Doctors, patients, friends and family can take some specific steps to curb the risk of fatal overdoses from heroin and opiate use, say guest columnists Caleb Banta-Green, T. Ron Jackson and Joseph Merrill.
THOUSANDS have become addicted to heroin and prescription-type opiates in recent years in Washington state. In 2010, 570 people died from opiate-involved overdoses (heroin and/or prescription-type) in Washington, up from 188 in 1995.
Heroin use is directly linked to the abuse of prescription-type opiates. Thirty-nine percent of local heroin users report that they were “hooked on” prescription-type opiates before heroin use. We also see this connection geographically as heroin use expands across the state.
As heroin use increases, the average age of those entering treatment has dropped precipitously — from 40 to 29 from 2004 to 2010. These data indicate a substantial addiction problem now and an increasing risk of fatal overdoses into the future.
What can patients do? Prevent unneeded exposure to opiates — do not accept a prescription for opiates from a prescriber unless you’ve had a conversation with him or her about the need for the medications.
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If you do need opiates for acute pain, a broken bone or a dental procedure, do not accept a huge number of pills. A Utah study found that adults accumulate opiate medicine prescribed to them at a rate of 10 percent per year. So, dispose of those unneeded medications appropriately and lock up medications you need to keep in your home.
Doctors can help in many ways. Have those hard conversations with patients about whether opiate medicines are really improving the quality of their life and whether their use might be getting out of control.
Doctors who prescribe potent drugs such as opiates should make regular use of the newly available prescription-monitoring program in Washington in order to find out the complete prescription history of their patients. We need all doctors who write prescriptions for controlled substances to use the monitoring program, not the 30 percent of providers as is typical in other states.
For those whose use of opiates gets out of control and turns to addiction — get drug treatment. Drug treatment works.
Fatal overdoses are a real threat. Overdose is clearly not just a risk for heroin users. Those abusing prescription opiates are also at risk for overdose. Some patients taking opiates as prescribed may also be at risk, particularly if they are on high doses or take other medications such as Valium or Xanax, drink alcohol or use other drugs. Three quarters of deaths involving opiates also involve alcohol, other medicines or other drugs. Combining drugs is dangerous.
If you or someone you love uses opiates, you need to know how to prevent, recognize and intervene in an overdose. The 911 Good Samaritan Law provides immunity from drug possession charges for those who have an overdose and those who seek medical aid during overdoses. Call 911 if you suspect an overdose; quick help can save a life.
The 2010 law also made it legal to prescribe an opiate antidote (naloxone) to potential overdose victims and to those who might be nearby. More than 10,000 overdoses have been reversed across the U.S. with naloxone given by bystanders. Encourage your medical providers to prescribe this medication, your pharmacies to stock it and insurers to pay for it.
Opiates are not a problem unique to Washington. Interventions, however, need to be local. Take action. It’s up to all of us to protect ourselves, our families and our communities.
Caleb Banta-Green is a research scientist at the University of Washington’s Alcohol and Drug Abuse Institute and an affiliate assistant professor with the UW School of Public Health and Community Medicine. T. Ron Jackson is the executive director of Evergreen Treatment Services and an affiliate professor at the UW School of Social Work. Joseph Merrill is a physician at the Harborview Medical Center and a clinical assistant professor at the UW School of Medicine.