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WOW program provides opioid education

The Feb. 1 Women of Wellness program (WOW) featured CVS pharmacist Don Weeks talking about "Opioids: What they are and how they work." Fallbrook Regional Health District (FRHD) hosted the program at Fallbrook Library.

First, Weeks said that it is "really illegal opioids that are the major problem" in the current opioid epidemic; while the number of prescriptions being written for opioids has leveled off, the use of illegal opioids has gone up.

According to Weeks, these drugs have molecules that attach to opioid receptors in the brain, nervous system and GI tract. Overall, there are 17 different types of receptors that opioids bind to, "suppressing the perception of pain, reducing the amount of pain felt and calming one's emotional response to pain," he said.

There are lots of different kinds of opioids that are derived from the opium poppy flower. Morphine, he explained, is the standard against which other opioids are compared to in the United States. He said codeine is one-third as potent as morphine whereas hypocodone, often mixed with acetaminophen, is 1 ½ times the strength of morphine. Oxycodone (Oxycontin) is also 1 ½ times the strength of morphine.

In the late 80s to early 90s, the medical community was concerned about untreated and under-treated pain in America. Weeks said that pain became the fifth vital sign after temperature, pulse, respiration and blood pressure. Unlike the other four signs which are objectively measurable, scoring pain is very subjective in how people feel and handle it.

Weeks said fentanyl, which was developed in the 90s and taken in lozenges or in sublingual form (under the tongue), is 50 to 100 times more potent than morphine. Fentanyl is measured in micrograms and is prescribed from 280 mg to 2400 mg a day.

In late 1995, Oxycontin was approved by the FDA. Oxycontin was then marketed in 1996 and made $45 million in sales. In 2000, after a market blitz, he said the drug made $1.1 billion for its company which touted it as non-addictive and safe. Oxycontin is designed to take two to three hours to take effect, so another dose is not needed for 12 hours. The drug builds up in one's system and takes three to four days to reach full strength. After that, it only last six hours so doctors began prescribing it for every eight hours and it became over-prescribed.

Starting in 1998, fentanyl was prescribed as a low dose patch which takes 24 hours to take effect and three to four days to reach the level it works best at for eight to 12 hours. Because it is slowly absorbed through the skin, into the bloodstream, the patch has a large concentration of the drug in it so that when the patch is changed every three days there is still a reservoir of opioids in the patch when it is discarded. This is a big issue, Weeks pointed out, because "people swipe patches out of the trash." When people use discarded patches, the rate of absorption is not known or controlled.

To dispose of the patches and other medications, besides taking them to the sheriff's station, Weeks advised mixing them loose (not in packaging or bottles) in bags with coffee grounds, vegetable waste or cat litter before putting them into the trash.

In the 2000s, government statistics showed an increase in overdose deaths. As a result, a lot of legislation has changed how drugs are handled. Vicodin and Percocet had been classified as Schedule 3 narcotics. In late 2015, new legislation changed them and hydrocodone to Schedule 2 narcotics for which prescriptions cannot be called in to a pharmacy. These prescriptions can only be sent electronically if the system is a secure one. Otherwise the doctors have to hand write the prescriptions to be carried into the pharmacy, all in an attempt to solve the problem of illegal opioid use.

While the number of opioid prescriptions has gone down, Weeks said, the number of deaths from opioid use has gone up. In 2014 there were 47,000 overdose deaths in the U.S. and in 2015 there were 50,000. In 2016 there were 63,000 accidental overdoses and in 2017 there were 66,000, most caused by illegal or illicit drugs on the street.

Many doctors are no longer writing prescriptions for opioids so people are finding their own. "That is the crux of the problem," Weeks said, "drugs come into the country full strength, then are cut and cut and cut again, so you don't know what you are getting."

While opioids are used as pain relievers, they have "a side effect of causing major respiratory depression; they block signals to the brain that keep you breathing," he said.

If the signal is blocked, people stop breathing so 90 percent of opioid deaths are the result of respiratory depression. A lot of these people are also on muscle relaxants, which also cause respiratory depression as do valium and Xanax, which are prescribed for anxiety. Add on use of illicit opioids and the person taking them goes to sleep and does not wake up.

According to Weeks, another problem is high school parties where teenagers bring drugs taken from their parents' and/or grandparents' medicine cabinets and throw them all into a container. Each teen reaches in, takes a handful of pills and then swallows them, sometimes all at once, which can kill them. They do it for the euphoria effect as the drugs produce endorphins.

Weeks said a lot more changes are coming up including enforcement with illegal drugs and how prescriptions are handled. Some insurance companies will now only allow a seven-day prescription.

Questions from the audience brought up related topics. Opioids also cause constipation as there are opioid receptors in the bowels and the drugs limit peristaltic movement. Many people who need opioids are inactive or flat on their backs, "a recipe for constipation," Weeks said. He also said that there are some opioids, like Imodium, that can reverse that side effect by attaching themselves to antagonist receptors.

Someone brought up a reminder that federal law prohibits a drug's use by anyone besides the person it was prescribed for. The subject of hospice and unused drugs also came up with one person saying hospice staff should take left over medications while someone else said he was told they belonged to the person's estate. Another person pointed out that there are opioid recovery programs to help people overcome addiction.

When it was said that drugs should be taken as instructed, Weeks said that it is mandatory by state law that a pharmacist must offer a consultation to any customer with a new prescription. The customer can decline it but the pharmacist is suppose to explain the drug and how to take it. A pharmacist can also answer questions about side effects and drug interactions.

WOW is presented by FRHD on the first Thursday of each month to educate local residents on a variety of health issues. Women, as well as men, are invited to the event to socialize, have refreshments before the program and win door prizes afterward. Local businesses and organizations donate food, water and prizes each month. Attendees are asked to contribute items for the Fallbrook Food Pantry.

For more information, contact Pam Knox at [email protected] or (760) 731-9187.

 

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