In Philadelphia, the Main Line and Montgomery County we are facing the same opioid crises that is affecting the United States. We are no better no worse off. Most of us have seen our practices change over the years as more and more heroin users are coming in for help. Suffice it to say, we are now all very experienced with heroin addiction. In the 1990s when I was in graduate school opiate addicts didn’t make it to treatment. They were either out there using, they were in jail or they were in methadone programs or they ended up dead. Now we have some great medications that can help with addiction like Suboxone and Buprenorphine, Naltrexone and Vivitrol. We also have increased knowledge as a nation of the importance of therapy, treatment and medical monitoring. We know treatment works and we have much more compassion as a society. Now we just have to encourage folks in for help.
Please read an op-ed I wrote for Philly.com.
Most patients and clients haven’t learned how medications can really help and save lives. Most addicts have tried these medicines through experimentation to no avail. It is essential that when someone uses these medicines that they are followed in talk therapy by an experienced licensed professional counselor or certified addictions professional and an addiction psychiatrist. We can connect people with those folks easily and quickly. We can help people learn what they need to know about opioid treatment, addiction and recovery.
Please don’t hesitate to call and ask questions or to encourage your loved ones to call. There are many options for treatment and we won’t push any one approach.
Opioids/Pain Relievers (Narcotics)
Narcotics: The legal definition of narcotics in the United States refers to opium, opium derivatives, and their synthetic substitutes. Narcotics can be grouped into two types, with four main classes. Namely, “natural” narcotics and “man-made” narcotics. Two of the most commonly known natural narcotics are codeine and morphine, and both are derived directly from the sap of the unripe seed pods of the opium poppy. The four classes of narcotics with their examples are “endogenous opioid peptides” which are produced by the body, “opium alkaloids” such as morphine & codeine, “semi-synthetic opioids” like heroin & oxycodone, and “fully synthetic opioids” such as pethidine & methadone. Common reasons for prescription of which are to assist in the cessation of pain and cough.
The method of action of narcotics is to bind to receptors in the brain blocking the transmission of nerve impulses, which transitively reduce pain sensations. Since the nerve impulse is being blocked, a person’s perception of pain is mended, thus narcotics do not cure pain. As narcotics enter the body they depress the Central Nervous System (comprised of the brain and spinal cord) because the nerve impulses that regulate the cardiovascular (heart rate) and respiratory system (breathing rate) are blocked. These phenomena of CNS depression can result in loss of consciousness, coma or death.
As a remedy to address cough or diarrhea, narcotics will work to slow or block muscular contraction resulting in cough cessation. Diarrhea results when the gastrointenstinal system (GI) is operating too quickly. When the CNS is depressed, the GI tract is slowed. .
In the prevention of withdrawal symptoms, narcotics dosages can be tapered until it is safe to fully discontinue the drug without side effects. Physicians may prescribe other drugs to alleviate withdrawal symptoms if necessary.
Common Narcotic Withdrawal Symptoms:
Runny nose Sweating
Commonly Abused Prescription Narcotics
|Generic Name||Brand/Trade Name||Street Name|
|Oxymorphone||Opana, Numorphone, Oxymorphine||Hillbilly Heroin|
|Morphine||Drugs containing Morphine: Avinza, Kadian, Roxanol, MSIR||Dreamer, Emsel, First Line, Hows, Miss Emma, Mister blue|
|Hydromorphone||Dilaudid, Palladone||Dust, Smack, Dilly|
|Hydrocodone||Vicodin, Vicoprofen, Lortab, Norco, Lorcet-HD, Hycodan, Zydone, Hydrocet||Nikes, Hydro, Norco, Vics|
|Oxycodone||Oxycontin, Roxicodone, Percocet, Percodan||O.C., Killer, Oxy|
|Codeine||N/A||Dice, Sparkle, Zoom, Glitter|
|Propoxyphene (withdrawn from US market in 2010)||Darvocet, Balacet, Propacet 100||Bennies, Bumble Bees, China White, Yellow Football|
|Fentanyl||Actiq, FentoraTM, Duragesic||Goodfellas, Great bear, Jackpot, King ivory|
What do the Prescription Drugs Contain?
|Drug||Drug Contents||Function of Drug|
|Hydrocodone||Acetaminophen or AsprinNarcotic analgesic (aka pain reliever)Cough-suppressant w/ a non-narcotic analgesic||For the relief of moderate to moderately severe pain; Acetaminophen increases the effectiveness of Hydrocodone|
|Lortab||Hydrocodone (pain reliever)Acetaminophen (analgesic)||For the relief of moderate to severe pain; Acetaminophen increases the effectiveness of Hydrocodone|
|Lorcet||HydrocodoneAcetaminophen||For the relief of moderate to severe pain|
|Vicoprofen||HydrocodoneIbuprofen||For the relief of moderate to moderately severe pain|
|Zydone||HydrocodoneAcetaminophen||For the relief of moder to severe pain|
|Darvocet||AcetaminophenPropoxyphene||Removed from U.S. drug market in 2010 due to very high probability of dependence|
|Oxycodone (opioid agonist)||Synthesized from ‘thebaine’, a constituent of opium. Thebaine is chemically similar to both morphine and codeine||Increased analgesic effect. The more you take the greater the pain control|
|Percodan||AsprinOxycodone||For the relief of moderate to severe pain; Related to Codeine|
|Codeine||Non-narcotic analgesic of some type||Suppresses a non-productive cough;|
|Hydrocet||HydrocodoneAcetaminophen||Smaller amounts of Hydrocodone and Acetaminophen are combined to provide a stronger analgesic effect than either of the two drugs can do alone.|
|Hydromorphone||Similar to Morphine||High potential for dependence and tolerance|
|Fentanyl||Synthetic opioid compound||Treatment of breakthrough cancer pain. Used when other narcotics have failed. Heroin or Cocaine is often combined when sold illicitly. 100X more potent than Morphine.|
|Morphine||Found in the unripe seedpods of the opium (poppy)||For the relief of acute and chronic severe pain|
A more detailed description of the drugs may be found by going to www.Explainingmedicine.com.
What can be done for a heroin overdose? From the National Institute of Drug Abuse
Overdose is a dangerous and deadly consequence of heroin use. A large dose of heroin depresses heart rate and breathing to such an extent that a user cannot survive without medical help. Naloxone (e.g., Narcan®) is an opioid receptor antagonist medication that can eliminate all signs of opioid intoxication to reverse an opioid overdose. It works by rapidly binding to opioid receptors, preventing heroin from activating them.23 Because of the huge increase in overdose deaths from prescription opioid abuse, there has been greater demand for opioid overdose prevention services. Naloxone that can be used by nonmedical personnel has been shown to be cost-effective and save lives.24 However, a key factor limiting widespread use of naloxone is that it is currently only available in injectable form.25 NIDA and the U.S. Food and Drug Administration (FDA) are working with drug manufacturers to support the development of new formulations of naloxone, such as nasal spray or autoinjector formulations, to facilitate broader use. In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) released an Opioid Overdose Prevention Toolkit in August 2013 that provides helpful information necessary to develop policies and practices to prevent opioid-related overdoses and deaths. The kit provides material tailored for first responders, treatment providers, and individuals recovering from an opioid overdose.