Prescription painkiller overdose is one of the leading causes of death in America right now, affecting millions of lives.

According to the Centers for Disease Control:

• In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.
• Opioid prescriptions per capita increased 7.3% from 2007 to 2012, with opioid prescribing rates increasing more for family practice, general practice, and internal medicine compared with other specialties.
• From 1999 to 2014, more than 165,000 persons died from overdose related to opioid pain medication in the United States.
• In 2013, on the basis of DSM-IV diagnosis criteria, an estimated 1.9 million persons abused or were dependent on prescription opioid pain medication.

There is no question that prescription opioids are being abused by many who claim to have a pain disorder. These addicted individuals visit several doctors for the same conditions in order to obtain multiple prescriptions. They fake illness or injury to get drugs. They falsify prescriptions and buy painkillers from the black market. They manipulate the system in order to get the drugs they are addicted to. In fact, nearly 30% of patients prescribed opiates had no recorded pain diagnosis, according to the CDC.

Lives are being ruined and lost because of prescription opiates. In order to combat this epidemic, several laws and practices have recently been put into place. There are now stricter regulations for doctors who prescribe controlled substance, more comprehensive reporting required by pharmacists who fill the prescriptions, and more data collected on patients who are taking the medications. However, because of the increased security surrounding prescription painkillers, many who legitimately need pain medication for severe and chronic pain are sometimes unable to get the medications they need. The question remains, to what extent are we as a country willing to negatively impact pain patients in order to stop painkiller abusers and addicts?

CDC Recommendations For Opioid Prescription

The CDC published its guidelines for prescribing opioids in 2016, in an effort to help doctors, pharmacists, and even insurance companies aid in curbing unnecessary opioid prescribing and abuse and addiction. However, the CDC’s publication is simply a guide and is not mandatory, but because of some overzealous following of these suggestions, and fear of the growing opioid epidemic, some pain patients find it difficult and even impossible to get the pain relief they require. Below are some examples of the struggle pain patients face trying to get the medication they legitimately need to manage pain, according to a study published in Science Direct.

• Twenty-six states have passed laws that impose mandatory limits on the prescribing or dispensing of opioids for acute pain from surgery or an injury.
• Some pharmacies have placed restrictions on opioid prescriptions they will fill, limiting numbers of pills dispensed as well as denying prescriptions with dosages stronger than the CDC’s dosing guide.
• More than half of the pain patients surveyed (56 percent) reported disruptions in care or outright abandonment by their physicians.
• Some physicians are being red flagged for overprescribing, some even losing their licenses or facing criminal charges for overprescribing. Some physicians are now leery to prescribe at higher levels, even when necessary, in order to avoid scrutiny from the DEA or state medical boards.
• The state of Oregon is considering a proposal that would end coverage for opioids for many chronic pain patients on Medicaid. The original proposal would have forced pain patients to taper off their dose of painkillers in 12 months. Since its original consideration, last August, officials in Oregon have scaled back their proposal, to taper patients to 0 “when appropriate” based on the individual’s needs.

See the CDC guidelines here.

Pain Patient Statistics

According to the CDC report:

• The 1999–2002 National Health and Nutrition Examination Survey estimated that 14.6% of adults have current widespread or localized pain lasting at least 3 months.
• Based on a survey conducted during 2001–2003, the overall prevalence of common, predominantly musculoskeletal pain conditions (e.g., arthritis, rheumatism, chronic back or neck problems, and frequent severe headaches) was estimated at 43% among adults in the United States.
• Most recently, an analysis of data from the 2012 National Health Interview Study showed that 11.2% of adults report having daily pain.
• On the basis of data available from health systems, researchers estimate that 9.6–11.5 million adults, or approximately 3%–4% of the adult U.S. population, were prescribed long-term opioid therapy in 2005.

Reinterpreting The Guidelines

Some people wonder if the changes in prescription regulations are even helping. The rate of prescribing opioids has dropped every year since 2011, and still, opioid overdose deaths have continued to skyrocket during that same time frame.

Risks associated with denying prescription painkillers to pain patients include a loss of productivity, inability to function, medical decline, and increased risk of suicide. Individuals are losing their livelihoods and even their lives because they are unable to deal with chronic pain day after day.

The American Medical Association has recently pushed back against the misapplication of the CDC’s guidelines. At its meeting last November, the AMA adopted a series of resolutions describing its stance.

“Our AMA affirms that some patients with acute or chronic pain can benefit from taking opioids at greater dosages than recommended by the CDC Guidelines for Prescribing Opioids for chronic pain and that such care may be medically necessary and appropriate.

Our AMA advocates against the misapplication of the CDC Guidelines for Prescribing Opioids by pharmacists, health insurers, pharmacy benefit managers, legislatures, and governmental and private regulatory bodies in ways that prevent or limit access to opioid analgesia.

Our AMA advocates that no entity should use MME thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids.”

Finding The Balance

So, what should be done? Prescription painkillers are addicting, and even when used as prescribed at first, can cause dependence and eventually addiction and drug-seeking behavior. First of all, we need to create better awareness of the dangers of any type of drug use. Doctors should try alternative forms of treatment whenever possible, and for those who require prescription opioids, they should be prescribed with care. Patients should be monitored closely for dependence and signs of abuse while on the medication, and patients should be screened for addiction prior to going on the medications.

On the other hand, physicians should be trusted enough to know which patients need more pain relief and should be allowed to prescribe based on the individual’s needs. Finding the balance between necessary pain relief and drug-seeking behavior is difficult, but if medical facilities take the CDC’s recommendations as just that and not requirements, we will provide more options for patients who desperately need this pain relief.

If you’re addicted to painkillers, you might need a detox program that can be monitored through residential or outpatient treatment facilities. Contact us now for more details.

According to the National Institute on Drug Abuse (NIDA), every day more than 130 people in the United States die after overdosing on opioids. This number has skyrocketed in the past five years, and many people blame the opiate crisis of the early 2000s for both the rise in addiction as well as the increase in opiate overdose deaths. When we look at the history of opiate misuse and addiction, we can see a little more clearly how the opiate crisis is related to the issue of addiction and overdose today.

History Of Prescription Opiate Abuse

The misuse and abuse of prescription opiates began to take hold in the late 1990s. It was during this decade that pharmaceutical companies really began marketing their prescription painkillers, and many believe the manufacturers covered up the addictiveness of these medications in order to sell their product. The result was a huge spike in the prescribing of various opiate painkillers as more and more people found effective pain relief from the medications. What people didn’t know at that time was how addictive many of these opiates really were, and as the number of prescriptions increased, so did the number of those dependent on and addicted to the drugs.

The opiate epidemic created more addiction because individuals who had no history of drug abuse or addiction were now finding themselves dependent upon their medication. Because this had not been a problem before, there was a great deal of misunderstanding surrounding opiate addiction, and many people were ashamed and tried to hide their problem. The number of addicted people rose steadily, but this was not just among people who have legitimately prescribed prescription opiates. Individuals who had considered experimenting with drugs but were afraid to in the past were convinced to try prescription painkillers. The fact that the drugs could be prescribed by a doctor made them seem safer and more appealing to many.

Others began taking advantage of the opiate boom as well. Soon, individuals who abused other drugs began turning to prescription opiates because they were cheaper and easier to obtain than many street drugs. Our country was now experiencing an opiate epidemic that was being fueled by the over-prescribing and under-monitoring of addictive medications. Some of these people were already suffering, but others were first-time drug abusers who either fell into dependency unknowingly or took advantage of inexpensive, easily obtainable drugs.

National Statistics For Opiate Addiction

National statistics about the relationship between prescription opiate use and other drug abuse:

• Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them, and between 8 and 12 percent develop an opioid use disorder (NIDA).
• An estimated 4 to 6 percent who misuse prescription opioids transition to heroin (NIDA).
• Four in five new heroin users started out misusing prescription painkillers (NIH).
• It is estimated that 23% of individuals who use heroin develop opioid addiction (NIDA).
• 75% of those who began their opioid abuse in the 2000s reported that their first regular opioid was a prescription drug (JAMA Psychiatry).
• 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain” (JAMA Psychiatry).

Opiate Addiction Statistics And Overdose Rates In Ohio

Ohio was effected badly by the opiate crisis and is considered “ground zero” for the opioid epidemic devastating the nation. According to OSU extension, There were 3,050 deaths in Ohio due to opioids in 2015, ranking Ohio number one in the nation. With an office located in all 88 Ohio counties, OSU Extension is uniquely positioned to address the prevention of opioid abuse statewide.

This Rise In Opiate Overdose Deaths

The opiate epidemic certainly increased the number of overdose deaths as well. In the early years of the opiate crisis there were relatively few overdose deaths, but this number has steadily grown since the 1990s.

One reason for the rise in overdose deaths is the lack of understanding of opiates. Some people consider prescription painkillers to be harmless, and they don’t realize how easy it is to overdose. Other people don’t understand the strength of the drugs they are experimenting with; for example, fentanyl is 50 to 100 times more potent than morphine, and carfentanil is a medication designed for large animals and is extremely potent. Still, other opiates are purchased from unreliable sources and the user can’t be sure of the ingredients or strength, yet they use the drugs anyway.

Overdose Death Statistics

According to the NIDA:

• Drug overdose deaths rose from 8,048 in 1999 to 47,600 in 2017.
• Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.
• The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.
• Opioid overdoses in large cities increase by 54 percent in 16 states.

Today, people from all walks of life are finding themselves trying and becoming dependent upon prescription painkillers, and then transitioning to street drugs like heroin or even harder drugs like fentanyl and carfentanil.

The Centers for Disease Control and Prevention reports that some of the greatest increases in heroin use have occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes. In particular, heroin use has more than doubled in the past decade among young adults aged 18 to 25 years. It is estimated that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

Solving The Opiate Addiction Problem In Ohio

The opiate epidemic continues to be a problem in communities throughout the country, but municipalities, law enforcement, healthcare providers, schools, and other groups are working to educate the public about the dangers of opiate drug abuse and find solutions to this issue. Prevention is key to keeping this problem from growing, and treatment is necessary to help those already struggling with addiction.

The Ridge can provide a residential treatment program or complete detox to help people suffering from addiction. Contact us today for more information.

When people talk about the dangers of certain substances, they often are referring to how addictive these substances are. This is not necessarily the same thing, because a substance can be extremely dangerous and have a high potential for overdose without causing much dependence. Other substances are more addicting, yet their risk for sudden overdose is low. However, these substances are dangerous in their own way because they cause serious health risks if used over a long period of time.

Understanding The Matrix Of Harm In Addiction

Researcher David Nutt and his colleagues studied the most harmful drugs in the world and came up with a list of the top five. Nutt and his team developed a “matrix of harm” that helped them assess and classify substances based on the risk of each drug.

Nutt explains in the study, which was published in The Lancet, “Drug misuse and abuse are major health problems. Harmful drugs are regulated according to classification systems that purport to relate to the harms and risks of each drug. However, the methodology and processes underlying classification systems are generally neither specified nor transparent, which reduces confidence in their accuracy and undermines health education messages. We developed and explored the feasibility of the use of a nine-category matrix of harm…to assess the harms of a range of illicit drugs in an evidence-based fashion. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.”

Top 5 Most Addictive Substances

The following are the five most addictive substances, according to researchers.

1) Heroin And Opiates

1. Heroin and Opiates. The number one addictive substance on Nutt’s list is heroin an opioid street drug. Included in this category would be other opioids, including prescription painkillers, which work on the brain in the same manner as heroin. This group of drugs received a score of 3 out of 3, putting it at the top of the addictive substance list.

Heroin increases the levels of dopamine in the brain, causing a feeling of euphoria and making the user instantly crave more. Opioids, in general, have caused a huge disruption in America in the last decade, as more and more people are becoming hooked on prescription painkillers or their more dangerous replacement, heroin.  It is estimated that nearly 25% of all people who try heroin at least one time will become addicted.

According to the National Survey on Drug Use and Health (NSDUH), in 2016 about 948,000 Americans reported using heroin in the past year, a number that has been on the rise since 2007. This trend appears to be driven largely by young adults aged 18–25 among whom there have been the greatest increases. The number of people using heroin for the first time is high, with 170,000 people starting heroin use in 2016, nearly double the number of people in 2006 (90,000). In contrast, heroin use has been declining among teens aged 12–17. Past-year heroin use among the nation’s 8th, 10th, and 12th graders is at its lowest levels since 1991, at less than 1 percent in each grade level.

According to the National Institute on Drug Abuse, those who are addicted to heroin and stop using the drug abruptly may have severe withdrawal. Withdrawal symptoms—which can begin as early as a few hours after the drug was last taken—include:

• restlessness
• severe muscle and bone pain
• sleep problems
• diarrhea and vomiting
• cold flashes with goose bumps (“cold turkey”)
• uncontrollable leg movements (“kicking the habit”)
• severe heroin cravings

2) Cocaine

Cocaine. Second on Nutt and his team’s list of most addictive substances is another common illicit drug, cocaine. This drug is a stimulant that interferes with the dopamine receptors in the brain, causing dopamine levels to increase and cause a feeling of euphoria. Cocaine also causes increased energy, rapid heart rate, and increased blood pressure. It has an extremely fast impact on the brain and a short half-life, which causes the user to seek more as soon as the high wears off.

It is estimated that 21% of people who try cocaine will become dependent on it at some time in their life. According to the National Survey on Drug Use and Health (NSDUH), cocaine use has remained relatively stable since 2009. In 2014, there were an estimated 1.5 million current (past-month) cocaine users aged 12 or older (0.6 percent of the population). Adults aged 18 to 25 years have a higher rate of current cocaine use than any other age group, with 1.4 percent of young adults reporting past-month cocaine use.

According to the National Institute on Drug Abuse withdrawal from cocaine causes:

• depression
• fatigue
• increased appetite
• unpleasant dreams
• slowed thinking
• insomnia
• agitation
• extreme cravings for the drug

3) Nicotine

Nicotine. It might come as a surprise to some, but nicotine was the number three addictive substance on Nutt’s list. As nicotine is smoked, it is delivered to the brain rapidly, mimicking receptors in the brain and causing an increase in dopamine similar to cocaine.

According to the National Survey on Drug Use and Health (NSDUH), fewer Americans are smoking today. In 2013, an estimated 55.8 million Americans aged 12 or older, or 21.3 percent of the population, were current cigarette smokers. This reflects a continual but slow downward trend from 2002 when the rate was 26 percent.

However, those who are addicted to nicotine find it extremely difficult to quit, even when faced with serious health concerns. In fact, tobacco use is the leading preventable cause of disease, disability, and death in the United States, with 16 million people suffering from a serious illness that is caused by smoking. More than two-thirds of Americans who tried smoking reported becoming dependent during their life.

According to the World Health Organization:

• Tobacco kills up to half of its users.
• Tobacco kills more than 7 million people each year. More than 6 million of those deaths are the result of direct tobacco use while around 890 000 are the result of non-smokers being exposed to second-hand smoke.
• Around 80% of the world’s 1.1 billion smokers live in low- and middle-income countries.

It is difficult to quit using nicotine. According to smokefree.gov, symptoms of quitting smoking include:

• cravings for cigarettes
• feeling down or sad
• insomnia
• irritability
• trouble thinking clearly and concentrating
• feeling restless and jumpy
• slower heart rate
• weight gain

4) Barbiturates (“downers”).

Next, on Nutt’s most addictive substance list are barbiturates or downers. These are medications that work on the individual by shutting down signals in certain regions of the brain. These medications are used to treat anxiety disorders and insomnia and can lead to addiction very easily.

Today in America, barbiturates have largely been replaced by benzodiazepines, which act in much the same way, and are also addicting. According to National Survey on Drug Use and Health (NSDUH), 12.5% of adults in the U.S. used benzodiazepines, which extrapolates to about 30.5 million persons. However, only 2.1% of U.S. adults misused them (at least once), and only 0.2% met the criteria for benzodiazepine use disorders. Among benzodiazepine users, 17.1% misused them, and fewer than 2% had benzodiazepine use disorders.

Barbiturates and benzodiazepines are dangerous to withdraw from, and the individual should be monitored when quitting these medications. Withdrawal symptoms include:

• irritability
• sleeplessness
• seizures
• tremors
• hallucinations
• fever
• sweating
• delirium
• cardiovascular collapse
• severe anxiety
• hypotension
• mood disorders
• death

5) Alcohol.

Finally, one of the most commonly used legal addictive substances in America is on Nutt’s list. Alcohol is consumed by millions of people throughout the world, some even citing health benefits to moderate drinking. Not all agree, however. Alcohol depresses the central nervous system, causing the brain to release dopamine and endorphins. Those who consume alcohol on a regular basis develop a tolerance to it, which requires them to drink more and more in order to feel the same effects. During this time, dependence settles in for many and can lead to a lifetime of addiction.

Dangerous Addiction Statistics

According to the 2015 National Survey on Drug Use and Health (NSDUH):

• 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.1 percent reported that they drank in the past year; 56.0 percent reported that they drank in the past month.
• In 2015, 26.9 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 7.0 percent reported that they engaged in heavy alcohol use in the past month.
• 15.1 million adults ages 18 and older had and alcohol use disorder (AUD). This includes 9.8 million men and 5.3 million.
• About 6.7 percent of adults who had AUD in the past year received treatment. This includes 7.4 percent of males and 5.4 percent of females with AUD in this age group.
• An estimated 88,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States.
• In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities).

Alcohol withdrawal is dangerous and should not be attempted alone. Symptoms include:

• agitation
• anxiety
• headaches
• shaking
• nausea and vomiting
• disorientation
• seizures
• insomnia
• high blood pressure
• hallucinations
• delirium tremens
• death

All of these substances are dangerous if overused or abused. Some, such as prescription medications, can provide benefits if used with caution. However, it is important that we work to educate our communities about the dangers of these very addictive substances so that we can work to prevent abuse and dependence and provide treatment to those who are struggling with addiction.

The Ridge offers an inpatient rehab facility along with detox programs to help people struggling with addiction.

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60464-4/fulltext

We hear about steroids all the time. But what are steroids? Steroids are hormones, substances produced by glands (or organs) that regulate bodily functions and behavior. It is important to understand that there are several types. Steroid hormones in general include:

• Corticosteroids, including most synthetic steroid drugs, with natural product classes the glucocorticoids (which regulate many aspects of metabolism and immune function) and the mineralocorticoids (which help maintain blood volume and control renal excretion of electrolytes) and,
• Anabolic steroids (also known as androgenic steroids), natural and synthetic, interact with androgen receptors to increase muscle and bone synthesis.

What are Steroid Hormones?

In popular use, the term “steroids” often refers to anabolic or anabolic-androgenic steroids (AAS). Anabolic steroids may be synthetic, or human-made, and are variations of the male sex hormone testosterone. The proper term for these compounds is anabolic-androgenic steroids [AAS]. “Anabolic” refers to muscle building, and “androgenic” refers to increased male sex characteristics. Some common names for anabolic steroids are Gear, Juice, Roids, and Stackers.

Our focus today is on the anabolic version, or anabolic-androgenic steroids [AAS].  These are used to build muscle mass to enhance athletic performance. (If your 65-year-old grandmother is on “steroids” they are most likely not anabolic but corticosteroids which are frequently used for such conditions as asthma, bad allergy reactions [e.g., poison ivy]) or some auto-immune diseases. The most frequently prescribed anabolic steroid is testosterone.

Are There Legitimate Reasons To Take Steroids?

There are legitimate medical indications for AAS to be prescribed to patients. The most common indication is to prescribe testosterone for patients that are deficient in testosterone, which includes hormone replacement for transgender men.  Testosterone is frequently used off-label in men with sexual dysfunction due to low testosterone associated with aging [Low-T]. [Testosterone is not recommended for low testosterone status due to aging due to potential risk for cardiovascular events and stroke.] AAS are prescription only medications. They are sometimes taken without medical guidance to increase muscle mass and improve athletic performance. AAS are recognized to enhance athletic performance by improving endurance and strength, by reducing post-exertion pain and enhancing recovery time. If used in medication that can be legally prescribed there are steroids not approved by the FDA for medical use including androlone and dromostanolone. These are frequently used by bodybuilders, power athletes, and weightlifters for the desired effect on muscle building and shaping. This style of use can cause serious side effects including addiction.

How Are Steroids Administered?

Anabolic steroids including testosterone can be administered as oral pills, injections, creams or topical gels, and skin patches. While testosterone is an FDA approved medication that can be legally prescribed there are steroids not approved by the FDA for medical use including androlone and dromostanolone. These are frequently used by bodybuilders, power athletes, and weightlifters for the desired effect on muscle building and shaping.

What Are the Common Adverse Effects Of Steroids?

Some of the adverse effects of anabolic steroids include but are not limited to hypertension, coronary disease, abnormal cholesterol and lipid profiles, mouth irritation, hot flashes, tendon rupture, muscle pain, emotional disorders including severe mood swings and aggressiveness, violence, suicidal thoughts, insomnia, skin rashes, and acne.

In some instances, individuals that use anabolic-androgenic steroids [AAS] develop an addiction which refers to the continued desire or craving to use a drug despite knowing about or experiencing serious adverse consequences.

Are Steroids Addictive?

The individual most prone to developing an addiction to anabolic steroid use is the athlete and there is evidence that some people who misuse them go on to develop an addiction. Though not generally considered to be intoxicating drugs, anabolic-androgenic steroids may produce potentially reinforcing psychoactive effects such as increased self-confidence and aggressiveness.

Some of the behavioral, social, and emotional symptoms of note include severe, frequently aggressive mood swings, withdrawal from friends and/or family, paranoid thoughts, excessive desire to workout and depression. There is no scientific evidence to support the concept of “Roid Rage” as a behavioral condition that can develop when people use increasing amounts of steroids over an extended period. As the term indicates, people may display unusual and excessive displays of aggression.

Treatment & Recovery For Steroids

Symptoms from anabolic-androgenic steroids withdrawal include mood swings, serious depression, fatigue and excessive sleeping, cravings for steroids, insomnia, loss of sex drive, and loss of appetite.

The first step to recover from addiction to anabolic-androgenic steroids [AAS] is detoxification off the steroids. Medications to stabilize mood swings in a safe environment (like an inpatient rehab center) is generally recommended although not always necessary. Treatment for anabolic-androgenic steroid addiction includes a safe and support environment with Cognitive Behavioral Therapy [CBT], one on one counseling, lectures and education, referral to self-help groups for ongoing support and physician managed medications to treat the psychiatric symptoms frequently seen. Athletes or competitors who abuse steroids may have to make lifestyle adjustments in order to maintain recovery. But as with other addictions, the first step with anabolic steroid addiction is to have the courage to reach out for help.

Sources:

https://en.wikipedia.org/wiki/Corticosteroid

https://en.wikipedia.org/wiki/Glucocorticoid

https://en.wikipedia.org/wiki/Mineralocorticoid

https://en.wikipedia.org/wiki/Anabolic_steroid