In short, this is what a council member from Ohio Dan Pickard recommended for anyone who would overdose more than twice. His proposal suggests that authorities should deny ambulance assistance for these patients. The main problem with this idea is that it would literally solve nothing while creating a whole new set of problems.
Let’s have a look at the whole issue from a more encompassing perspective.
In 2015 Ohio led the nation in the number of deaths caused by opioids overdose with 3,050 recorded cases. It represented an increase of 20.5% compared to the year before, when 2,531 people died in the same state and from the same causes – a massive leap and usually one that would call for immediate measures.
In 2016 at least 4,149 people from Ohio died from opioids overdose, which is a further 36% increase from the infamous record of 2015. Not only did the authorities fail to reduce the negative effects, but they actually increased and by a greater margin. Moreover, the aforementioned figure for 2016 is not final, since some coroners still haven’t sent in their overdose reports.
So how is 2017 going along?
Apparently, 2017 already seems destined to surpass the shocking 2016 and in one county the number of deaths has already surpassed the record from the entire previous year. It is clear that the problem is not only here to stay, but that it is getting worse by the day. The most affected counties in Ohio are Cuyahoga, Summit, Lucas, Franklin, Montgomery and Hamilton and the number of deaths in these went up by almost 100% in just one year!
Mind you, Ohio is just the most severe case, but the entire USA has seen a 33% increase in drug overdose deaths in the past five years.
Why is this happening?
When we talk about opioids overdosing, heroin is the easiest to blame. It is a highly addictive drug and very dangerous and if it were the only issue, the proposition of the politician from the beginning of this text would perhaps be a bit more understandable, albeit still unacceptable.
However, what the coroners in the state of Ohio have found is that many of the deaths don’t actually come from heroin overdose, but a medicine called fentanyl. It is an opioid used to treat severe pain, but it comes with a high risk of addiction and it can cause even death in higher dosages. In short, it is 50 times stronger than morphine.
Even more shockingly, they have also found carfentanil, which is an extremely powerful animal tranquilizer which can be deadly for people even in very small dosages. Heroin has always been present, but the sudden soar in opioid deaths seems to come from pain medication.
So, why would drug addicts replace heroin with the likes of fentanyl?
Actually, they are not. Many of the people who are now suffering from opioids addiction started off by using pain medication which got them addicted. Ohio Attorney General Mike DeWine thinks that about 80% of people who are on heroin actually started with painkillers. This is so serious that in 2015 prescribed painkillers, not heroin, were the top reason for overdose deaths.
This is why Dr. Tom Frieden, director of the CDC, said that doctors need to cut down on the amounts of opioids they prescribe. But this brought another problem. Many of these patients are already addicts and even if the dangerous opioids are no longer available to them, be it through reduced prescriptions or higher prices, they turn to heroin and other drugs in order to deal with pain, but also satisfy their addiction. Mind you, the addiction that had developed long before they even tried heroin.
The problem with fentanyl is spreading since, according to Catherine Candinsky and Alan Johnson from The Columbus Dispatch and Dr. Thomas P. Gilson, Cuyahoga County’s medical examiner, drug dealers are now mixing fentanyl with cocaine and heroin and thus introducing it into minority communities. They are doing this because of fentanyl’s high addictiveness.
Just as an example, in 2015 fifteen people died of drug overdose in Allen County. One year later the number went up to 36 and each and every one of those deaths was directly related to fentanyl. Their Coroner Gary R. Beasley said that 14 of the 36 died from fentanyl, while the rest died from mixtures of drugs such as heroin with fentanyl.
Similarly, almost half of 308 opioids related deaths in the Summit County included carfentanil, the mentioned animal tranquilizer.
How did these painkillers become this common?
Believe it or not, this is the most shocking part. Apparently, it was deliberate.
The state of Ohio is suing several pharmaceutical companies claiming that they falsely represented the addictive power of their medication to the patients and even doctors. The mentioned Ohio Attorney General Mike DeWine explained several shocking findings that he and his team are aiming to prove.
First of all, they claim that since the 1990s big pharmaceutical companies have been ‘changing the culture of prescribing’ by approaching primary care physicians (not the experts) and explaining the benefits of these drugs, while misinforming them about the addictiveness.
This resulted in a dramatic change in the way these drugs have been prescribed. Their primary use should have been for patients in the terminal stages of cancer who are looking to relieve severe pain, or the ones who would take one or two pills to deal with acute pain from a surgery of accident, which means that the patients should never have used them on a long-term basis.
However, by misinforming the doctors and patients about the dangers of prolonged usage, they greatly increased the number of prescriptions and brought the issues that we are dealing with today.
Moreover, Mr. DeWine claims that they have done this knowingly. He supports this claim by comparing the information that the doctors were getting from the brochures against the fine print in the prescriptions where the companies were ‘much more honest about acknowledging the dangers’. He also claims that the whole epidemic coincides with a huge increase in the number of prescriptions for pain medication.
And Ohio is not alone in this. West Virginia and Mississippi have also brought similar cases, so it seems that there is somewhat of a consensus regarding the source of the problem.
If all this is true, then it is also understandable why these opioids are pushed as the only option.
We have come to think that side effects are inevitable and in some cases they truly are. However, there are other, non opioid pain relief options which are neglected simply because they can’t be patented.
For example, palmitoylethanolamide is an endogenous fatty acid which has been proven to reduce both pain and inflammation. Moreover, it has been thoroughly tested in numerous medical studies, researched by some of the best names in science including Nobel laureate Rita Levi-Montalcini and proven completely safe. There is no overdose level, no tolerance buildup, no addiction or allergy issues, no confirmed side effects and it is readily available as a medical food.
In fact, the only downside is that the detrimental opioids offer almost immediate relief, while palmitoylethanolamide takes some time for the initial buildup in the body. This might seem like a big problem for people who are experiencing severe pain, but palmitoylethanolamide can be used together with any other drug, including opioids without any negative interactions. This means that you can use it together with opioids for a short time (just like opioids are intended to be used) until the levels of palmitoylethanolamide in the body increase so that it can take over the pain relieving function.
So, are options like palmitoylethanolamide the solution?
Yes and no. For people who are just starting treating pain it is a godsend. Anyone whose only problem is pain can find a safe relief in alternative options such as palmitoylethanolamide. Just make sure you get good quality product.
However, having in mind the whole story above, this is no longer just a pain issue, but more of an addiction one. While pain and pain medications may have started it, that’s not what it is all about now. The opioid issue could have been avoided using non opioid treatments, but now we have a whole new problem on our hands that the authorities need to deal with.
For the people who have succumbed to the opioid epidemic, pain is no longer the biggest problem. All the others can turn to alternative treatment options and help prevent further spreading of the deadly addiction.