Opioid Addiction in the United States

Other webinars in series:

• Why Naloxone is Important and How to Use It(Part 2)
• How Your Prescription Medication Could Lead to Addiction (Part 3)
• Keeping Your Children Safe When Taking Medication (Part 4)

Videos:

• Risk Factors for Opioid Use Disorders
• How Opioid Abuse Impacts Quality of Life

Articles:

• Is the Opioid Crisis Only an American Issue?
• Common Opiates & Intended Use
• Common Signs of Opiate Abuse

Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. Hey, welcome everybody. I am Alison from Advanced Recovery Systems. Welcome to our mental health awareness month series. We are absolutely thrilled to be able to share more information with you. We have a huge commitment to educating the community and our continuing education events that go on regularly, but we wanted to do something really special during the month of May to continue to raise awareness about mental health and, of course, substance use as well. We are thrilled today to be kicking off an amazing series called “Minding Your Meds With Miss America,” and we’re going to get started here in a second. I wanted to share a little bit more about Advanced Recovery Systems.

 

If this is your first interaction with us, we are a national behavioral health care company. We actually started in Central Florida about seven years ago, and we’re now in five, almost six states. We’re getting ready to open up in New Jersey later this year, but we’ve been able to build out two wonderful treatment programs, both inpatient and outpatient. We’ve expanded into telehealth, and we absolutely love being able to help transform lives and repair families and bring people back together again and help heal individuals from their struggles.

 

We know that addiction is an issue that is only becoming more and more and more of a crisis, and through everything with COVID-19, we know that mental health is an absolute priority and we need to be addressing it. We need to be talking about it, and we want everybody to know that we’re here to help. Regardless, if we’re the provider that’s able to help you, we will connect you. So I want to encourage you: If you’re struggling to reach out to us, we’re always here. But I want to continue to move on with the presentation today.

 

So a couple of things are going to happen. Camille is, of course, going to share her presentation with you. This is actually a four-part series, so if this is something that you’d like to come back and join us in every week, we’re going to be here — same time, same place — every Thursday, so we’d love for you to join us. We’d also love for you to stay to the end. We have some giveaways that are going to happen at the end we’re really excited about, and as long as you’re here, you might as well participate in the chat. So go ahead, and you can include comments. We’ll be taking some questions and answers at the end, and Camille will be sharing some additional insight then too, but go ahead and use the chat function. In the meantime, go ahead and let us know who’s here. You can comment in the chat, both on Zoom if you’re joining us that way or on Facebook. So, thanks again.

 

And without further ado, I have the distinct honor of introducing Miss America, Camille Schrier, to all of you today. When I saw that her platform was “minding her meds” — her social impact cause that she’s championing throughout her year of service — I had a big hope and wish and dream that we’d be able to do something together. We’ve had the chance to partner with the Miss Florida organization over the last four years with Real Talk, but this was a really wonderful opportunity, and I’m so glad it came to fruition. And Camille, I’m going to turn it over to you. What an honor it is to be here with you today, and thank you so much for joining us to raise awareness about these issues. I’m going to turn it over to you; the floor is yours.

 

Thank you so much, Allison.  I’m really excited to be able to be here and work with you all. Yes, my platform is “Mind Your Meds,” so I focus on drug safety and abuse prevention from pediatrics to geriatrics, and that stems from my education as a pharmacy student. And I also had a mom that was a nurse growing up, so I learned a lot about medication safety and how even the medicines that we take prescribed by a doctor can sometimes be dangerous for us.

I have dedicated my time, as both Miss Virginia when I was Miss Virginia and now as Miss America, to talking about this. I am going to share a little bit today about opioids specifically, which is a huge problem that is facing our country. You’ve probably heard about them, and we’re going to learn a little bit more about them.

 

So we’re today going to talk about opioid addiction in the United States. It is really one of the two large branches of my work, so I feel like my social impact has this piece that is medication safety in the home. But then there’s this abuse prevention piece that I also focus on, and I specifically do a lot of work with opioids, which is probably, if not arguably, the largest prescription medication that is abused in our country, and we’ll talk about that in a little bit.

 

I think with anything, we need to go back to the basics. I don’t really think I understood what an opioid was until I went to pharmacy school, so I’m going to give you that knowledge because I wish I had it earlier. So, opioids are a class of drugs. They actually originate from the opium poppy plant. That plant that you see up there in the upper right corner of your screen — that is an opium poppy. It’s actually illegal to grow here in the United States, and it produces a chemical called morphine.

 

And there is, you know, most of the drugs that we take, and when I say drugs, I mean medicines. The medicines that we take to help us recover from different ailments have been derivatives of plants. This is something that really isn’t different from other medications. We’ve discovered them over time by taking different plant substances and seeing how they affect our body. This particular chemical morphine is what comes out of that plant and has many different derivatives.

 

It works on the brain to produce a lot of different effects, including pain relief, and that’s its main use. It blocks these pain signals between our brain and our body and it’s typically prescribed to treat moderate to severe pain, and that’s really how it’s been used for a long time. This is not a new medication. It’s been around for thousands of years. It’s been abused for thousands of years, and we’ve had wars over it; quite literally there were opium wars, so this is not anything new. It is just something that we’re continuing to see even still in 2020.

 

So, lots of different forms of opioids. They come in both prescription forms, but also forms that are illicit. And by “illicit,” that would be illegal forms, so there’s lots of different prescription opioids. You might’ve taken codeine in Tylenol cough syrup or Tylenol with codeine, maybe some cough syrup with codeine in it. Vicodin — I had to take Vicodin when I got my wisdom teeth out in, I guess, high school. Pretty common. Oxycodone is the generic name for Oxycontin, and that is one of the opioids that has been really in the news lately. That is, it has a lot of stigma associated with it and a lot of history that we will go into.

 

Oxymorphone, hydromorphone (which is Dilaudid) and then morphine. Fentanyl is actually a prescription drug, and you hear a lot about fentanyl right now in terms of street drugs being cut into heroin. But fentanyl is actually used for medical purposes, and fentanyl patches for pain relief, but it can also be a component of a lot of heroin on the street. And that has become even more frequent as time progresses; it’s a lot more common now than it was even 10 or 15 years ago. An illicit drug like heroin is illicit because it has no intended or valued medical use, versus these other ones that are prescription because they do have a medical use, and that is the difference between that fentanyl piece and the heroin piece. Heroin does not have an acceptable medical use; therefore, it is a Schedule I by the DEA and is not able to be used. But that does not mean that it is not used.

 

Lots of different side effects. It’s funny — I was watching TV a few weeks ago, and there’s these medications that are now being advertised for opioid-induced constipation, which is a great indicator of how many people in our country are taking opioid medications. Because now we have another medication to treat an opioid side effect, which I find very interesting. There’s lots of different side effects that can come from these medications. Some of them are mild, but there’s also really incredibly dangerous side effects like addiction, overdose and physical dependence. And those are the three that really make this a really dangerous chemical. I think with great power, we have a lot of responsibility to keep each other and keep our patients safe with medications like opioids. That’s an important piece that is important if you’re taking an opioid drug or if someone you know is — that you have to understand that piece of it before you put that in your body.

 

It wouldn’t be right to talk about opioids without talking about kind of the physiology behind this. And as someone who loves science and the body and medicine, I felt like I needed to include this. It’s important to talk about endorphins when we talk about opioids. So, our body has these receptors. Basically, the best way to describe this is you have a certain key to your house, right? And your house only accepts that key. And when you use that key, it opens your door. It’s kind of like an opioid receptor.

 

There’s only a few different keys that can work in that particular lock. That lock is the opioid receptor; when you turn the key, it turns it on. And we have natural keys in our body, and those are called endorphins for the opioid receptors that we do have. Endorphins literally mean an endogenous morphine — so, the morphine within our body. They function as neurotransmitters; they’re normal. They are released when we exercise. If you’ve ever watched Legally Blonde, you hear this quote in there and she says, “Exercise releases endorphins and endorphins make you happy, so happy people don’t shoot their husbands,” ‘cause she’s in law school and she’s doing this whole trial associated with a murder case.

 

That’s true: Endorphins make you happy and they are associated with exercise. They are also associated with pain and physical stress. They relieve pain, but they also make you feel really good. They make you happy, they lower your respiratory rate and they decrease your anxiety and depression. These are all good things. It’s part of why exercise can make you happy, but those same receptors can also accept what that opium poppy produces, which is morphine and its derivatives. That’s where we get into opioid medications, and then we get into the piece where these receptors get overloaded and you end up in a situation like an opioid overdose. Doesn’t matter if you’re taking a prescription opioid or an illicit opioid — both of them can lead to an opioid overdose. So it’s not just that you have to take heroin, which is an illicit opioid, to end up in an overdose situation. It’s really important to realize that.

 

We have these receptors in our brain. We have them in different pieces of our nervous system. They’re in the place that makes us happy in our nervous system, they’re in the place that helps us breathe and they’re in the place that makes us feel pain. The opioid receptors where we breathe get overloaded, and if a person takes too much in these receptors all attached with opioids, they can cause us to stop breathing. That is the really dangerous piece of opioids. And again, I will say this so many times: This can happen even if you are not trying to misuse an opioid drug. If you are not minding what you’re taking and you’re prescribed an opioid, there’s a potential that you could end up in this situation. It’s very important to be mindful of this.

 

I think we see some questions. “How come both opioids and endorphin receptors use the same domain?” That might be a question that we can — actually, I’m going to get to these at the end cause I don’t want to distract too much from these.

 

Those receptors, and the incredible part of this, is that our body has these receptors — in our nervous system. And we basically found a way to hijack those by using a chemical from a plant. That’s the dangerous part of this, and we’ll talk a little bit about that. The other thing is these effects are strengthened with alcohol. That is another depressant chemical, and the risk of these kinds of overdoses happening is stronger if you are consuming alcohol at the same time.

 

But there’s this wonderful miracle drug called naloxone and Narcan. You might’ve heard of Narcan; it is a nasal spray that is used to bring people back from an overdose situation. And it is really a miracle, but it’s because of science. It’s called an antagonist. And the best way to think of this is, if you look at this image, those little white dots are the opioid that was on there in that other image before, and Narcan binds more strongly to this receptor than the drug does. Basically, it’s like having a stronger magnet and it physically bumps off the actual drug from the receptor, but it doesn’t activate it. It turns it off and blocks it from accepting those opioid drugs, and it allows you to come back.

 

And actually, if someone is revived with Narcan, it takes a very short period of time — I mean, within a minute, probably — to bring someone from almost a sedated, unconscious state to being back and awake and breathing and able to restore function. It’s a life-saving drug. And we’re going to talk a little bit more about that at the end. It is something that is traditionally prescription medication, but because of laws to help with the opioid epidemic, it is something that you can get personally now, and I do have it. I carry it with me.

 

Okay, so we talk about addiction. We talk about opioid addiction and addiction to other drugs. There’s a difference between dependence, physical dependence and addiction. Physical dependence is quite literally your body being dependent upon that substance. You’ve taken something over a long period of time, and now your body basically feels like it needs it to function, and if you don’t take it, you don’t feel well. The best description of this is me with my coffee, and if you’re a coffee drinker, you will completely feel this way. I drink coffee, and if I don’t drink coffee, I sometimes will get a headache and I won’t feel well because my body has become physically dependent upon caffeine, whether or not that’s good or bad. But this is a lot more severe in opioids, and that can be a huge issue, and once someone ends up physically dependent upon an opioid, it can be really difficult for them to get out of that cycle because it’s incredibly uncomfortable to feel sick for a long period of time. That’s called withdrawal; I’m going to talk about that.

 

Addiction is more complex, I think, than physical dependence. You ended up taking drugs compulsively, even though you know that it’s giving you negative consequences in your life and it can take over your entire life. And sometimes, these go together. Sometimes, someone is physically dependent, but also addicted at the same time. And this is why addiction and drug abuse and substance abuse can be such a complex issue to address, and it’s important to know that.

 

Why do we even get addicted to drugs or substances? It’s pretty much because it goes back to that endorphin piece. So, we said endorphins make us happy. They use the same receptor that an opioid drug does. They make us feel happy, to an extent — a chemical extent that our bodies are not used to. So endorphins make us happy, right? But opioids are so much stronger than our natural endorphins that they basically cause a huge rush of our happy hormones, and it actually messes up the cycle of how our body can feel happy with those hormones.

 

So our body starts to then create this extra intensity that only this drug can bring, and that is what starts to stimulate an addiction. This is a really interesting piece because I have had people tell me, “You know, addiction is not a disease. This is a choice.” And I love to go back to the science in this because addiction is 100% a disease. It is a physiological disorder, and it should be treated like one. And when you look at this, and when you look and understand how opioids and drugs and substances affect the brain, and you go back to the brain chemistry, it’s hard to understand how this might be a choice. Maybe someone made a bad decision that led to an addiction, but now they’re fighting a disease and we should treat it like that, so that’s my soapbox of this slide.

 

Withdrawal. We talked about it — it’s like when I don’t have my coffee in the morning, but way, way worse when you’re on an opioid medication. It can be really severe for people, and the strength and the duration of this withdrawal is dependent upon how long and how much people have been taking in terms of an opioid drug. So, how long have they been doing this? How much tolerance does their body have? It’s really important to think about that. These are all these really bad things that can happen when you then stop taking. Think of someone who is in an addiction cycle, and they’re taking opioids on a regular basis. You might’ve heard people be like, “Well, just stop taking them.” It’s like, okay, sure, but you’re going to experience all of these symptoms very severely for a good duration of time.

 

It makes it hard then for someone to get out of the cycle of taking drugs because they are quite literally trying to fight something called dope sickness. I read this book called “Dope Sick,” which talks about this crisis that’s happening in the country and how, many times, when those who are addicted are taking more drugs, it’s not because they want to — they are trying to ward off these horrible symptoms that will happen if they stop taking this drug, and it’s very hard. It taught me, when I was reading this, so much empathy for people that are going through this because, okay, maybe they made a bad decision. Maybe they didn’t. But now they’re stuck in this cycle, and this is why it’s really important to go through treatment programs. It’s almost impossible to get off of those types of medications by yourself. It’s always important to have medical professionals help with that because of these withdrawal symptoms.

 

Here’s an idea of a timeline. So, I said it’s not just a day. If you look at, you know, you take your last dose — 72 hours later, you’re feeling chills, fever, body aches, diarrhea, insomnia, muscle pain, nausea, dilated pupils, all these things. A week later, you’re still feeling tiredness, sweating, body aches. Two weeks later, it’s still anxiety, irritability, all these things. And can you imagine you are trying to get yourself off of this? It’s a difficult thing to do, and for almost a month later, you are feeling not yourself. Again, it’s so important why we need to have recovery and treatment programs for people that are afflicted by addiction.

 

Next slide. So, we know the basics. We kind of have an idea of what this is and why we have an epidemic of this in our country. We’re going through a pandemic right now. We have a pandemic actually happening worldwide with opioids that we haven’t been talking about. If you look at just some data in terms of death rates in the United States in 2017, look at how many people were murdered: 16,214. 38,659 people died in roadway fatalities, so car crashes. 39,773 as a result of a firearm injury. Total fatal overdoses: 70,237, and 68% of that, which is 47,600, lost their lives to an opioid overdose specifically.

 

More people died of an opioid overdose than in a car crash in the year of 2017. This is a huge issue, and it needs to be addressed as one. Look at this — it continues to be a huge problem. Just general drug overdose in the country, and again, 68% of these are illicit prescription or illicit opioid overdoses. And on average, 130 Americans die every single day of an opioid overdose, and that’s about one American every 12 minutes. Keep that in mind.

 

Why is this happening? There’s a lot of reasons. It’s a complex issue. You know, it is a really addictive substance, but one of the real reasons why this started to begin was the overprescribing of prescription opioids — primarily started in the 1990s, but of course was happening before. There was some manufacturer marketing of these products. They basically said that it was not addictive, and they were pushing this to doctors and patients to prescribe. And that really led to a huge epidemic in the country, and you might’ve heard about this in the news recently with Oxycontin. If you want to learn more about this, I would highly suggest watching The Pharmacist on Netflix. It’s a four-part docuseries with this pharmacist in New Orleans, Dan Schneider, who does an amazing job talking about this. He’s become a friend of mine through this process — would highly recommend.

 

So, think you’re overprescribing these medications and they have a huge addiction potential. Maybe you’re saying that they don’t, but we talked about all those withdrawal symptoms — how our brains are chemically dependent upon these things. So once people are addicted, it’s so difficult for them to overcome that. It takes a lot of work, and so when we look at people who are either using or misusing prescription medications or then turn to drugs like heroin, go back to the root cause of how this happened in our country. And I put this statement down here, and this is from the CDC: About 80% of people who used heroin or who use heroin first misused prescription opioids. So if we look back at what potentially the root cause of this is, it’s so important to think about how prescriptions have led to this. It’s not the only cause, but it is definitely a huge piece of it.

 

So what can we do? Because you know, it’s one thing to talk about all these things, but I’m an action kind of person, and that’s part of what I do as Miss America. So here’s some things that we can do. If you are someone who is thinking about — if you have pain and chronic pain — going to a doctor, talk to them, talk to them about alternative pain relief modalities. You can take non-opioid medications: Tylenol, Motrin, Advil, Aleve. There are some muscle relaxants and antidepressants that your doctor can give you that can help with pain, but there’s other treatments that you can take. Physical therapy is a huge piece of it. Ice and heat, those traditional kinds of things you can put right on a place that is hurting. Massage, acupuncture, nerve blocks and surgery are extreme examples of this, but if there’s something physiologically happening that needs to be changed or fixed, talk to your doctor about that. But absolutely talk to your doctor.

 

What if you have to take opioids? Some people, their doctor and them have had a discussion and it is the right choice for them, but there are so many things that we can do to keep ourselves safe. The biggest thing is to make sure that you’re taking your medications exactly as your doctor prescribed — not taking more just because you’re still in pain. Go back to your doctor and talk to your doctor. If you have a substance use disorder, mental illness in your family — if you have a history of this, talk to your doctor. Give them that information.

 

Never give your prescription to anyone else. If you feel like you’re taking it for reasons other than pain, go back and talk to your doctor. We’re going to make sure that we’re taking leftover pills, disposing of them properly — I’m going to talk about that in a moment. Locking them up. Do not combine them with alcohol. There are things that you can do to prevent yourself from ending up in an overdose situation and from becoming addicted. Biggest thing is to stay in open communication with your provider, and make sure that they know what’s happening in your life and that you are keeping that open.

 

Next one: Safely store your medications. This is such a huge piece. Accidental poisonings of children is a huge problem in this country. I have collaborated with some poison control organizations, and it becomes a huge issue for kids. Lock your medications up, not just opioids. Lock them up, keep them up and away from children and other people. You never know — you might have someone come in your home, and if you have opioid medications that are kind of lying around or easy access in a cabinet, they could be taken without you knowing if you’re not using them. They can be sold; they can be used and misused, and so we want to protect other people. If we are owning these medications and we have them in our homes, it’s our responsibility to protect others from them. Even if we can be using them for the right reasons, we want to protect them. I put that little pill organizer down in the lower right corner to remind you that those things are not child-safe, so those are not an exception. Those also need to be up and away from kids; they need to be locked up if they have opioids in them. Just a little reminder.

 

Safely dispose of your medications. This is a lovely topic that I could talk all day about. Not only for the environment, but also to protect others — same idea. If you have those opioid medications and you are in ownership of them, it is your responsibility to dispose of them properly to prevent people from getting their hands on them or prevent people that could misuse them from using them. I worked with the DEA on some National Drug Take Back Day public service announcements. They have this National Drug Take Back Day twice a year that, around the country, is a movement to get rid of your old medications and put them in the right disposal locations.

 

A lot of pharmacies have safe disposal containers that you can get rid of your medications in, many police stations. But there are also some safe disposal things that you can do at home. So there’s a little bag up in the top right corner of the screen and then a solution next to it, like an actual solution where those things break down medications — they completely inactivate them. So if you put your pills or liquid medication in them, it’ll break it down, and then you can throw that away in your regular trash at home. There’s also some other techniques, like mixing things with dirty kitty litter and coffee grounds and really destroying them the best that you can, so they can’t be misused. You never want to flush things down the toilet, number one, but you do want to make sure that you are throwing things away in a proper way. So I would always recommend a safe disposal location, but if for some reason you can’t access one, those things on the top are also good alternatives.

 

Naloxone. We’re going to talk about this in another week, but the biggest thing that I’m going to get you out of this slide is attending naloxone training. Come listen to the webinar about naloxone — it is the medication that can bring people back. You can get it really easily. Every state, you can get it without a prescription. It just depends on whether or not you have to pay for it in many states. I got it for free from my health department in Virginia. Educate others, especially young people, because if we can be open with our young people and tell them why these medications can be dangerous — it’s one thing to make a bad decision, but if we make a bad decision with an opioid like heroin, we can lose our lives. If we even take a prescription opioid and misuse that or abuse that, we can risk our lives. Making that extremely clear to our young people, and I do that when I go around. Not to scare them, but to — you can upset your friend and you can say sorry the next day, but you can make a bad decision with these types of chemicals and they can completely alter your life.

 

So this is just kind of a rundown of what I just talked about. What can you do? Understand your prescriptions, take them as prescribed. Think about other things that you can do to talk to your doctor about opioid-free pain relief modalities. Don’t ever share prescriptions or take anyone else’s medicine; lock them up, dispose of them properly. And naloxone — follow up on that one. So just a few resources before we are done. Definitely the recovery village, you can check out their website at therecoveryvillage.com. Then also the SAMHSA, which is the Substance Abuse and Mental Health Services Administration which is a government agency, has a treatment helpline, which I’ve put there. Also, their website and the findtreatment.gov.

 

I know it’s a lot of information and a half of an hour, but I hope that you learned a little something more about opioids and how addiction works, and we’ll be able to talk a little bit about it more in the upcoming weeks. Camille, you are wonderful. Thank you so much. Such a packed with information — I mean, so good, right? There’s so much to this; as you mentioned, this is a complex issue. It is not a one-size-fits-all proper solution, and it’s so critical that people understand how this happens. Because sometimes it happens quickly, but sometimes it takes a long time for dependence and addictions to develop and having those candid conversations.

 

Thank you for reiterating, “Talk to your doctor, talk to your doctor.” Have those conversations. Don’t be ashamed to bring them up because our amazing resources are out there, and the goal is to get connected with who you need to get connected with when you need to so that it doesn’t get to a point where it’s reached just a horrific level. But if it does, there are great organizations that you can turn to. And I appreciate you sharing the information about our site, as well as the SAMHSA. We will always connect people, regardless of where they’re located or whatever their needs are, to the proper resources. Thank you so much for sharing today. We are thrilled that you will be back next week to talk about naloxone. It is such a life-saving drug. We carry it too, and it’s so critical, right? Especially for individuals that are struggling or for loved ones and family members to have it in their homes and with them at all times. God forbid a situation escalates and they need it. So thank you so much. Thank you for watching this video. We hope you enjoyed the presentation.