FACTS ABOUT OPIOIDS

Opioids include Heroin, Morphine, OxyContin (Oxycodone), Percodan (Oxycodone and ASA), Percocet (Oxycodone and Acetaminphine), Codeine, Methadone, Suboxone (Buprenorphine and Naloxene) Fentanyl, Demerol (Meperidine, Pethidine), and Dilaudid (Hydromorphone).

Opioids are frequently mentioned in the media, as both Canada and the US are currently experiencing an “opioid epidemic”. This means that record number of peoples from all walks of life are becoming addicted to, and dying from opioid overdoses – not just the “back-alley” drug users, but soccer moms, CEOs, and all manner of folks who may have became addicted byway of trying to manage legitimate pain.

Back in the 1990’s the slow-release drug OxyContin entered the pain management world with claims that the drug posed little danger of addiction, even with long-term use. Turns out, that was not accurate. The lawsuits against Perdue Pharma continue, and not just suits from individuals, but also cities (Everett, WA), and entire US states (New Hampshire, South Carolina).

Fentanyl: A further contributor to the drug epidemic

For the street and drug entrenched, the introduction of fentanyl-laced recreational drugs has brought fatal overdoses to record numbers. Dr. Christy Sutherland, a family physician on Vancouver’s Downtown Eastside predicts opioid-related deaths in BC to be more than 1,500 for 2017. Fentanyl has been found in everything from heroin, cocaine, meth, MDMA, and even marijuana. Why is fentanyl being cut into these drugs? Because it is cheap, available, and easy to synthesize. A user is still getting “high”….just not necessarily the high they envisioned.

The real fear with fentanyl-laced drugs is that one cannot predict the potency and consistency between batches. A better means of understanding this lack of drug-batch consistency is the “chocolate chip cookie” analogy. With cookie-baking, some cookies may have few chips, others may be fully loaded; not each cookie is going to yield the exact same number of chocolate chips. Similarly, a dealer making batches of a recreational drug in a bathtub or warehouse does not have standardized controls in place, and simply cannot predict the dosing of fentanyl per unit of their drug. Two buddies partying together with drugs from the same dealer could have very different experiences – one could experience a mild high, the other could overdose. Partying is now a game of Russian roulette – there has never been a more dangerous time to engage in recreational drug use.

What Does Withdrawal for Opioids Look Like?*

HEROIN and MORPHINE: The symptoms appear 8-12 hours after the last dose, increase over the next 3 days, and gradually disappear over 7-10 days.

OXYCODONE and HYDROMORPHONE: The withdrawal is similar to morphine, but slightly less intense.

METHADONE: The symptoms appear 24-48 hours after the last dose, increase over the next 3-6 days, and gradually disappear over 3-6 weeks.

BUPRENORPHINE (the opioid in Suboxone): The symptoms appear 1-3 days after the last dose, increase over the next 3-7 days after the last dose, and may continue for 2-4 weeks.

MEPERIDONE, PETHIDINE: The symptoms appear 3 hours after the last dose, increase over the next 8-12 hours, and gradually disappear over the next 4-5 days.

CODEINE: The withdrawal is similar to morphine, but much less intense.

PHYSICAL SYMPTOMS:

Muscle, bone, and joint pain (especially in the legs and lower back)
Sweating; alternating between chills and waves of goose bumps
Loss of appetite, nausea, vomiting, stomach cramps, diarrhoea
Restlessness, nervousness, weakness
Muscle spasms and kicking movements
Insomnia
Fever, headache, flu-like feeling
Rapid heart rate
Runny eyes, runny nose, sneezing, yawning

ACUTE WITHDRAWAL:

First Stage

Psychological Symptoms

Anxiety
Obsession with getting the drug
Irritability

POST ACUTE WITHDRAWAL

Second Stage – these symptoms can last for 2-6 months. They gradually decrease during the 2-6 month period

Physical Symptoms

Insomnia
Weakness, tiredness
Poor appetite
Muscle aches

Psychological Symptoms

Unable to tolerate stress
Overly concerned about physical discomfort

What Can Be Done to Minimize the Opioid Crisis?

Be informed about the risks of doctors overprescribing pain medication. A recent study by doctors at the University of Michigan show that about 1 in 16 patients prescribed opioids become chronic users. Research shows that relapse rates after opioid addiction treatment could be as high as 91%. Most surgical patients do not need the usual 30-90 opioid tablets for pain management upon surgical discharge. If you are concerned about your opioid pain medications, ask your doctor if you can reduce your duration on the drug, or inquire about non-opioid pain management options.

Take a harm reduction approach to addiction. If you are a recreational drug user, use with a friend or administer your intravenous drugs at a Safe Injection Site.

Check out BC’s Take Home Naloxone (THN) program proactively targeting saving lives from overdose. Naloxone is a medication that reverses the effects of overdose from opioids (heroin, methadone, fentanyl, morphine). Website: com

Compassion is key. Recognize that “addiction begins with pain and ends with pain” (Eckhart Tolle). Addicted individuals are traumatized individuals. We now know that punitive actions do not “help” our addicted loved ones. Newer research in the study of addiction suggests that the opposite of addiction is connection. Check out Johann Hari’s summary of Bruce Alexander’s Rat Park study: https://www.youtube.com/watch?v=PY9DcIMGxMs and Gabor Mate’s assertion of how a lack of early life attachment and relational trauma forms a foundation for addiction to flourish:

https://www.youtube.com/watch?v=x9cvEa5qFQc. When we are better informed, we can create more empathetic and viable solutions.