about your drug use.
- Immediate withdrawal can harm your baby, so do not abruptly stop taking opioids without first speaking to your primary care provider.
- Stop or decrease your use of other substances like methamphetamine, alcohol, marijuana and nicotine.
- Learn what to expect when your baby is born.
You are not alone. Please call the Washington Recovery Helpline at (866) 789-1511 to speak with someone who can connect you to treatment and services based upon your specific situation and needs.
Pregnancy and Marijuana
Marijuana is old, but the science is new. Using pot while pregnant can hurt the baby. The THC crosses the placenta into a baby’s bloodstream: marijuana use during pregnancy changes how the baby’s brain develops, which can cause lifelong behavior problems. Marijuana use during pregnancy could impact a child’s learning ability and memory.
No amount of marijuana has been proven safe to use during pregnancy.
Using marijuana during pregnancy may cause problems for your baby, like premature birth, problems with brain development and stillbirth.
It’s not safe to use marijuana to treat morning sickness. Talk to your health care provider about treatments that are safer for your baby.
If you use marijuana, don’t breastfeed. You may pass chemicals from marijuana to your baby through breast milk.
Talk to your provider if you need help to quit using marijuana or any other street drug.
Living with a recovering drug addict or alcoholic requires a lot of love and support. Substance abuse and recovery not only affect the addict, but family and friends as well. As a loved one, it is crucial that you get involved with the recovery process to prevent relapse. Recovery is a lifelong commitment that loved ones must be involved in. Loved ones also need to learn how to take care of themselves and deal with any personal issues they’ve developed as a result of their family member’s addiction.
How can you prevent children from starting to use drugs?
Significant adults in a child’s life are the most powerful influence on their health. Having a significant adult, whether it’s a parent, guardian, coach, teacher, increases a child’s resiliency to drug abuse. But it takes more than just bonding. Setting boundaries and clear expectations about not using drugs, and monitoring their behavior in a respectful way, helps to reinforce healthy behaviors. Talking to middle school and high school children about the facts about drugs empowers them to make health choices. https://www.starttalkingnow.org/start-the-conversation
How can I help without enabling?
There is no simple answer to this, as every family’s needs are unique. There are, yet, some basic guidelines that can help in determining the difference.
Enabling behavior can do more harm than good for yourself and your loved one. Here are a few to avoid:
- Ignore unacceptable behaviors and/or excuse them as caused by the drug
- Take care of your loved one’s daily responsibilities or financial obligations while they are using
- Lie for a family member, make excuses, and generally hide the problem from others
- Make open-ended threats and ultimatums
- Make many appointments for evaluations and counseling services that are never kept
It is important for loved ones of the person struggling to learn how to redirect good intentions. Learning these skills will help guide a loved one towards positive, helpful behavior. Here are a few to practice:
- Acknowledge the disorder causes out of character behavior and address it without judgement
- Help with tasks within your reasonable scope while the individual is in treatment
- Speak up when talking with professionals and support systems who can help
- Set clear boundaries for your willingness to help and keep those boundaries
- Keep a short list of who to contact if/when the individual agrees to treatment – find out who accepts walk-ins for evaluations
How to Handle a Relapse
A relapse does not mean that treatment failed or that the person is a failure. It just means that the person needs to readjust their treatment plan or try another form of treatment. Relapse rates for addiction are similar to rates for other chronic diseases such as diabetes, high blood pressure, and asthma. Going back to rehab should not be considered a failure, but rather an act of courage. The person realized the dangers of falling back into addiction and valued their life enough to make a positive change. Though it may seem difficult, the relapse can be seen as a learning opportunity that can strengthen recovery. The person needs to understand what triggered the relapse and develop a plan for preventing another one.
A person entering rehab after a relapse may have more guilt or shame because they may feel like they “messed up.” But they may also have less anxiety because they know more what to expect from treatment. They may even be more determined because they now understand that staying in recovery is hard work. For more information about what not to do when a loved one comes out of recovery, visit https://www.recovery.org/post-rehab-11-things-to-avoid-when-a-loved-one-comes-home/
The financial, legal, and emotional issues of raising a relative’s child can be challenging. Services and support when raising a relative’s child can be a lifesaver. The Washington State Department of Social and Health Services has information about support services, available benefits, healthcare and legal issues. They are here to help. [Find out more] https://www.dshs.wa.gov/altsa/home-and-community-services-kinship-care/kinship-care
Opioid overdose deaths have increased dramatically over the last two decades, leading federal authorities to declare an epidemic. Though the opioid death rate in Spokane county has decreased since 2006, non-fatal opioid events continue to increase. Opioid overdose hospitalizations have increased 2.5-fold since 2004.
Opioids are highly addictive substances and a leading cause of morbidity and mortality due to widespread misuse. In the past 10 years, more than 500 people have died from opioid-related deaths in Spokane County–about 4 people per month.
County Health Insights and Indicators
Additional County Health Insights data indicators demonstrate changes within the county over time and, when available, make comparisons between Spokane County, Washington State, and the United States. Additionally, lower socioeconomic status is often associated with poorer health outcomes. When available and appropriate, health indicators were analyzed by age, sex, race, education, and income to identify disparities.
The Washington Poison Center
Provides immediate, free, and expert treatment advice and assistance on the telephone in case of exposure to poisonous, hazardous, or toxic substances. All calls are confidential. According to their analysis of 2018 data, unintentional opioid ingestions are common in children 0-5 years, while opioid therapeutic errors are common in adults over the age of 60 years of age.