A Response to the Opioid Crisis: How We Got Here and What It Takes to Recover

by Cara McLeod, MA, LPC-S, Enterhealth Outpatient Center of Excellence Clinical Director

According to the numbers published by the Centers for Disease Control (CDC) in 2018, more than 130 people in the United States continue to die every day due to opioid overdose. Misuse and addiction to has risen to the point that in late 2017, then-acting Health and Human Services (HHS) Secretary Eric D. Hargan issued a public health emergency regarding the crisis at the request of President Donald Trump.

In April 2017, HHS unveiled a new five-point Opioid Strategy, with the five following priorities:

  • Improve access to prevention, treatment, and recovery support services
  • Target the availability and distribution of overdose-reversing drugs
  • Strengthen public health data reporting and collection
  • Support cutting-edge research on addiction and pain
  • Advance the practice of pain management

Additionally, during Fiscal Year 2017, HHS invested almost $900 million in opioid-specific funding, including support for state and local governments and civil society groups to support treatment and recovery services, target availability of overdose-reversing drugs, train first responders, and more.

How serious is the Opioid Crisis?

Currently in the United States:

  • Roughly 21-29% of all patients who are prescribed opioids for chronic pain misuse them.
  • Between 8-12% develop an opioid use disorder as a result.
  • An estimated 4-6% who misuse prescription opioids transition to heroin.
  • About 80% of people who use heroin first misused prescription opioids.
  • Opioid overdoses increased 30% from July 2016 to September 2017.
  • Opioid overdoses in large cities increase by 54% in 16 states.
  • In the past year, approximately 11.8 million people 12 years or older misused opiates (4.4% of the total U.S. population).

What are opioid drugs?

Opioids are a class of drugs that includes legal painkillers such as oxycodone, hydrocodone and codeine, as well as illicit drugs such as heroin. Opioids reduce feelings of pain by attaching themselves to the body’s natural opioid receptors in the brain and throughout the body. The body already contains opioid chemicals, such as endorphins, which relieve pain and make you feel good during exercise.

When opioid drugs attach to these receptors, they further reduce a person’s perception of pain. That’s why they can be so useful for people who are recovering from serious injuries or surgery. However, opioids also have a profound effect on the brain’s natural reward system, which can cause users to feel a euphoric high. The problem is that once this reward system has been altered by prolonged use of opioid medication, it is difficult for it to return to its normal baseline state, which can lead to unpleasant feelings for users – a condition commonly known as withdrawal.

Legal prescription opioid pain medications include:

Prescription V. Heroin

Even though heroin is an opioid, there’s a reason you can’t get a prescription for it. Heroin is a synthetic narcotic made from morphine that involves several steps of processing with various chemicals, which can differ depending on where it’s produced. Heroin is a street drug, not controlled by FDA regulations, meaning users don’t know the potency of the opioids it contains, nor what other substances have been mixed in with it.

Because heroin is typically either injected, snorted or smoked, it enters the body and brain rapidly and produces an extreme high, but it doesn’t last very long. This makes it a poor option for pain relief, but an easy substance to become addicted to.

Prescription opioids, on the other hand, are designed to affect users more gradually and produce milder effects compared to heroin, but they work for longer periods of time. Unfortunately, those who want to use them to get high will often crush the pills to then snort or inject the powder to get a more immediate and stronger effect.

All too often, people who begin by misusing prescription pain relievers will shift to using heroin because it’s cheaper and they can get it on the street instead of having to get a prescription or pay more for illegally resold prescription pills.

The health risks of opioids

As mentioned earlier, opioid drugs bind to opioid receptors on cells in the brain and throughout the body in order to release other chemicals, such as endorphins, which in turn reduce feelings of pain. However, these chemicals also affect things like digestion, breathing, and other vital functions.

In lower doses, opioids produce feelings of sedation, a muffled perception of pain, and mild euphoria. That’s not to say there aren’t negative side effects, though. Even in small doses, opioids can cause nausea, constipation, slowed breathing and unconsciousness. In higher doses, the sedative effects can be profound (with users often drifting in and out of consciousness), and the drugs severely depress the person’s breathing and heart rate, which poses the greatest risks of coma or death.

For every 1 overdose death in the United States, there are:

  • 15 addiction treatment admissions
  • 26 emergency room visits
  • 115 addicted users
  • 733 nonmedical users
  • $4.35 million in healthcare-related costs

Addiction is a chronic brain disease

Substance abuse (opioid abuse in particular) causes damage not only to the body, but also to the brain and its ability to function normally. Somewhat similar to a traumatic brain injury (TBI), this damage often leads to altered cognitive, behavioral and emotional functioning, as well as a disorder of the brain’s natural reward system.

Opioid Use disorder criteria:

  • Using in larger amounts or for longer than intended
  • Wanting, but unable, to cut down  or stop using
  • Spending a lot of time to get, use or recover from use
  • Craving
  • Inability to manage commitments due to use
  • Continuing to use despite negative consequences
  • Giving up important activities because of use
  • Withdrawal

How do you treat opioid addiction?

Unlike more traditional addiction treatment providers, Enterhealth relies primarily on science- and evidence-based treatments that have been clinically proven to work. This includes the use of anti-addiction medications, which are used to normalize a patient’s brain and body chemistry without the negative effects that accompany the abused substance. Anti-addiction medications also reduce physiological cravings and make patients more comfortable by reducing anxiety and making it easier to get sleep.

In addition, Enterhealth utilizes cutting-edge diagnostic tools that can allow us to gather information about motor, linguistic, and higher functioning skills. This detailed understanding of a person’s psychological functioning then informs what types of therapy fit best into each patient’s customized treatment plan.

Enterhealth offers several different types of therapy in addition to the standard one-on-one and group therapy sessions, including family therapy, motivational enhancement therapy, as well as advanced therapeutic modalities such as EMDR and Magnetic e-Resonance Therapy (MeRT).

Why treatment at Enterhealth produces better outcomes

At Enterhealth, we understand the intricacies of treating addiction as a brain disease because we’ve been doing it for more than a decade. Our team of physicians, psychologists and other clinicians provide each patient with a comprehensive, personalized recovery plan that combines state-of-the-art diagnostic capabilities, innovative behavioral therapy, anti-addiction medications and more to help patients overcome substance abuse and realize a long-lasting recovery.

If you would like to learn more about Enterhealth’s proven, evidence-based treatment for opioid addiction, call 1.800.388.4601 or contact us today.