GUEST COLUMN

Opiate epidemic hits home in Toledo

11/11/2012

Toledo is suffering from an opiate epidemic that involves prescription painkillers as well as heroin. Five out of six patients who undergo detoxification at our facilities — COMPASS Corp. for Recovery Services and Substance Abuse Services Inc. — are treated for opiate and/or opioid addictions.

Most users get hooked by taking powerful prescription painkillers legally or recreationally. When users have trouble obtaining a growing supply of these painkillers, they often turn to heroin, which is cheaper and easier to buy on the street, with plentiful illegal supplies from Mexico.

Opiates are one of four major classes of addictive drugs (the others are nicotine, alcohol, and amphetamines and other psychostimulants). They are poppy derivatives such as opium, codeine, morphine, and heroin.

Opioids are synthetic opiates, usually prescribed to control pain. They include OxyContin, Vicodin, Demerol, Darvon, Opana, Fentanyl, and Percocet.

Opiates and opioids are highly addictive because they interact directly with neurotransmitters in the brain’s pleasure centers. They produce highs and relatively quick addiction.

As tolerance develops, more of these drugs are needed to fuel the highs. Their use alters brain chemistry, making withdrawal excruciating and relapse common.

One out of every 10 American adults suffers from substance abuse. Men and women with chemical dependencies are of all ages, income levels, and ethnic groups.

In the past three years at COMPASS, we have treated more than 5,100 Lucas County residents for substance abuse. Drug-use trends here mirror those in much of the rest of the country.

Yet efforts in Ohio and elsewhere to make prescription painkillers harder to obtain are having a unexpected and dire consequence: They push users — especially those between the ages of 20 and 35 – toward heroin.

The Toledo Police Department’s Metro Drug Task Force reports that almost all new heroin users started with prescription painkillers. According to our medical staff, new users are already hooked on opiates and don’t consider heroin a dangerous drug, unlike the Baby Boom generation.

As a result, overdose deaths are rising. New users are more likely to be young, white, suburban, and female than in the past.

Opiates have been used and abused for centuries, so what caused this epidemic? The U.S. government inadvertently played a role a decade ago.

The Ohio Prescription Drug Abuse Task Force reported that doctors were encouraged to treat pain more aggressively. At the same time, drug companies introduced powerful new opioid painkillers, and began marketing them directly to consumers.

What makes today’s epidemic so frightening is that developing an addiction to opiates and opiods takes far less time than alcoholism. Withdrawing from opiates is agonizing and painful, especially going cold turkey without medical intervention. The lure to relapse can be overwhelming.

Still, there are treatment successes, particularly among patients who take Methadone or Suboxone while they receive counseling and behavior modification. These medications are opioids, so they stave off withdrawal while doses decrease.

For long-term users, Methadone is effective when it is provided regularly through a clinic. It permits an addict to work and live a reasonably normal life.

Suboxone is a newer treatment, prescribed by physicians for more recent addicts. We find Suboxone works best when it is prescribed as part of a comprehensive program of treatment and counseling. This regimen generally takes about a year for a compliant patient to complete, usually with the help of a support network or recovery program.

Because addiction is a disease, simply punishing users is ineffective. The tools in our arsenal are education of physicians about the dangers of prescribing unnecessary opiates and opioids, more effective ways to halt drug trafficking, and prevention through awareness.

Such awareness needs to occur in all parts of the health-care community, including medical schools. Young people, elderly people, parents, public officials, and employers also need to know what’s going on.

Addiction can be treated successfully. Getting people into recovery is not easy. But as I walk through our lobbies, I know that the effort is worth it.

Bob Stokes is CEO of COMPASS Corp. for Recovery Services in Toledo.