Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



PHYSICIANS: JOIN ECMS                  PUBLIC: FIND A PHYSICIAN

 

 

 

 

 

11:07 AM
August 21st, 2017

Narcotics Addiction and Overdose

Narcotics Addiction and Overdose

The Erie County Medical Society shares the deep concern and sadness of the community locally and broadly over the recent surge in narcotics related deaths. This surge is superimposed on the steadily climbing number of such deaths over recent years.

 

One factor contributing to the recent increase may be the emergence into availability of heroin forms that can be snorted or smoked instead of injected intravenously. First, this presents a less repulsive method of administration than intravenous injection. Second, it caters to the mistaken illusion that the drug is less dangerous when snorted or smoked than when injected.

 

While no “magic bullet” currently exists, progress toward the solution of the problem begins with understanding. Accordingly, we present this information to enhance understanding of the disease.

 

Scope of Problem

The year 2014 witnessed 47,055 drug overdose deaths in the US compared with 32,675 traffic accident deaths. These data are from the US Centers for Disease Control and the US Department of Transportation, respectively. Meanwhile,

here in Erie County, Pennsylvania, drug-related deaths rose 61% from 59 in 2015 to 95 in 2016.

 

Fentanyl has become a major factor in drug overdose deaths. Fentanyl is either legally manufactured but illegally obtained, or illegally manufactured and obtained. Fentanyl-related deaths increased 80% in 2014.

 

Internationally, the US is hit especially hard by opioid abuse. Americans constitute less than 5% of the world’s population, but consume 80% of the world’s opioids. Americans consume 99% of the world’s supply of hydrocodone, the active ingredient of VicodinTM. Finally, Americans consume two-thirds of the world’s illegal drugs.

 

Causes of Opioid Dependence

Opioid dependence is a disorder with pharmacologic, genetic, social, and psychodynamic causes. It is a true medical problem, not a moral failing or personality shortcoming.

 

Pharmacologic factors weigh heavily in opioid addiction. Certainly, drugs other than opioids have significant addiction potential; but, opioids, with their rapid development of physical dependence and their severe protracted abstinence syndrome, make abstinence especially difficult.

 

Genetic factors also contribute. There is a high degree of heritable vulnerability for opioid dependence. Gene polymorphisms for receptors for dopamine, serotonin, and other neurotransmitters also seem associated with opioid dependence vulnerability. Perhaps future medications can be designed to take advantage of these genetic factors.

 

Psychopathologic diagnoses seem to factor in. Preexisting mental health diagnoses seem to increase risk for long-term opioid use among adolescents with chronic pain.

 

Social factors have notable influence as indicated by the high rate of drug use in areas with poor parental functioning, high crime, and high unemployment.

 

Signs of Opioid Abuse

Opioid abuse is evidenced by any two of the following signs occurring within a 12-month period.

  1. Taking larger amounts than intended.
  2. Unsuccessful efforts to reduce use.
  3. Spending substantial time and activity related to opioids.
  4. Craving opioids.
  5. Failure to fulfill obligations of home, work, or school.
  6. Continuing opioid use despite opioid-related problems.
  7. Relinquishing social and other interests because of opioid use.
  8. Continuing opioid-related activities when those activities present a physical hazard.
  9. Tolerance and withdrawal, except when the opioids are used exclusively for medical reasons and under close medical supervision.

Tolerance, Withdrawal, and Addiction

Tolerance, withdrawal, and addiction are three separate entities. They are not just different ways of saying “addiction.”

 

Tolerance is the requirement for increased doses of the drug to achieve the same effect. Thus, increasing doses of the drug are needed to induce the same euphoria.

 

Withdrawal is the occurrence of symptoms on abrupt cessation of the drug. The onset and duration vary with the drug. Heroin withdrawal symptoms tend to peak in 36-72 hours and last 7-14 days.

 

The symptoms of withdrawal are typically diarrhea, runny nose, nausea, “gooseflesh,” restlessness, tremors, abdominal cramping, muscle aches, and craving for the drug.

 

Addiction consists of drug craving, compulsive use, and strong tendency to relapse after withdrawal.

 

Toxicity

At some unspecified point, the side effects of opioid use turn into toxicity. The typical side effects are small pupils, loss of appetite, sleep disturbances, and constipation. As side effects become toxicity, blood pressure may fall, stupor develops (sometimes to the point of unresponsiveness), and respirations slow (sometimes to the point of stopping).

 

Toxicity Treatment

Clearly, respiratory insufficiency is an emergency, as inadequate respirations lead to death or irreversible brain damage in only a few minutes. The treatment is to begin artificial respiration and reverse the opioid.

 

The principal opioid reversal agent is naloxone. At one time, this medication was supplied only in glass ampoules for professional use. The ampoules had to be broken open and the medication drawn into a syringe and subsequently injected into a flowing IV line. Administration systems for this medication have been redesigned to be more user-friendly so that the lay public can utilize them in an emergency situation.

 

In 2014, the FDA approved a naloxone autoinjector for home use by family members and caregivers. The device is designed for use on the outer thigh, through clothing. It has no visible needle, contains two doses of naloxone, and comes with voice prompts that begin playing as soon as it is removed from the box. A trainer mock-up allows the potential user to acquire the “feel” of the device without actually administering any medication.

 

In 2015, the FDA approved naloxone for intranasal spray. This permits bystander rescue by simply spraying half the naloxone charge into each nostril of an unresponsive patient.

 

A shortcoming of these two rescue technologies is the short duration of the reversal medication, naloxone. The reversal dissipates quickly and the respiratory depressant effect of the opioid reestablishes itself. The temporary reversal of the opioid requires subsequent transportation to the emergency department (ED) to preclude subsequent respiratory re-arrest. The newly revived patient sometimes refuses such transportation for fear of being put into a situation where the craved opioids are unavailable.

 

Addiction Treatment

 

Addiction treatment is a different matter from toxicity treatment. Toxicity treatment involves the emergency treatment of respiratory arrest. Addiction treatment is less emergent but more complicated.

 

The goals of addiction treatment are

  1. Ameliorating withdrawal symptoms
  2. Reducing cravings
  3. Reducing needle sharing and promiscuous behavior leading to the spread of other diseases as HIV and hepatitis
  4. Reducing relapse rates 
  5. Reducing drug diversionMaintaining longer abstinence

 

  • The general outline of addiction treatment is
    1. Switch the patient from short-acting opioids to longer-acting opioids. This reduces the “rush” of the rapid opioid onset and the “withdrawal” of the rapid opioid offset. It also reduces target drug craving and replaces the more dangerous target drugs with drugs having a broader margin of safety.
    2. Switch the patient to opioids of a different form, such as subcutaneous implants, that cannot easily be diverted to street sale.
    3. Switch the patient to oral opioids combined with opioid reversal agents that are effective intravenously but not orally. This reduces the risk of these drugs being diverted to intravenous use for the attainment of a “rush.”  
    4. Slowly taper the substituted opioid to reduce withdrawal and craving.
    5. Add adjuvants as clonidine and COMT inhibitors to prolong abstinence and reduce cravings.
    6. Reduce stress with propranolol to reduce the risk of relapse.
    7. Begin cognitive behavioral therapy to help identify and avoid situations conducive to relapse.
    8. Recognize that detoxification alone is not sufficient to effect long-term abstinence.
    9. Institute group therapy to help minimize the social stigma of having lost the ability to control one’s behavior with respect to a substance.
  • Things You Need to Know

    1. Even after prolonged recovery, it is never possible to use the target substance in a controlled manner.
    2. Treatment alone is hardly ever successful without rehabilitation.
    3. Will power is not enough.
    4. Relapse during recovery is not unusual and could be a valuable experience.
    5. Dysphoria, or unpleasant mood effect after abstinence, is the main reason for relapse.
    6. Even after long abstinence, it is necessary to avoid high-risk situations.
    7. A major aid to abstinence is Narcotics Anonymous.
    8. Friends and family must be compassionate but assertive and resist the urge to engage in enabling behavior with the patient.
    9. Finally, remember that addiction is a disease, not a character flaw or moral shortcoming. Addicted patients deserve the attention and respect of the healthcare delivery system.
  • Sources

  • The primary reference here is Dixon and Xiong, which provides much useful information, but is written at a technical level. I have reformulated some of the information to make it more available to the general public.

     

    Dixon, D., DO, & Xiong, G., MD. (2017, May 03). Opioid Abuse. Retrieved May 31, 2017, from http://emedicine.medscape.com/article/287790-overview

     

    Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M. (2016). Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR. Morbidity and Mortality Weekly Report,64(50-51), 1378-1382. doi:10.15585/mmwr.mm6450a3

 

 Thomas Falasca, DO

This video is a narcotics overdose case from Saint Paul's Emergency Room in British Columbia

Narcotics Addiction and Overdose

The Erie County Medical Society shares the deep concern and sadness of the community locally and broadly over the rec ...See More


Narcotics Addiction and Overdose

Narcotics Addiction and Overdose

The Erie County Medical Society shares the deep concern and sadness of the community locally and broadly over the recent surge in narcotics related deaths. This surge is superimposed on the steadily climbing number of such deaths over recent years.

 

One factor contributing to the recent increase may be the emergence into availability of heroin forms that can be snorted or smoked instead of injected intravenously. First, this presents a less repulsive method of administration than intravenous injection. Second, it caters to the mistaken illusion that the drug is less dangerous when snorted or smoked than when injected.

 

While no “magic bullet” currently exists, progress toward the solution of the problem begins with understanding. Accordingly, we present this information to enhance understanding of the disease.

 

Scope of Problem

The year 2014 witnessed 47,055 drug overdose deaths in the US compared with 32,675 traffic accident deaths. These data are from the US Centers for Disease Control and the US Department of Transportation, respectively. Meanwhile,

here in Erie County, Pennsylvania, drug-related deaths rose 61% from 59 in 2015 to 95 in 2016.

 

Fentanyl has become a major factor in drug overdose deaths. Fentanyl is either legally manufactured but illegally obtained, or illegally manufactured and obtained. Fentanyl-related deaths increased 80% in 2014.

 

Internationally, the US is hit especially hard by opioid abuse. Americans constitute less than 5% of the world’s population, but consume 80% of the world’s opioids. Americans consume 99% of the world’s supply of hydrocodone, the active ingredient of VicodinTM. Finally, Americans consume two-thirds of the world’s illegal drugs.

 

Causes of Opioid Dependence

Opioid dependence is a disorder with pharmacologic, genetic, social, and psychodynamic causes. It is a true medical problem, not a moral failing or personality shortcoming.

 

Pharmacologic factors weigh heavily in opioid addiction. Certainly, drugs other than opioids have significant addiction potential; but, opioids, with their rapid development of physical dependence and their severe protracted abstinence syndrome, make abstinence especially difficult.

 

Genetic factors also contribute. There is a high degree of heritable vulnerability for opioid dependence. Gene polymorphisms for receptors for dopamine, serotonin, and other neurotransmitters also seem associated with opioid dependence vulnerability. Perhaps future medications can be designed to take advantage of these genetic factors.

 

Psychopathologic diagnoses seem to factor in. Preexisting mental health diagnoses seem to increase risk for long-term opioid use among adolescents with chronic pain.

 

Social factors have notable influence as indicated by the high rate of drug use in areas with poor parental functioning, high crime, and high unemployment.

 

Signs of Opioid Abuse

Opioid abuse is evidenced by any two of the following signs occurring within a 12-month period.

  1. Taking larger amounts than intended.
  2. Unsuccessful efforts to reduce use.
  3. Spending substantial time and activity related to opioids.
  4. Craving opioids.
  5. Failure to fulfill obligations of home, work, or school.
  6. Continuing opioid use despite opioid-related problems.
  7. Relinquishing social and other interests because of opioid use.
  8. Continuing opioid-related activities when those activities present a physical hazard.
  9. Tolerance and withdrawal, except when the opioids are used exclusively for medical reasons and under close medical supervision.

Tolerance, Withdrawal, and Addiction

Tolerance, withdrawal, and addiction are three separate entities. They are not just different ways of saying “addiction.”

 

Tolerance is the requirement for increased doses of the drug to achieve the same effect. Thus, increasing doses of the drug are needed to induce the same euphoria.

 

Withdrawal is the occurrence of symptoms on abrupt cessation of the drug. The onset and duration vary with the drug. Heroin withdrawal symptoms tend to peak in 36-72 hours and last 7-14 days.

 

The symptoms of withdrawal are typically diarrhea, runny nose, nausea, “gooseflesh,” restlessness, tremors, abdominal cramping, muscle aches, and craving for the drug.

 

Addiction consists of drug craving, compulsive use, and strong tendency to relapse after withdrawal.

 

Toxicity

At some unspecified point, the side effects of opioid use turn into toxicity. The typical side effects are small pupils, loss of appetite, sleep disturbances, and constipation. As side effects become toxicity, blood pressure may fall, stupor develops (sometimes to the point of unresponsiveness), and respirations slow (sometimes to the point of stopping).

 

Toxicity Treatment

Clearly, respiratory insufficiency is an emergency, as inadequate respirations lead to death or irreversible brain damage in only a few minutes. The treatment is to begin artificial respiration and reverse the opioid.

 

The principal opioid reversal agent is naloxone. At one time, this medication was supplied only in glass ampoules for professional use. The ampoules had to be broken open and the medication drawn into a syringe and subsequently injected into a flowing IV line. Administration systems for this medication have been redesigned to be more user-friendly so that the lay public can utilize them in an emergency situation.

 

In 2014, the FDA approved a naloxone autoinjector for home use by family members and caregivers. The device is designed for use on the outer thigh, through clothing. It has no visible needle, contains two doses of naloxone, and comes with voice prompts that begin playing as soon as it is removed from the box. A trainer mock-up allows the potential user to acquire the “feel” of the device without actually administering any medication.

 

In 2015, the FDA approved naloxone for intranasal spray. This permits bystander rescue by simply spraying half the naloxone charge into each nostril of an unresponsive patient.

 

A shortcoming of these two rescue technologies is the short duration of the reversal medication, naloxone. The reversal dissipates quickly and the respiratory depressant effect of the opioid reestablishes itself. The temporary reversal of the opioid requires subsequent transportation to the emergency department (ED) to preclude subsequent respiratory re-arrest. The newly revived patient sometimes refuses such transportation for fear of being put into a situation where the craved opioids are unavailable.

 

Addiction Treatment

 

Addiction treatment is a different matter from toxicity treatment. Toxicity treatment involves the emergency treatment of respiratory arrest. Addiction treatment is less emergent but more complicated.

 

The goals of addiction treatment are

  1. Ameliorating withdrawal symptoms
  2. Reducing cravings
  3. Reducing needle sharing and promiscuous behavior leading to the spread of other diseases as HIV and hepatitis
  4. Reducing relapse rates 
  5. Reducing drug diversionMaintaining longer abstinence

 

 

 Thomas Falasca, DO

This video is a narcotics overdose case from Saint Paul's Emergency Room in British Columbia

Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, l ...See More


Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, lunches, starting school, homework/study habits, and hygiene. Here are some helpful tips on how you can promote a healthier, happier school year.

 

Backpacks

  • Backpacks should have wide, padded shoulder straps and a padded back.
    The backpack should never weight more than 10-20% of the child’s weight.
    Both shoulder straps should be used so as not to produce uneven strain on either side of the back.
    Heavier items should be arranged close to the midline of the back.
    Do not ignore back pain in a child.
    If a child develops back pain that doesn’t improve, consider a second set of textbooks to keep at home.

 

Lunches

  • Consult school menus and consider packing a lunch on days when the menu includes items that your child doesn’t eat.
    Remember that a typical 12-ounce soft drink contains 10 teaspoons of sugar and 150 calories. Drinking just one can daily increases your child’s risk of obesity by 60%.

 

For Children Starting School

  • Answer any questions about school before classes begin.
    Introduce children to their school and, if possible, to their teacher, in advance.
    If possible, introduce them to classmates before the school year begins.
    Spend time talking with children about what happened in school.
    Make morning preparation as stress-free as possible by laying out books and clothes the night before.
    Let the child know that is normal to be a little anxious about starting school Assign a permanent workspace conducive to doing homework.

 

Homework and Study Habits

  • Schedule enough time for homework.
    Consider prohibiting TV and similar distractions during homework time.
    Supervise computer and internet use.
    Be available for consultation during homework time but do not do the child’s homework.

 

Hygiene

  • Stress hand washing before eating and after using the toilet,blowing the nose, tying the shoes, or playing outside.
    Handwashing should continue for as long as it takes to sing the “Happy Birthday Song” twice.
    Give the child an alcohol-based hand sanitizer to use whenever washing is unavailable and after using shared computers, pencil sharpeners, or other community objects.
    Remind the child to keep hands away from eyes and out of mouth.
    Stress the importance of not sharing food, water bottles, or other personal items.

 

So, with these tips in mind, the school year should bring peace of mind to the adults and new growth to the children.

 

Thomas Falasca, DO

 

 

For More Information Please Visit

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org/page.ww?name=Starting+School&section=Facts+for+Families

 

American Academy of Orthopedic Surgeons
http://orthoinfo.aaos.org/topic.cfm?topic=A00043

 

American Academy of Pediatrics: Back to School Tips http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Back-to-School-Tips.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%253a+No+local+token

 

American Psychiatric Association
http://www.healthyminds.org/More-Info-For/Children/ABCs-of-Starting-School.aspx

 

Mayo Clinic
http://www.mayoclinic.com/health/childrens-conditions/CC00059/NSECTIONGROUP=2

Famous People with Diabetes

Diabetes is a disease that does not discriminate among its victims. It affects people that ...See More


Famous People with Diabetes

 

 

Famous People with Diabetes

 

 

Do you know someone with diabetes? Chances are that you do. Diabetes is a disease that does not discriminate among its victims. It affects people that are female and male; Caucasian, African, and Asian; rich and poor; ordinary and famous.

 

These are some of the more famous people afflicted with diabetes.

 

       Yuri Andropov - Soviet politician

       Thomas Edison – American inventor

       Yuri Andropov – Soviet politician

  •        Ray Kroc – creator of McDonald’s
    •        James Farmer – American civil rights leader
  •        Mikhail Gorbachev – Soviet politician
  •        Fiorello LaGuardia – New York City depression-era mayor
  •        Ty Cobb – American baseball player
  •        Joe Frazier – American boxing champion
  •        Billie Jean King – American tennis player
  •        Ron Santo – American baseball player
  •        Sugar Ray Robinson – American boxing champion
  •        Jackie Robinson – American baseball player
  •        Dick Clark – American emcee
  •        Della Reese – American singer
  •        Ella Fitzgerald – American singer
  •        Mary Tyler Moore – American actress
  •        James Cagney – American actor
  •        Miles Davis – American jazz musician
  •        Bo Diddley – American rhythm and blues musician
  •        Halle Berry – American actress
  •        Tony Bennett – American jazz singer
  •        Jerry Lewis – American comedian
  •        James Brown – American musician
  •        Elvis Presley – American musician
  •        Wilford Brimley – American actor
  •        Luther Vandross – American singer and songwriter
  •        Larry King – American talk show host
  •        Johnny Cash – American musician
  •        Ernest Hemingway – American Nobel Prize winning author
  •        Mario Puzzo – American author
  •        Anne Rice – American author
  •        Paul Cezanne – French impressionist painter
  •        H. G. Wells – English author
  •        Delta Burke – American actress
  •        Paula Deen – American chef
  •        Patti LaBelle – American singer
  •        Paul Sorvino – American actor
  •        Vanessa Williams – American actress and singer
  •        Jay Cutler – American football player
  •        Aretha Franklin – American singer
  •        Theresa May – British politician
  •        Mike Huckabee – American politician
  •        B. B. King – American singer and songwriter

 

These are some of the amazing people who have also had to deal with diabetes and who have blessed our lives with their achievement and inspiration.

 

Thomas Falasca, DO

See More

Drug Overdose from St. Paul's ER

2017-06-02 03:47:42

Inside St. Paul’s ER: Front Line of the Overdose Crisis ...

Narcotic Addiction and Death - Tim Pelkowski, MD

2017-06-13 03:15:27

Narcotic Addiction and Death ...

Secondhand Smoke from Canadian Government

2017-06-13 03:15:27

Info on secondhand smoke from the Canadian Government. ...

Secondhand Smoke - Dr. Thomas Falasca

2017-06-13 03:15:27

Secondhand Smoke - Dr. Thomas Falasca ...