The opioid epidemic in the U.S. continues to plague our communities
and hospital systems. Why has it become such an insurmountable burden?
First, it’s important to understand the neurological mechanisms behind the
Opioids Are Not Inherently “Bad”
Opiates are a naturally occurring class of drugs found in the opium or poppy plant. These drugs have been around for ages in helping with pain control. The properties of opiates are deeply linked to serotonin and dopamine, chemicals in the brain that provide attachment.
“It is very easy to become addicted to an opiate, in the same way when you meet your parent for the first time, or you fall in love,” states Dr. Erica Locke, Emergency Medicine Physician at Salinas Valley Memorial Healthcare System (SVMH). “When we use an opiate and there's no pain, serotonin and dopamine surge to incredible levels and provide euphoria. It's part of why we can become so addicted to these very dangerous substances”
However, opioids do play an important role in medicine when used appropriately. The epidemic arose out of misinformation relayed by pharmaceutical companies—assuring medical communities that patients would not become addicted. Eventually, the widespread use and subsequent abuse of opioids, either as prescribed or in the form of synthetic street drugs, led to intervention by the Department of Health and Human Services.
Fentanyl: A Newer Enemy
One of the most dangerous battles medical professionals and law enforcement officials are facing now is the synthetic opiate fentanyl. This drug is about 100 times more potent than any known opiates of years’ past. “With fentanyl in the street drugs, it seems our ‘street chemists’ don't totally understand yet microgram versus milligram. So, when they're creating these street drugs, you can have a very small amount of fentanyl that actually leads to devastating effects in our population. That's part of why we're seeing so much death associated with our street drugs,” explains Dr. Locke.
Fentanyl use has actually changed the messaging that surrounds opioid use. For example, Dr. Locke urges everyone to never buy street drugs, even if they look like prescription drugs dispensed from a pharmacy.
“There are a lot of pills out there that look like prescription drugs. Someone might say, ‘Oh, this is my mom’s, or this is my dad's’ but they're actually counterfeit street drugs made to look like prescription drugs.”
Another strategy is to raise awareness about the overdose reversal drug Narcan. “When they’re old enough, I plan to tell my kids about Narcan, how to use it,” adds Dr. Locke.
Importance of Medication Assisted Treatment
If someone is addicted to opioids, the first step towards abstention is wanting to get sober. The next step is to get into a medication assisted treatment program.
“Chemical changes are happening in the brain, alongside physical changes. Withdrawal is very uncomfortable. There's diarrhea, sweating, vomiting. As a health care system and as providers and as a community, finding ways to help people is very important,” shares Dr. Locke. “Medication assisted treatment is key.”
While methadone has been the traditional approach to medication assisted treatment, newer drugs have emerged that are more effective, safer, and longer lasting. This also helps mitigate the challenges of visiting a methadone clinic every day.
Monterey County Prescribe Safe: Unifying Providers and Community Members
A tremendous resource in Monterey County is Monterey County Prescribe Safe, which has been instrumental in unifying hospitals, clinics, and community members. It’s a multidisciplinary approach to meeting the needs of affected individuals and providing tools to help reduce addiction and overdose-related deaths.
One recent “win” was to keep a supply of Narcan in the emergency department that can be handed out whenever anyone needs it. “Any of the nurses, docs, really any human who is in our system can come down to the ER and say, ‘I have a loved one who needs Narcan’ and no questions asked. So, that's been a big win, partnering with the pharmacy in order to provide that,” notes Dr. Locke.
Another advancement is the availability of in-house testing for fentanyl—which was previously not possible.
Dr. Locke also gives great credit to the social work department. “They work tirelessly to speak with our patients and get them into treatment, because it's more than just here’s a prescription and ‘good luck’. There's a whole network of therapy, peer support, and life support that people really need. Opiate use disorder can completely devastate a life when it comes to your finances, housing, food, and even access to your family.”
**To listen to an in-depth conversation on this topic with Dr. Erica Locke, Emergency Medicine Physician