Pubdate: Sat, 10 Dec 2016
Source: Medicine Hat News (CN AB)
Copyright: 2016 Alberta Newspaper Group, Inc.
Contact:  http://www.medicinehatnews.com/
Details: http://www.mapinc.org/media/1833
Author: Gillian Slade
Page: A3

FENTANYL PREYING ON YOUNG MEN LACKING A HISTORY OF USE

Many young males without a history of prescription opioid use are
arriving in emergency departments due to fentanyl overdoses, says
Alberta Health Services.

"A lot of the individuals we are seeing coming into our emergency
departments, who are dying from fentanyl overdoses, tend to be younger
males who don't often have a history of prescription opioid use," said
Dr. Nick Mitchell, senior medical director, addictions and mental
health Alberta Health Services.

There are also older people with chronic opioid use over time. The
dose may have been increased, other medications added, or they may be
more medically frail, said Mitchell.

Detoxifying is one aspect of treatment but depending on the person, to
abstain can lead to a dire situation.

"Particularly with opioids where there's a high risk of overdose,
relapse can be deadly," said Mitchell.

After a period of detoxing they lose their tolerance to the opioids.
If they then have a relapse there is a high likelihood of overdosing
on even the same amount of medication they had been using previously.
Their body is no longer able to tolerate it, said Mitchell.

Medically-assisted treatment moves people off substances acquired on
the street to pharmaceutically-controlled substances such as methadone
and buprenorphine (commonly known as suboxone) given in secure
environments. This is combined with other programs such as
counselling, said Mitchell. This approach is broadly known as "harm
reduction" for those encountering challenges maintaining abstinence.

"That is considered to be the standard of care for people with opioid
use disorders," said Mitchell. "Wherever possible we try to get people
to use substitution therapies and appropriate counselling."

The ultimate goal is to get people off of methadone or suboxone but
some people remain on those medications indefinitely, said Mitchell.
There is the potential over time for the person to reach the point
where they are slowly weaned off those medications under the direction
of their treatment team when they feel it is safe to do so.

"However, not everyone makes it to that point," said
Mitchell.

With all the reports of deadly results from illicit substances, many
people continue to take them. Thinking of drug addiction as a moral
issue, the person lacking self-control or determination, is not
accurate. There are likely psychological or social stressors, a lack
of coping strategies, financial stressors or homelessness, said Mitchell.

"I have seen a number of individuals clinically who have presented
with fentanyl overdoses, who have friends and family who have died
from fentanyl and still they struggle to stop," said Mitchell. "These
are intelligent people. Some of them are high functioning individuals
who are still maintaining jobs and family."

In general, more people are seeking help for addictions, particularly
around opioids, said Mitchell. It is not clear whether this is
associated with the increased risk with illicit fentanyl.

"It might be that we are seeing more people seeking help because there
are more people using," said Mitchell.
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MAP posted-by: Matt