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Wednesday, April 12, 2017

Opioid Addiction

Posted By: Advancing Care

What you need to know about this frightening epidemic.

By Laurie Yarnell

According to the Centers for Disease Control and Prevention, someone in the U.S. dies of an accidental drug overdose every 19 minutes, primarily from prescribed opioids. In 2015, more than 33,000 Americans, more than any year on record, suffered fatal opioid overdoses, with nearly half of those deaths involving a prescription opioid. “Prescription opioid abuse is the fastestgrowing drug problem in the United States, and the Hudson Valley area is not immune from its ravages,” says Stephen J. Ferrando, MD, Director of Psychiatry at Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth).

Some of the most commonly prescribed opioids are medications such as hydrocodone (Vicodin),  oxycodone (Percocet), hydromorphone (Dilaudid) and fentanyl.

To learn more about the serious public health issue known as opioid addiction (OA), we spoke with Dr. Ferrando and two other experts in this field, Naim Korça, Administrator of Behavioral Health Services at Bon Secours Charity Health System, and Allen Nace, Administrative Director of Community Rehabilitation Services for HealthAlliance of the Hudson Valley and MidHudson Regional Hospital, all members of WMCHealth.

How do people typically become addicted to opioids?

Korça: Adults start taking opioids to manage pain as a result of medical conditions, and our children can get these from our medication cabinets at home or from drug dealers in our communities.

Nace: There is no one way into addictive drug use. For some it’s lifestyle — who you spend time with and what they are doing.

How do opioids differ from opiates?

Korça: Opiates are chemicals derived from opium and are the key ingredient of heroin, the most widely used illegal substance. Many individuals start with prescribed opioids, and when they cannot obtain them, due to the price on the streets and/or cannot get any more prescriptions, they may start using heroin because it is cheaper.

How do you know if you or someone you know is experiencing OA?

Korça: Usually it starts with changes in behavior; they are not the same person anymore. For children, grades go down, they isolate, change friends, miss school, ask for money all the time or are irritable. [In adults] you see problems like loss of a job, running through credit cards, etc.

What’s the best treatment for OA?

Ferrando: There is no “one size fits all.” For some, it’s outpatient counseling; some need medically managed withdrawal or detox, others rehab. Still others may have better outcomes with medical treatments. And many individuals participate in 12-step programs with professional treatment or alone.

Can OA be cured?

Korça: Addiction is a chronic disease that can be managed successfully with discipline and support, such as counseling and medications. In the majority of cases, professional help is needed…you cannot just stop cold turkey. Relapse is very common.

Nace: I believe that addiction is more than the substance. There are underlying issues. Have they been addressed? Has a person “matured” out of an addictive cycle, or is it an embedded lifestyle?

What is the “typical profile” of an opioid addict?

Nace: There really is not one; it impacts people from all walks and stations of life. Addiction is an equal-opportunity predator and will impact most families.

If you suspect that someone you love is addicted to opioids, what should you do?

Korca: Understand that in the majority of cases, professional help is needed and that you cannot just stop cold turkey. Relapse is very common.

What else should people know about opioid addiction?

Nace: Addiction is not a choice. When you develop addiction to opioids and stop taking them, you will go through withdrawal symptoms that are quite severe, though they are not usually life-threatening.

Ferrando: Once we realize that each person is someone’s loved one, maybe the stigma associated with addiction and mental-health issues can be reduced and treatment seen as a more normal situation, similar to help for other ailments.

How does opioid use affect the brain?

According to Naim Korça, opioid use triggers two major changes in the brain:

  1. The body naturally produces endogenous opioid peptides, such as endorphins, that support pain control. With continued use of opioids, the body stops or decreases their production.
  2. Opioid use also stimulates production of dopamine, a neurotransmitter that helps control the brain’s reward and pleasure centers and creates the effect of being “high.” The body responds by decreasing the levels of dopamine it produces.

Thus, individuals battling addiction often say that they take drugs just to “feel normal.” This is the result of the body reducing the production of normal levels of dopamine and endogenous opioids because it has grown dependent on (become addicted to) taking opioid substances.

Opioid Addiction Resources At WMCHealth

Bon Secours Community Hospital Detox: 845.206.5305 Rehab: 845.858.7234

Good Samaritan Hospital Detox: 845.499.4278 Rehab: 845.368.5242

HealthAlliance Hospital Detox and Rehab: 845.334.4705 Outpatient Therapy (Methadone): 845.943.6022 Outpatient Programs and Counseling 845.943.6091

MidHudson Regional Hospital Detox, Rehab, and Outpatient Counseling Programs: 845.483.5514