Pubdate: Thu, 05 Jan 2017
Source: Philadelphia Daily News (PA)
Copyright: 2017 Philadelphia Newspapers Inc.
Author: Rima Himelstein, M.D.


Recent headlines tell it all: "9 dead from apparent heroin ODs over
weekend in Kensington area"; "Medical examiner: Philly overdose surge may
have killed 35 over 5 days"; "New Jersey's overdose nightmare hits a new
peak"; and "Growth in the use of opioids is fueling a nationwide epidemic
of deaths from drug overdose".

Heroin mixed with fentanyl - or heroin alone - may be responsible for this
surge in overdoses. In the past, Philadelphia typically had three
overdoses a day and they were not all fatal. Last June, the Philadelphia
Medical Examiner's Office confirmed nearly 700 drug-related deaths in
2015, twice as many deaths as there were from homicides. At the current
rate, 2016 will end with even more.

It's not just a local problem. The Centers for Disease Control and
Prevention found last year that 47,055 people died from drug overdoses in
the United States in 2014, more than double the rate in year 2000.
Combining drugs is a common occurrence with drug overdoses. According to
the CDC, 61 percent of overdose deaths involved opioids, 90 percent
involved opioids and benzodiazepines, and 70 percent involved opioids and

Narcotics as medication. Narcotics include heroin as well as prescribed
opioids such as morphine (MS Contin), hydromorphone (Dilaudid), oxycodone
(OxyContin, Percocet), hydrocodone (Vicodin, Lortab), fentanyl (Duragesic)
and codeine. Heroin is a Schedule I drug meaning there is no currently
accepted medical use and a high potential for abuse. Since 1999, the
number of prescriptions for opioid pain relievers in the U.S. nearly

Narcotics as drugs of abuse. Narcotics activate reward regions in the
brain causing a high. Their misuse can lead to:

It often starts with a pain pill. People who misused opioid pain relievers
within the preceding year were 19 times more likely to start using heroin
than those who did not, according to data pooled from the National Survey
on Drug Use and Health. Findings from a study of 50 16- to 25 year-old
injection drug users found that nearly all had misused opioid pain
relievers prior to using heroin. The opioids were obtained from family,
friends or personal prescriptions.

Sadly, it's not for adults only. From 2000 to 2012, there was a five-fold
increase in the number of babies born with neonatal abstinence syndrome -
equivalent to one baby suffering from narcotic withdrawal born every 25
minutes. A recent study published in JAMA Pediatrics looked at over 13,000
U.S. pediatric discharge records for patients 1-19 years of age who were
hospitalized from 1997 to 2012 for opioid poisonings. Hospitalization
rates were highest in older adolescents 15-19 years of age, whose
hospitalizations increased 176 percent from the prior year, but the
largest percentage increase was among children 1-4 years of age, whose
hospitalizations due to accidental ingestions increased 205 percent.


* Every second counts when dealing with a possible narcotic overdose. Some
signs and symptoms of an opioid emergency are breathing problems (which
can range from slow or shallow breathing to no breathing), extreme
sleepiness, slow heartbeat or not being able to respond. Friends and
family in contact with someone who abuses narcotics should have the
antidote naloxone (Evzio, Narcan) ready if needed. It will temporarily
reverse the effects of an opioid medicine. It is given either as an
injection or as an intranasal spray. It usually works within five minutes,
but repeated doses may be necessary. Call for emergency assistance (911)
after administering the first dose and keep the person under close watch
until help arrives. The CDC states that over the past 20 years, naloxone
has saved 26,463 lives nationwide.

* In 2014, Pennsylvania's Physician General signed David's Law (Opioid
Overdose Reversal ACT 139), a statewide standing order (prescription) that
makes naloxone available to any Pennsylvanian without a prescription and
allows willing pharmacies to dispense it. You can call your pharmacy to
see if they are willing.

* If you are a Pennsylvania resident and need treatment for substance
abuse, here are a few valuable resources:

* If you have no health insurance, contact the Behavioral Health Special
Initiative at 215-546-1200.

* If you have medical assistance or Medicaid, contact Community Behavioral
Health at 888-545-2600.

* If you have private health insurance, contact your insurance company to
find out where to get substance abuse treatment (the telephone number is
usually on the back of the card).
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