Plain talk about drug addiction
GREENFIELD — While foreign cartels, smugglers, and street gangs are the source of many addictive drugs, some come from a lot closer to home.
Most young heroin addicts began their habits with opiate-based prescription painkillers, said Dr. Ruth Potee of Northfield during a “Safe and Competent Opioid Prescribing Education” presentation at Baystate Franklin Medical Center Saturday.
Medicines meant to help alleviate pain can end up causing the patient, and the community, to suffer more in the long-run, she said. There are steps that doctors can take, though, to keep patients from developing addictions and keep drugs from getting into the wrong hands.
Potee is a primary care physician at Valley Medical Group. Though she does not specialize in addiction, she said she does not shy away from addicts like some doctors may.
Some of the heroin and painkiller addicts she sees in her office are teenagers.
“They could just as easily be my own 16-year-old son,” said Potee.
The oldest was about 70, she said, though he was an anomaly.
“You rarely see heroin addicts over 55,” she explained. “They die before that.”
While it doesn’t combat long-term effects of the drugs, Potee said many overdose victims can be saved by a simple treatment, if they receive it in time.
Narcan, available in an easily administered nasal spray, can bring a user out of an overdose. It can be administered by anyone and the state’s Good Samaritan law removes the potential for liability for lay-people who are trying to help.
Though heroin carries the stigma of a dangerous street drug, Potee said most users first became addicted to related prescription drugs.
It’s a doctor’s responsibility to the patient and society to explain the risks and benefits of opioid treatment to the patient, evaluate the patient’s abuse and addiction potential and keep an eye out for red flags that indicate addiction, drug seeking or “doctor shopping,” and resale of prescription drugs, said Potee.
Doctors should also make note of their patient’s mental health and life stresses in addition to their pain levels and physical condition, and not hesitate to recommend therapy, said Potee.
She said it can take as little as six weeks to become physically dependant on opioids. Unchecked, it can lead to addiction. After about six months, she said, users stop feeling any euphoric highs and need the drug just to escape painful withdrawals and function normally.
Patients taking short-acting opioids multiple times a day ride a roller coaster, the drugs kicking in and wearing off quickly, Potee said. This leads to withdrawal symptoms, including pain, causing patients to think they need another pill.
At some point, the doctor may stop prescribing the painkillers. By then, the patient could be addicted and many begin to buy the pills illegally or switch to heroin.
To combat that, said Potee, prescribers need to regularly see their chronic pain patients, tracking changes in their condition and medication. Doctors need to make sure their patients are getting the right pain medicine for their condition, at the right dosage.
Once someone’s developed a dependency and is ready to end opioid treatment, their doctor needs to work closely with them to help ween the patient from the drugs.
Potee said the final step is the hardest. No matter how slowly someone’s dosage is decreased, she said, it’s always hard to give up those last few milligrams.
Many providers require anyone receiving long-term opioid treatment to sign a “pill contract,” a standard practice for chronic pain treatment. Under the agreement, patients must submit to random drug tests, not be involved in illegal activity, and go in for regular visits and “pill counts.”
If a drug test comes up negative for opioids or positive for illicit drugs, or the pill count comes up short, the doctor can end the prescription then and there.
The purpose is to make sure the medications are not being abused or sold.
“People find ways around everything, though,” Potee admitted.
She said some will borrow pills from others when it’s time for a pill count, and find ways to get around pill makers’ attempts to make their products abuse-resistant. When the makers of high-strength time-release opioid Oxycontin made it harder to abuse, users quickly found a workaround, said Potee.
Once the new pills were released in 2010, she regularly checked online and found instructions how to abuse the new pills within a month.
“Nothing is truly abuse-resistant,” she said.
She also noted that Suboxone, which contains an opioid as well as a compound that blocks the brain’s pathways for the drugs, can be abused by those who have not built up a tolerance to opioids.
Potee is a firm believer in Suboxone treatment for addiction, though, and is one of few area doctors certified to prescribe what she called a “life-saving” medicine.
Potee said that if Suboxone and the overdose-stopping Narcan were more available, fewer would die from opioid abuse.
Though treatment for addiction is important, it’s a doctor’s duty to the individual and the community to help keep patients from becoming hooked, Potee added.
“No matter how hard it is, you have to be able to say ‘I can no longer give you this drug, because it’s no longer safe for you,’” said Potee. “If you think someone’s developed an addiction, treat it, and refer them to a specialist if needed.”
You can reach David Rainville at: firstname.lastname@example.org or 413-772-0261, ext. 279