Battle Creek, Michigan –
Defense Logistics Agency employees in Battle Creek, Michigan, gathered May 16 to hear about how abusing drugs meant to relieve one type of pain can bring on a new one.
Guest speaker Dr. Dan Hunt, medical director for the Accident Fund Group, talked about the issue -- how it got started, what opioids do the brain and challenges in treatment and recovery from opioid abuse. Hunt said he sees his talks as a way to “speak to lot of people at a lot of different levels” about the problem. A former surgeon, Hunt said it was a “great treat” to visit the building that once housed the Battle Creek Sanitarium where Dr. John Harvey Kellogg performed many surgeries of his own.
Hunt said that when he worked as a surgeon he would prescribe opioids for pain relief like many of his colleagues. Today, he said, doctors must be careful to understand the effects of these drugs. In fact, he noted the Surgeon General of the United States wrote to doctors last year about opioid prescribing patterns and requested they take a pledge to be more thoughtful in prescribing them.
While the United States has only 5 percent of the world’s population, Hunt said Americans consume 80 percent of the opioids. He also noted that one person in America dies from drug abuse every ten minutes. He believes the problem started when a 1986 study - looked at only 28 patients before the researchers decided prescribing opioids could be done safely “and was more humane than other alternatives.” When the Food and Drug Administration approved oxycotin for treating musculoskeletal ailments, Hunt said it also increased opioid use.
“It means you can give it out for any ache or pain,” Hunt said.
A campaign by the American Pain Society to make pain measurement a fifth vital sign was another step that Hunt said encouraged the use of more pain medications. Everyone treated for pain today is asked to rate his or her pain level, but Hunt said people vary a lot in how they deal with pain. Some patients, he said, are more “stoic” and downplay their pain while others may exaggerate it. If the measurement is high, caregivers can feel pressure to relieve the pain quickly.
Hunt said advances in neurobiology are helping doctors today understand the effects of these drugs because it is easier to capture images of the brain at work and while it is being affected by opioids.
“This interplay of chemicals in our brain is what drives how we feel about the world and how we feel about ourselves, Hunt said. “You may have never thought about, ‘Why do I have good days and bad days?’ It really is driven entirely by this biochemical reaction in our brains.”
After prolonged use, Hunt says addicts will develop a tolerance and no longer experience the euphoric effects of the drug, but trying to do without it brings on a “terrible panic attack that won’t stop.” He stressed that the panic is so intense that addicts will do anything to avoid withdrawal.
“It’s more powerful than love, friendship or any sense of moral obligation,” Hunt said.
Hunt went on to describe the level of abuse as something that crosses every demographic line in America to include all economic levels and all ethnic groups. He said a recurring theme in the cycle of abuse often involves a son or daughter who is injured playing sports.
“They hurt themselves in high school; they hurt themselves in college; they see the doctor and they get a script for opioids,” Hunt said. “Then they probably went back and got a second script, but when they go back the third time, most doctors are going to say the injury looks good, and ‘I don’t feel good about writing a script. Let’s try some Motrin.”
For someone who is not addicted, Hunt said the change is fine, but for those addicted it will not work. He said addicts then have to get drugs on the street or use other sources. In time, addicts may switch to heroin, which Hunt said is cheaper and easier to find. A new threat has arisen from the use of fentanyl, a synthetic opioid used for cancer patients, mixed with heroin today, makes heroin’s effects ten times more powerful.
“So if you’re an addict used to taking a certain amount of heroin who now injects some with fentanyl, you can go in respiratory arrest,” Hunt said.
Once addicted, Hunt said it is difficult to recover from opioid abuse because of damage to the brain that complicates long term rehabilitation. He explained that a trigger will often drive the abuser back to the desire to use the drug. Hunt also noted that genetic research is looking into ways to block some triggers.
“How can you keep people from using again,” Hunt said. “If you can fix that then … you could go a long way toward fixing the problem.”
Medication assisted treatments like methadone can help, but Hunt said it is less practical because it requires a lot of training to administer, there are only a few clinics across the country and the treatment must be received as an in-patient. Another drug, however, requires much less training to provide and the pills can be provided to addicts as out-patients. Hunt said the pills have offered good results and talked of people who were sitting at home addicted using the drug “to get their life back,” but noted the pill is an opioid itself.
“Some who are not fond of it will say that the patient is trading one addiction for another, but the point is that it doesn’t have any respiratory depression so you can’t overdose from it or cause euphoria,” Hunt said. “It does take away the cravings.”