Pubdate: Mon, 19 Nov 2007
Source: Patriot Ledger, The  (Quincy, MA)
Copyright: 2007 The Patriot Ledger
Author: Colleen LaBelle
Note: Colleen LaBelle, RN, is the nurse program manager for  the
office-based opioid treatment program at Boston  Medical Center. She
lives in Hanover.


'Heroin is killing our kids." This has been the  headline on the
South Shore and in the Northeast for  too long!

Opiates are the leading drug problem in the Northeast  and it is the
only region in the country where this is  so.

Providing Narcan to an addict is a tool, it is an  emergency measure
to treat an overdose for themselves  or someone else. No addict wants
to be given Narcan.

Working in the field of addiction at Boston Medical  Center, I have
yet to see a person who was still  responsive hear the word "Narcan"
uttered and not try  to flee the situation. When Narcan is
administered, it  displaces the opiate from the receptor in the brain,
  making the person physically ill, and reverses the  respiratory
depression that causes the overdose.

When someone is addicted to opiates they spend their  day trying to
keep from becoming sick. Over time, their  body has developed a
tolerance and without the opiate  they are "dope sick" and with the
opiate they feel  "normal." It is a vicious cycle that many struggle
  with day in and day out.

So, we say: Just stop, go to detox, put the drug down  and get on with
your life. Why do we need Narcan, and  why do we care what happens to
people who make a  conscious decision to use opiates and potentially
overdose and die?

Because addiction is a disease, it is a brain disease  and we need to
treat it much like we do other chronic  diseases. We arm diabetics
with sliding scale insulin,  perform repeated limb amputations, we
give chemo to the  lung cancer patient who goes outside and smokes
cigarettes between treatments, we resuscitate the  obese,
hypertensive, cardiac patient and perform open  heart surgery multiple
times, we treat the alcoholics'  GI bleeding, and cirrhosis.

But we continue to treat the patient struggling with  opiate
dependence differently believing that because  they are "addicted,"
they made the choice to be  "addicted." The obese patient, the
uncontrolled  diabetic, the cardiac patient and the alcoholic, they
have a disease much like the addict; it is a chronic  disease and it
affects the brain. Science has proven  this and yet society continues
to look at it  differently.

Initial drug use is voluntary, however once addiction  develops this
control is disrupted and it is no longer  a choice to use, it is now a
chronic relapsing disease  caused by prolonged effects of drugs on the

Prevention, education and treatment are all critical  components in
the process, but what about those already  addicted and not at the
stage of change where they are  willing to put down that cigarette, go
on that diet,  exercise or stop using drugs? Do we forget them and
move on? No, we meet them where they are at in their  stages of
change, providing them with tools, education,  treatment and support.
We meet people where they are at  and hope over time they will move
forward and get the  treatment they need for their disease.

Time is critical when someone overdoses, and having  Narcan available
for that immediate response before  medical help is sought can be the
difference between  life and death.

It is critical to view addiction as a brain disease and  understand
the brain has been altered and this drives  the behavior of addiction.
Therefore, treatment is  required to deal with the altered brain
including  addressing behavior and the social components of the
illness. The management of a chronic disease is  lifelong; it is a
chronic illness for which there is no  cure.

We need to help folks change their behavior, and move  forward in
their recovery process but this takes time,  lots of hard work and
commitment. Changing behavior is  not an easy task for anyone. How
many stick to their  New Year's resolution and stop smoking, stop
drinking,  eat healthier or exercise? It's not easy.

Providing Narcan to addicts or others for emergency  measures will
save lives! Addicts are not going to use  because they know there is
some Narcan in their pocket.  Giving them Narcan will not replace
treatment but it  will give them a tool to treat their disease should
they need it until such time that they are willing and  able to engage
in treatment. It saves lives!

Heroin is killing our kids, it's impacting our  community, and we need
to make a commitment to use  whatever tools and resources we have in
treating this  disease!

"How many deaths will it take til too many have  died?" Peter, Paul,
and Mary.

Colleen LaBelle, RN, is the nurse program manager for  the
office-based opioid treatment program at Boston  Medical Center. She
lives in Hanover.
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