IBS 2017 online (PH.260.600.

81) Final Essay paper

Name: Debangan Dey

The Opioid Crisis

Being a new-comer in the United States, I didnt know much about the opioid epidemic in the
country. When I first listened to the round table discussion from Harvard School of Public Health
website, I was shocked to learn how a drug abuse, specifically prescription drug abuse, is killing
thousands of people. In 2015, 33000 people died due to opioid abuses, which is more than the
death from car crashes and gun homicides. Just from this fact, we can realize how big a public
health problem it has become in recent years. I was really concerned to see that someone, who
has had a surgery in recent times, might be prescribed opioids by a physician but this might end
up in a completely wrong direction for the patient. I realized that the opioid crisis is becoming an
issue which needs to be addressed for seriously and immediately to prevent thousands of
unfortunate deaths. This is the reason why I decided to pick this topic and wanted to explore
things to write about this issue.

How does a human body become addicted?

First, we have to know what is an addiction and who is an addict. American Psychiatric
Association defines an addict as someone who satisfies at least three criteria out of five

1. Tolerance the need for increasing amount to get the desired effect from a substance
2. Withdrawal uncomfortable or dangerous symptoms upon stopping substance use
3. Loss of control taking more substance than intended over longer period of time
4. Preoccupation spending a great deal time to obtain, use and recover from substance
5. Continuation despite subsequences sacrificing life aspects to crave substance

Now, to find why an addict does these things, we need to know what happens inside his body,
specifically his nervous system. After a decade long research, it was revealed that the
psychoactive substances cause surges in dopamine and other pleasure or reward signaling brain
messengers. Pleasure and reward turn into cravings stored inside a persons memory which
makes him lured by the substance. Also, PET scans revealed some parts of the nervous system to
be unusually active during the period of craving. Even a slightest bit of stimulation can turn on
cravings for a particular substance. Its also now known that persons with inherited or acquired
weak neurological constitution (exposed to stress or trauma) are predisposed to addiction than
neurologically normal people.

Effects on body functions

The opiates leave an adverse effect on a lot of body systems, but mainly on the nervous system.
Depressed respiration caused by opioid intake can decrease the amount of oxygen reaching the
brain and in such way, an occurrence of hypoxia can lead to neurological disorders and even a
comma. Also, people with opioid abuse are more prone to develop depression, anxiety disorders
IBS 2017 online (PH.260.600.81) Final Essay paper

and bi-polar disorders. Other than this, opioid abuse is known to reduce quality of life and induce
plenty of gastro-intestinal, cardiovascular, immune-endocrine system and sleep problems thus
putting the user at 87% higher mortality risk than the non-users in the United States.

The most severe effect happens when someone takes a significantly higher amount of dose than
intended, then the bodys metabolic system cant detoxify the drug and people can die from drug
overdose. Moreover, opioid addiction can leave negative emotional effects on friends, family and
community thus destroying the social life of the user.

What can be done in public health?

As I am currently a graduate student in biostatistics, the first thought came in my mind is running
clinical trials for drugs than can have similar effects as opioids but without the addiction part.
Also, in this era of individualized medicine, we need to find out people who are prone to drug
addiction depending on certain other socio-physical factors and can treat them differently when
they require painkillers. In order to succeed at this, we need a good program for educating
physicians so that they can understand the risks and start prescribing otherwise. The problem is
bigger when we see that people who got addicted from prescription drug for the first time, will
get attracted easily toward the street drug opioids like heroine. We have to see this different
from the criminal aspect and make mental and physical support available to the victims so that
they can successfully complete rehabilitation.

These days, a lot of people are trying to brainstorm something to prevent the prescription drug
abuse. The education of naloxone use at a broad level is the immediate idea to reduce overdose
deaths. I also saw a start-up called Peris creating safe smart pill bottles to restrict the release of
opiate pills as the physician suggested. We can modify it to a extent so that pills can be available
only in such bottles and when a patient tries to break the bottle to take more pills, an alarm will
be raised or the pills will be destroyed. In this way, we can regularize the opioid pill intake and of
course, we need statistical experiments performed before adhering to a new method. I
personally think that this might solve the pill mill problem. We can implement strict legislations
on the pharmaceutical companies to conform to new recommendations.

References:

1. Pfizer (2006): Retrospective on Addiction

2. Harvard School of Public Health (2017): Video - The Opioid Crisis
3. The effect of opiates on the mind and body, retrieved on Sept 4, 2017 from
http://www.rebostreatment.com/effects-opiates-mind-body/
4. Heroin deaths surpass gun homicides for the first time, CDC data shows, By Christopher
Ingraham (https://www.washingtonpost.com/news/wonk/wp/2016/12/08/heroin-
deaths-surpass-gun-homicides-for-the-first-time-cdc-data-
show/?utm_term=.cffab6d33da3)