Dr. Joanne Magro “The Power of the Stiletto.” News Column (04)

Edition Four- Week Four; News Column:

Written by: Dr. Joanne Magro 

Dr. Joanne Magro: The OPIOID Epidemic

A Written Introduction: Dr. Joanne Magro and Her Experience in The Field Working the Emergency-Room

“So, let’s switch gears for a bit and discuss what I refer to as “the elephant in the room”. This article is strictly based on a topic that is near and dear to me, Addiction, or shall I say “the abuse of illicit substances” to limit stigmatizing language. At this juncture Addiction plays a role in everyone’s life in some capacity. It surely does not imply that you the reader has a
substance use disorder, but rather everyone out there knows or has an affiliation with an individual that have impacted their life. It has become the “way of the world”. I always say.

“No one woke up one day and spoke. “Oh…I think I’d like to be an addict”. What one must consider is that ‘Addiction” does not discriminate. It does not see color, gender, race, or ethnicity. Everyone is vulnerable to this disease. This is a very heavy topic and deserves more attention than it’s being given right now.

In this article I would like to touch on “The Opioid Epidemic” as having been an Emergency Room physician for most of my career each shift was becoming more and more cumbersome as the number of fatal overdoses that were flooding our Emergency Department was overwhelming and downright devastating to us and our peers. This topic needs to be addressed as our youth are dying at the hands of this epidemic every minute of every day. This article is not intended to give my readers advice on treatment modalities yet rather give an understanding of the devastation we see across this country.”

Dr. Joanne Magro explains to us the details regarding this ongoing epidemic. This written piece serves as an introduction to the topic in question.

What is the Opioid Epidemic?
The opioid epidemic is an ongoing public health crisis that has affected millions of people in the United States over the past two decades. Officially declared a Public Health Emergency by the U.S Department of Health and Human Services (HHS) in 2017, the epidemic has claimed the lives of hundreds of thousands of Americans. While the roots of the epidemic are complex, many agree that its origin can be traced to the late 1990s when the increased availability of prescription opioid pain killers led to a spike in opioid use disorder, a pattern of opioid use leading to “impairment or distress”. In some cases, the disorder can lead to overdose and death.

Opiates, opioids, narcotics: what’s the difference?
Opioids are a broad category of drugs that interact with receptors in the brain to interfere with or dampen pain. They include both prescription medications such as oxycodone, hydrocodone, codeine, morphine, and illegal substances such as heroin and fentanyl. The term opiates refer only to naturally derived opioids including heroin, morphine, and codeine.

The term narcotics originally indicated any substance that “dulled the senses and relieved pain”. While some people still use the term to all illegal drugs, “opioid” is now the preferred term for both legal and illegal substances.

The Four Waves: how opioid use became an epidemic:
Over its history, the opioid epidemic has moved through four phases, or “waves”. These waves are overlapping, creating epidemics within epidemics. The first wave of the opioid epidemic began in the 1990s with an increase in opioid prescriptions, which included natural and semi-synthetic compounds. Physicians prescribed medication for non-cancer related pain as well as for chronic pain, creating greater opportunities for addiction. The most commonly prescribed opioids included oxycodone and hydrocodone. Also known as OxyContin and Vicodin. Oxycontin in particular, released by Purdue Pharma in 1995, was marketed as a less-addictive, milder form of opioid. The aftermath of the first wave manifested in the doubling of the rate of opioid-related deaths in the U.S. from 1999 to
2010.

The second wave extended from 2010 through 2013 and was marked by a rapid increase in overdose heroin deaths. It’s believed that one major contributor to the increase was the effort to curb prescription-related overdoses, which led to a large population of people dependent on prescription opioids to take up heroin as an alternative. Heroin, a highly addictive drug made from morphine, is dangerous on its own. When used in conjunction with other drugs, or alcohol, its danger is multiplied. From 2002 to 2013, rates of overdoses by heroin nearly quadrupled in the US. The second wave was prompted by the heroin market, which “expanded to attract already addicted people”.

The third wave began in 2013 and was characterized by an increase in overdose deaths from synthetic opioids, particularly fentanyl. Fentanyl is 50 to 100 times more potent than morphine. While fentanyl is occasionally used in health systems for surgical procedures, fentanyl-related overdoses primarily occur from illegal forms of the drug, The latest phase of the opioid epidemic, the fourth wave, is still ongoing. It’s distinguished
by the increased use of multiple substances at once, specifically, the combined use of cocaine or methamphetamine plus fentanyl. This was exacerbated by the Covid-19 pandemic, during which time opioids increased, with 80,411 overdose deaths recorded in 2021 accounting for 75% of all overdoses.

For the first time since the Civil War, opioid overdose deaths did not “move” into the rural areas, but a new independent outbreak began in rural areas until the death rate exceeded those in urban areas. This was the result of overprescribing semisynthetic opioids. Every time a new wave of opioids would sweep America, it would cause an acceleration, but urban areas and rural areas were not in sync until the fourth wave.

Who is affected by the crisis?
The CDC States that Unintentional Drug Overdose Reporting System reported 51,435 total overdose deaths in 2022. Males are more likely than females to die of a drug overdose, as are people aged 35-44. American Indian/Native and Non-Hispanic have the highest death by drug overdose rate by race/ ethnicity.

Tackling the Opioid Epidemic

Dozens of organizations and hundreds of researchers across the country have been working to understand and address the epidemic. Public health officials have turned to “harm reduction” which I will explain the meaning of at a later time approaches to combat the opioid crisis. We’ll be talking about this and more in our upcoming series of articles with a focus on the opioid crisis and what “we” can do as a community as well as other substances of abuse.

“The Doctor Joanne Magro Foundation for Physician Health and Wellness”/ jmagromd@gmail.com and Peer Support Specialist for Addiction Recovery and Support Community Outreach/ jmagromd@gmail.com.

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What topics would you like to read next by authorship of Dr. Joanne Magro in the upcoming edition of her column? Leave your comments below!