A day in the life of the City of Pittsburgh on December 15, 2016, as reported yesterday by Rich Lord in the Pittsburgh Post-Gazette:
- Four emergency responses to overdoses from opioids in Pittsburgh; four more in the adjacent, but much smaller city of Washington, PA:
The overdoses come in waves, said Chief Farrow. “If it’s a strong version of heroin laced with anything, people tend to overdose rather quickly,” he said. “We can get four or five of them in an hour.”
- 31 addicts at one full detox facility:
This is the slow time. People postpone the decision to go into treatment, or to nudge a loved-one into rehab, until after the holidays. By the second week of January, if history is any guide, demand will surge.
- 10 police complaints filed by Pittsburgh police officers involving opioids, including heroin, and involving one student at a prestigious university:
A Carnegie Mellon University student, age 20, spent Dec. 15 in custody for drug delivery counts.
The afternoon before, CMU police responded to a medical assistance call, and found a different student, referred to as John Doe, suffering “abdominal pains” after taking five oxycodone pills, according to an affidavit. “John Doe” revealed that the pills came from the 20-year-old student, that they’d arranged the purchase via text messages, made the payments through PayPal and done the handoff on Margaret Morrison Street.
The accused student told police that he was selling pills he’d gotten after surgery, according to the police affidavit
- 26 preliminary hearings at Pittsburgh Municipal Court and three federal court cases related to heroin charges:
The heroin defendants’ ages ranged from 19 to 62. Nine were women. All were arrested in the city. Their home addresses included Atlasburg in Washington County, Beechview, Bloomfield, Brackenridge, Bridgeville, Carnegie, Carrick, Castle Shannon, Duquesne, Ford City, the Hill District, Lawrenceville, Leechburg, McKees Rocks, McKeesport, Millvale, Perry South, Ross, Sheraden and Spring Hill.
The stamp bags police reported seizing from those 26 defendants were branded with the names A+, Ass Up, Black Jack, Bobby Brown, Dope Boyz, Gucci, Horse Power, K.O., Killing Time, Love, Old School, Panda, Passion, Power, PS4, Quick Stop, Real G4 Life, Scorpion, Tuff Stuff and Zip Em Up. Some were decorated with images of footballs, boxing gloves or a thumbs-up.
- 10 newborn babies in withdrawal:
Sometimes there are two, other times a dozen, but babies born opioid-dependent are “a constant issue” in the Magee-Womens Hospital of UPMC maternity ward, according to Richard Beigi, the Oakland hospital’s chief medical officer.
On Dec. 15, there were eight such babies, and this year Magee has seen close to 500 pregnant women who were using opioid rehabilitation medicines like methadone or buprenorphine, or actively using painkillers or heroin, Dr. Beigi said. “That’s maybe six or seven percent” of pregnant patients, he said.
Physicians’ prescribing practices certainly deserve a good part of the blame for the increasing public health and social devastation arising from America’s opioid epidemic. In another article in yesterday’s Pittsburgh Post-Gazette, Lord says federal authorities are requiring physicians who prescribe narcotics and other controlled medications (like pediatricians prescribing ADHD stimulants) to check an electronic database for a list of “frequent flyers”:
The “list” is actually the state’s drug monitoring program, a database of controlled substances purchases, fully implemented in August. The main goal is to help physicians to recognize patients that are “doctor shopping” for narcotics that they might abuse or sell. At year’s end, doctors will be required by law to check the database every time they prescribe an opioid or a benzodiazepine tranquilizer.
The database will also be used to investigate “rogue” prescribers, said Gary Tuggle, special agent in charge of the Drug Enforcement Administration in Pennsylvania. That has made some doctors cautious, he said. “It has affected the discussion in the examining room.”
But Maia Szalavitz writes in Scientific American that the opioid epidemic, which she says is killing 29,000 Americans annually, is due to illicit drug use and not prescription meds:
You’ve probably read that 80 percent of heroin users started with prescription medications—and you may have seen billboards that compare giving pain medication to children to giving them heroin. You have probably also heard and seen media stories of people with addiction who blame their problem on medical use.
But the simple reality is this: According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer.
And 90 percent of all addictions—no matter what the drug—start in the adolescent and young adult years. Typically, young people who misuse prescription opioids are heavy users of alcohol and other drugs. This type of drug use, not medical treatment with opioids, is by far the greatest risk factor for opioid addiction, according to a study by Richard Miech of the University of Michigan and his colleagues.
In order to reduce addiction to opioids, Szalavitz says, “we have to target the real risk factors for it: child trauma, mental illness and unemployment”:
Two thirds of people with opioid addictions have had at least one severely traumatic childhood experience, and the greater your exposure to different types of trauma, the higher the risk becomes. We need to help abused, neglected and otherwise traumatized children before they turn to drugs for self-medication when they hit their teens.
Further, at least half of people with opioid addictions also have a mental illness or personality disorder. The precursors to these problems are often evident in childhood, too.
The solutions to the problem of opioid addiction, as well solutions to so many other of society’s maladies, begins not by reacting to the behavior of the adults, but rather, by paying attention to the lives of our children:
Many people would prefer it if we could solve addiction problems by busting dealers and cracking down on doctors. The reality, however, is that as long as there is distress and despair, some people are going to seek chemical ways to feel better. Only when we can steer them towards healthier—or at least, less harmful—ways of self-medication, and only when we reach children before they develop this type of desperation, will we be able to reduce addiction and the problems that come with it.
We’ve discussed the opioid epidemic previously on The PediaBlog here and here.
(Back pat: John Duffy, PT)