10 June 2019

Part 2 - Healthy Living for Life - Opioid Addiction in America: Part 1

More than 100 people die every day from an opioid overdose. Regardless of region, race and education, opioid addiction doesn't discriminate. It can happen to ...

- Welcome back to Healthy Living for Life. We're now talking to Lisa Sather. Lisa is

the director of pharmacy services for Mountain-Pacific Quality Health and she has more than 25 years of pharmacy experience. Thanks for being here with your expertise. - Good morning, Beth. Thank you for having me. - So let's talk about opioids and when they are prescribed, what medications are we talking about specifically? - Sure, so firstly, opioids in general are a group of medications that act on what we call opioid receptors in the brain. So just to get that out there. And the meds that folks most commonly are gonna be familiar with are those by the generic name oxycodone with is brand OxyContin, hydroxodone also known as Vicodin, Lortab which contains a Tylenol component as well, morphine is very commonly known and that's MS Contin, and then another powerful medication is also known as a durogesic, it's fentanyl. And we're gonna talk some more about that. - [Beth] Okay. And so why are opioids prescribed? - Sure. So most commonly, opioids are prescribed in events of moderate to severe pain. And that may involve someone who's been in an accident, who's had to have an elective surgery. In addition to that, we use opioids to treat severe pain in instances of cancer, folks who are suffering from that kind of pain situation. - [Beth] So we know that opioids can be addictive, but there are other side effects that people should know about when it comes to opioids? - Sure, that's a great question. So one of the most common side effects of opioids is constipation. We have those receptors in our gut as well so that can make folks have that specific side effects. Of course, sedation is one of the biggies and drowsiness. And those are one of the things we really are concerned about when folks first are getting something like this prescribed because we want to make sure that they're not operating machinery or equipment or something like that where they could get in an accident. One of the biggest fears we have about opioids and misuse and potentially getting into trouble with is that of respiratory depression. And when we talk about discussions with overdose, that's what we're worried about is that these medicines work on the brain and they depress our drive to breathe. And so the severe respiratory depression, the inability to breathe, that's one of the biggest things that we are really worried about with opioids.

- So let's talk about addiction now. You mentioned the opioids receptors in our brains. Is that why opioids are addictive, or why, why are they addictive? - Yes, that's a great question. So that's exactly why. We have opioid receptors in our brain that work to help control pain when something's bound to those, but they also are in the emotional center of our brain as well. And so when opioids bind to opioid receptors in the brain, they also can cause a feeling of euphoria or a good sense of well-being. And especially in folks that are susceptible to that. Not everybody necessarily has that same effect but there are susceptible individuals who potentially can feel that. And so of course as they're taking the medicine and they get that good feeling, their body says I like that and I want to continue using that to continue to produce that same good feeling. And that's part of that addiction component. Again, it's important to mention that's not in everyone, but in certain susceptible individuals. - Okay. And can people build up a tolerance to opioids? - Yes, that's a definite thing. So tolerance is a situation where you have the opioids binding to receptors in the brain and it's a complex chemical situation, but in a nutshell basically, those receptors can become desensitized to having the opioid present in their brain all of the time. And so what happens is you end up having to take more and more of the medication in order to achieve the desired therapeutic effect. And tolerance will develop whether or not someone ends up having a substance use disorder or an addiction to something. It's just a physical phenomenon that happens when you take an opioid. - Okay. And so we talked a little bit too about overdose earlier. And so what makes somebody susceptible to overdose? Is it a higher dose that they're taking or can you talk about that a little bit? - You bet. Yeah, that's a great question. We do know in fact that folks who are taking higher doses of opioids are more susceptible to overdose. We equate strength of opioids all back to the strength of morphine in general. And so we know that folks who are on over 100 morphine equivalents if you would call it that are nine times more likely to have an overdose. It's just a higher dose. In addition to that especially if they get prescribed another medication that might interact, it really can interfere with their respiratory drive and so those kind of work in combination.

- Okay. And so if someone is prescribed a higher dose or they have any concerns about the risk of opioids, what should they do? - Yes. So obviously prescribed is the key term here and if that's the case and you do have a concern, you're gonna want to make sure you visit with your physician. Sometimes opioids don't necessarily improve pain or functioning. In a lot of cases, they do for folks. It's very patient specific. So if that's a concern, someone should definitely have that conversation with their doctor. It's always a risk benefit situation and you want to make sure you visit with them. This is not something you stop all of a sudden. And if you in that discussion with your physician feel like it is in your best interest to potentially lower the dose, your doc can work with you in terms of doing that over a slow period of time, what we call a taper to avoid any withdrawal symptoms or any discomfort that you might have. - [Beth] Okay. So we're just about out of time but last question here really quickly. There are also street opioids, drugs used out on the street that aren't prescribed. Can you talk about what a couple of those are and are they as dangerous or more dangerous than prescription opioids? - Sure. So one of the big ones, of course, people have heard about is heroin. It's a derivative of morphine. And then another one that there's a big trend towards right now is synthetic and chemical derivatives of fentanyl. I talked about fentanyl earlier but chemists are actually figuring out a way to modify that particular drug and make it so it's not detectable in drug screens and things like that. It's used also to be mixed with heroin. So very dangerous. Folks don't know exactly how much is in any particular one of those versus prescription drugs that we know the exact amount. So both can be dangerous. It just depends on the specific situation obviously. - Okay, perfect, thank you. We need to pause here for another break but up next, it's a good idea to keep your medication safely locked away and out of the wrong hands, but what's the right way to do that? We'll talk about that right after this. Don't go away.