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Medical Experts Explain What Is Really Fueling the Opioid Epidemic

According to CDC data, death rates from fentanyl, pinky and other synthetic opiates rose 72.3% from 2014 to 2015 across the nation. More than 33,000 Americans succumbed to an opioid overdose in 2015 and 91 Americans die every day from an opioid-related overdose. Nicholas King, associate professor at McGill University in Montreal stated that the dramatic surge in opioid-induced deaths nationwide may be attributed to several factors, including the increased use of prescription opioid pain relievers among patients and the use of opioids in combination with alcohol and/or other legal/illegal drugs.

Deaths involving opioids seem to come in groups - for instance, in September last year 7 people lost their lives to opioid-related overdoses in Cuyahoga County, Ohio in merely 24 hours and at least 14 died of an opioid overdose in the same county over the first weekend in February this year. More than half of the autopsies performed at the Montgomery County Coroner's office so far this year involved opioid overdose deaths, many of which were linked to long-term abuse of prescription opiate pain relievers and heroin.

As opioids bind to those areas of the brain which are responsible for controlling emotions and pain, they excite dopamine-containing neurons and produce intense feelings of euphoria. Increased activity of such neurons is needed for the reinforcing effects of this class of drugs. When used for a prolonged period of time, the body can build up a level of physical tolerance to these drugs and develop a dependence on them. Tolerance occurs when the body needs to use more to get the same pain-reducing effect, while dependence involves relying on the drug to prevent symptoms associated with opioid withdrawal.

N. King, who has researched the factors behind the overwhelming rise in opioid overdose deaths explained that from the historical experience with "cancer clusters", the clustering phenomenon is usually the result of confirmation bias or simply random chance, cautioning that deaths which seem to happen in spurts aren't necessarily linked. However, he added, in some specific cases, medical experts can pinpoint an underlying cause for multiple overdoses in a very short period of time (1-2 days). One of these causes can be identified for instance after the introduction of an illicit opioid with an extremely high potency. Cutting down both the demand and the supply are crucial steps in reducing the opioid overdose death rate.

Dr. David Fiellin, professor at Yale School of Medicine and whose research focuses on opioid abuse treatment strategies reinforced King's statement, saying that the introduction of a very powerful opioid such as fentanyl could spawn a large number of deaths in a very short time span. Dr. Fiellin stressed that it is the extent to which such highly potent opiates are being distributed within the illegal drug market. Opioid users may congregate in a certain community in an attempt to buy high potency versions of these drugs when these are available on the drug market. High-potency opioids include fentanyl, a synthetic opioid painkiller that is 50 to 100 times more potent than morphine and it's usually prescribed for patients with cancer and carfentanil, used as an elephant tranquilizer and which is 10,000 times more powerful than morphine.

Dr. Fiellin added that combining opiate pain relievers with alcohol or other drugs such as benzodiazepines can significantly increase the symptoms of an opioid-related overdose i.e. loss of consciousness and respiratory depression. In Connecticut for example, more than 40% of people who succumb to an opioid-related overdose have other substances in their body in addition to opioids at the time of their demise. An opioid overdose is often treated with naloxone (Narcan), approved by the FDA in 1971, but Dr. Fiellin warns that although this life-saving medication effectively and rapidly treats the acute episode, it doesn't, however, address the underlying disease.

Those who are revived using naloxone and survive an overdose episode are thus at multiple-fold risk for a fatal opioid overdose because typically, the level of tolerance in people with an opioid use disorder develops right to a point where they are using these drugs to help them with the withdrawal symptoms, rarely continuing to use them for the feeling of euphoria. Therefore, overdose patients need to receive medication-assisted treatment for their opioid use disorder after treatment with Narcan.


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