Many who attended the recent forums on opioids held throughout the Miami Valley by Your Voice Ohio and this newspaper submitted questions about the epidemic. Here are some of the answers to those questions.
Q: How are the drugs coming into our country?
A variety of ways. Heroin may first enter the country through underground tunnels or in secret compartments hollowed out of car panels or welded into semi-trailer truck frames. At times, a dealer simply schedules a pickup with FedEx and plays the odds that a shipment will make it through.
Sometimes it comes in through a drug courier’s bowels, as mules are paid to carry balloons of heroin over the border on foot or through an airport.
Regardless of how it’s delivered, authorities say most of the heroin purchased in southwest Ohio — and in America today — is trafficked by violent criminal organizations based in one country: Mexico.
“To get a kilo of heroin in the Dayton area five years ago, that was a lot of heroin. Nowadays it’s not,” said Tim Plancon, assistant special agent in charge of DEA’s Ohio Columbus District Office.
Fentanyl — heroin’s more potent cousin, which is responsible for the large spike in deaths in the region seen in 2016 and 2017 — comes mainly through the mail from China.
Chinese authorities place little emphasis on controlling fentanyl production or export because the synthetic opioid is not widely used in China.
The fentanyl is sometimes difficult to trace because it arrives through a range of products that include fentanyl-laced counterfeit prescription drugs like oxycodone.
Authorities say Chinese chemical exporters get around U.S. laws by exploiting unregulated online ordering systems, mislabeling shipments, and modifying banned substances to create yet-illegal substances.
Q: What are the true demographics of the addict population?
Final 2017 overdose numbers including demographic info on those who died aren’t available yet, but the 2016 numbers show the wide range of ages, races and cities affected by the epidemic.
In Montgomery County in 2016, the youngest to die was 2-year-old Lee Hays, who somehow got hold of fentanyl. The oldest was a 79-year-old man. Eighty percent were white; 64 percent were men. Dayton had the most deaths with 162, but people also overdosed and died in 20 other communities including Brookville, Clayton, Miamisburg, Oakwood and Washington Twp.
Q: Why is there not more focus on alternative medicines to opioids?
It has been shown that opioid addictions can start when undergoing treatment for short-term pain. Additionally, the use of opioids during short-term treatment has increased in the past few years.
To avoid the risk of addiction, researchers have explored using tylenol and ibuprofen for pain rather than opiates. A study in the Journal of the American Medical Association found that on patients with broken bones and sprains, acetaminophen and ibuprofen worked as well as opioids at reducing severe pain.
The study notes that a pill combining ibuprofen and acetaminophen affects different pain receptors in the body, and can be highly effective. Pills that combine the two drugs are not yet available in the United States, and it’s also important to note that this study only looked at short-term pain relief in the emergency room.
Using ibuprofen and acetaminophen may not be ideal for long term use, according to Good Rx.
Q: What about medical marijuana?
While using marijuana to treat pain may have less mainstream approval than other treatments, a report by the National Academies of Science, Engineering, and Medicine shows it can be effective in reducing neuropathic pain, a form of chronic pain that can cause damaged nerve endings.
Cannabinoids are seen by many doctors as actually “safer” than prescribing opioids, PBS reports. There are lower rates of addiction, and they don’t affect the brain stem. That means when using cannabis, your breathing and other basic life support functions are not affected, avoiding the risk of fatal overdoses.
Dr. Jordan Tishler, who handled emergency medicine at the Boston VA, states that most patients only need low doses of cannabis to treat chronic pain: “The amount they find relief with is nowhere near what laypeople recommend to each other or what recreational users take.”
Ohio’s medical marijuana program is set to launch later this year.
Q: How do people get hooked on opioids?
A 2013 study examining national-level general population heroin data — including those in and not in treatment — found that nearly 80 percent of heroin users reported using prescription opioids prior to heroin. We also know that roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
When someone suffers from chronic pain, their body is constantly sending pain signals to their brain; which doesn’t allow their body to produce enough natural endorphins. At this point, a doctor would prescribe an opioid medication. Now the opioids and their natural endorphins can both land on their nerve receptors.
Next, the brain cells that have opioid receptors on them gradually become less responsive to the opioid stimulation. Once someone develops a tolerance, withdrawal symptoms begin to occur if a higher dosage is not given. Repeated exposure to escalating doses of opioids alters the brain so that it functions more or less normally when the drugs are present and abnormally when they are not. Therefore, even more opioid intake becomes necessary to produce pleasure comparable to that provided in any previous drug-taking episodes.