Opioids and Heroin: A New Look at Some Old (And Not So Old) Drugs

Drug overdoses are the leading cause of injury-related death in the United States, eclipsing deaths from motor vehicle crashes or firearms. According to the Centers for Disease Control and Prevention (CDC), there were nearly 64,000 overdose deaths in 2016, or approximately 174 per day. Over 42,249 (66%) of these deaths involved opioids. CDC’s preliminary data estimates more than 74,000 drug overdose deaths in 2017.

The misuse of controlled prescription drugs (CPDs) and the growing use of heroin, illicit fentanyl, and fentanyl analogues are reported in the United States in unprecedented numbers. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2016 National Survey on Drug Use and Health, 6.2 million people over the age of 12 misused psychotherapeutic drugs (e.g., pain relievers, tranquilizers, stimulants, and sedatives) during the past month. This represents 22% of the 28.6 million current illicit drug users and is second only to marijuana (24 million users) in terms of usage.

The U.S. opioid overdose epidemic is still worsening. Emergency department visits for suspected opioid overdoses increased 30% in 45 states between July 2016 and September 2017, and all five U.S. regions experienced rate increases. Of the 11.5 million Americans reporting past-year misuse of opioid prescription medicines, many may have misused a counterfeit prescription pain medication.

 Dr. Teresa Rummans, M.D., Professor at the Mayo Clinic discusses How Good Intentions Contributed to Bad Outcomes: The Opioid Crisis. In a recent paper, Dr. Rummans and her co-authors describe the origins of the opioid crises. Thirty years ago, a claim that those suffering from chronic pain who received opioids rarely became addicted changed prescriber attitudes towards opioid use. She describes the transition from opioids being reserved for treatment of acute or terminal pain conditions and instead being used to treat any pain condition.

 Bruce Goldberger, Ph.D., Professor, University of Florida discusses The Opioid Crisis – An Epidemic of Overdoses and Deaths. Dr. Goldberger tracks drug use data and deaths throughout Florida through the Florida Drug-Related Outcomes Surveillance and Tracking System, which helps fight prescription drug abuse. He also studies the effects of fentanyl on medical examiner offices across the country. Illicit labs change fentanyl formulations, and medical examiner offices often lack appropriate testing methods with which to identify them.

 Brian Fuehrlein, M.D., Ph.D., Assistant Professor of Psychiatry, Yale University School of Medicine; Director, Psychiatric Emergency Room, VA Connecticut Healthcare System discusses The Use of Medication Assisted Treatment for Opioid Use Disorder in an Emergency Room Setting. From 1999 to 2016, more than 200,000 people died in the U.S. from overdoses related to prescription opioids. The death rate of synthetic opioids (other than methadone) increased by 100% from 2015 to 2016. The rising overdose rate is mirrored by an increased number of emergency room visits. Fuehrlein is the Director of the psychiatric emergency room at the VA Connecticut where veterans suffering from opioid addiction and overdose seek treatment. Fuehrlein points out that patients who have received an overdose treatment are at high risk for future overdoses. Many have a history of other substance use disorders, including marijuana, alcohol, cocaine, and sedatives. Fuehrlein’ s approach to a patient following medical stabilization, which often includes Narcan administration and other treatments, is to encourage medication-assisted treatment.

 Dolores Breiner, Intelligence Research Specialist, Domestic Strategic Intelligence Unit, DEA discusses An Overview of The Heroin Situation in the United States. The 2016 National Drug Threat Survey found that the threat posed by heroin in the United States is serious and increasing. Heroin is available in larger quantities, used by a larger number of people, and is causing an increasing number of overdose deaths. Breiner follows and reports on the domestic heroin threat and is working on the 2017 assessment.

Moderated by Mark S. Gold, M.D., Chairman of Rivermend Health’s Scientific Advisory Boards.