Four Opioids Georgia Parents Should Have on Their Radar

It is now a matter of national discussion that the United States is in the grip of an opioid epidemic. A cursory search for the word “opioid” will churn up headline after headline of the dire situation that this country faces. Since 1999 prescriptions for opioids in the US has quadrupled, making us responsible for 90% of the prescription painkiller market. To put that in stark perspective a population that accounts for a little less than 4% of the people on the planet is consuming practically all of some of the most powerful drugs ever created. At the risk of a bad pun, that is a sobering thought.

Georgia has seen some of the worst this epidemic has to offer. In the past ten years emergency rooms in the state have seen a 1,000% increase of opioid related overdoses. In 2014 deaths from opioid overdose surpassed deaths from car crashes. It’s the unfortunate truth that Georgia has borne the brunt of several drug crises. From the cocaine boom of the 80’s, to the wave of heroin in the 90’s, to the current Opioid concern, Georgia’s has had to deal with a lot of drug related problems. This is due in part to Georgia’s location. The black market drug trade makes heavy use of the state’s central location in the south east to distribute to the rest of the country. In communities already inundated with legally obtained prescriptions for opioids there is a constant supply of illegal alternatives.

Raising kids in the atmosphere created by the opioid epidemic can be incredibly difficult. When every news headline blares the message that overdoses are killing hundreds and drug dealers are funneling more and more deadly drugs into the state, it can all seem overwhelming. As a parent it is important to stay informed about the challenges and dangers your kids may be facing on a daily basis, particularly when it comes to their environment. Part of what makes it extra difficult in the cases of opioids is the challenge may not always be the classic “drug dealer in a parking lot” scenario. Opioids may make their way into your child’s hands through completely legitimate means, but even with a prescription they can become a problem. Consider this, one survey found that 80% of heroin users started by taking prescription drugs.

This article will attempt to cut through the noise and give some simple insight into the four most dangerous, or most prevalent, opioids on the market, what these drugs are capable of, how your kids might get them, and touch on some measures you can take to protect your family.

What Are Opioids?

Opioids are the latest additions to the oldest family of pain relief drugs in the world. They are synthesized from the alkaloids present in the opium poppy and are direct descendants to the granddaddy of all pain killers, morphine.

Opioids function in the body essentially as pain inhibitors. The way they achieve this effect is by binding to specialized nerve cells called receptors. Your nervous system has literally thousands of different types of receptors: receptors for tasting food or detecting temperature, receptors for feeling texture or smelling smoke. Receptors are a big part of how you interact with the world. One type of receptor is, believe it or not, called an opioid receptor, a cell that matches the structure of the alkaloid in the opium poppy. This specific chemical structure matches because your body has its own pain relieving molecules called endorphins (literally internal morphine). Endorphins manage your pain response—they’re the reason you don’t pass out every time you stub your toe—and are also instrumental in the reward pathways of your brain, helping to make good things feel good.

So, when a person takes an opioid drug it hijacks the natural communication system in their brain and shuts down their pain response by binding to the receptors normally reserved for endorphins. This has two effects. The first, any pain a person is feeling? That’s killed. The second, the brain releases dopamine, what is sometimes called the “feel good” molecule. This release of dopamine is why people take these drugs recreationally. When taken in high doses or in such a way that the drug enters the blood quickly (like snorting or injecting) the brain creates a massive flood of dopamine in response to the stimuli of the opioid. This is effectively the “high”.

An opioid high can be incredibly intense. It causes feelings of euphoria, numbness, weightlessness, and overall wellbeing. A high can also cause muscle spasms, drooling, loss of consciousness, respiratory or cardiac failure, and, of course, death when the high carries over into overdose. The dopamine rush made by opioids doesn’t come without a price. The brain will notice the imbalance and move to correct it. An opioid user will need to use more of their drug of choice the next time to reach the same level. This cycle of dopamine rush followed by a crash eventually leads to the brain essentially stopping production of dopamine and other endorphins. At this stage the user will need the drugs just to feel normal. This is why opioids are so fearsomely addictive.

Addiction is a mental disorder caused by the chemical imbalance in the brain that these drugs (or any addictive substance) onset. It goes without saying that addiction is not something you want your child to have to deal with. Opioids in particular have dangerous addiction potential, and, because of the newer versions of these drugs appearing on the black market, an opioid addiction can be uniquely life threatening.

The Four Opioids to Keep On Your Radar

Oxycodone: This is the drug that many point to as the prime suspect in the cause of the opioid epidemic. You’re probably more familiar with the brand names associated with the generic oxycodone, that is, Oxycontin, Percocet, and Xolox (among others). These drugs are prescribed to treat moderate to severe pain. They have been ever increasingly prescribed since the start of the new millennium. Recall that prescriptions of opioid pain killers have quadrupled since 1999. Oxycodone accounts for a large portion of that.

You may have a bottle of one or more oxycodone derivatives in your medicine cabinet right now. The danger of these drugs is they are often prescribed for fairly long periods, so patients will often find they develop an opioid dependence without ever using these drugs recreationally. Once a habit is formed, however, they can be incredibly difficult to break. The prohibitive cost of these drugs will in turn cause many unfortunate new addicts to seek out the much cheaper street drug, heroin, to get their fix.

In Georgia’s illicit market, Percocet in particular has become infamous as fake pills have been circulated that actually contain a form of the vastly more powerful fentanyl (more on that later). In June, 2017 in a period of 48 hours 4 people were killed and a further 12 hospitalized by this fake Percocet.

If you or your child is prescribed oxycodone by a doctor there are steps you can take to protect yourselves. Never exceed the recommended dosage. Use the drugs sparingly and for the minimum time required. Ask your doctor for non-opioid alternatives as early as possible. In the case of Percocet, never take any pill that you cannot personally verify came directly from the pharmacy. Use extreme caution.

Hydrocodone: Second to oxycodone only because it is slightly less potent, hydrocodone is another widely prescribed painkiller. You will most likely have encountered it as Vicodin. Have any of your kids had their wisdom teeth pulled? If so, Vicodin was very likely the drug prescribed to ease recovery. Like oxycodone long term use of this drug can lead to dependence and a similar sad trajectory toward heroin use. Again, the high cost and high addiction potential have ensnared many unwitting victims into a full blown opiate addiction.

The safeguards for Vicodin are very much the same as those stated for oxycodone. Don’t be fooled by how common these drugs are, especially since Vicodin has less of a reputation than Oxycontin or Percocet. The dangers inherent in all opioids are present with Vicodin and other forms of hydrocodone.

Methadone: Methadone presents a unique challenge. It is a powerful painkiller originally designed to be used in late stage cancer treatment and in surgery. It has found alternative use for quite some time as a treatment for opioid addiction. It is most famous for being prescribed to heroin addicts trying to treat their addictions. It can be used in this way because it has the same effect of other opioids but lacks the additional release of dopamine, so it will treat pain (as well as withdrawal symptoms) but not necessarily create a high.

Recently Georgia lawmakers made headlines by capping the number of methadone clinics allowed within the state. This is a result of methadone itself being abused like other opioids. Many opioid addicts will point out that the first time they were prescribed these pills was when they were trying to get off heroin which is a sort of inversion of the previous trajectory we touched on above.

If you’re family comes into contact with methadone it may be because you are already dealing with a crisis. Always follow the advice of your doctor and be watchful for telltale behaviors of abuse if your child needs methadone. Explore possible alternatives to pharmacotherapy, support groups like Opioids Anonymous for example. For more information, read how long methadone stays in your system.

Fentanyl: This is the opioid that has been getting the most news attention recently, and that is for a good reason. It is absolutely deadly. It is 100x more powerful than morphine. There are forms of it that can cause an overdose simply by coming into contact with skin. A dose the size of three grains of salt can be enough to kill a person (dependent on how it’s concentrated).

Fentanyl was originally intended for end of life treatment for cancer patients. It was a tool for doctors to make the last days of a terminal patient’s life more comfortable. Since it has made its way onto the illicit market US supplies have been severely curtailed. However, cartel trafficking through Georgia has brought an influx of even more powerful Chinese manufactured fentanyl into the country.

Even more alarming, street-level dealers have begun cutting heroin and other drugs with fentanyl, making incredibly dangerous cocktails of substances. Additionally, one fentanyl analog called archyfentanyl is not only deadly enough to kill through skin contact, it is resistant to the drugs Narcan and Naloxone, drugs used to save someone in the throes of an opioid overdose. The only defense you have against fentanyl is to avoid any black market drugs as the upsurge of fentanyl on the market has caused a crisis in emergency rooms across the state.

Talk with your kids. Explain the very real, the very life threatening danger posed by the introduction of fentanyl to the street market. Since it is very unlikely you will be prescribed fentanyl (as was the case with our previous items) only honest communication and awareness can protect your family from this dangerous drug.

Conclusion

While the threat of opioids is real and the epidemic in Georgia and across the US is nowhere near contained, as a parent sometimes you have to remind yourself to trust your kids. Thankfully there’s some hopeful numbers emerging from surveys done over the past five years that shows opioid use amongst teenagers has been dropping year over year since 2010. Maintaining an open and honest dialogue with your kids about the dangers of drug abuse is one of the most important things you can do.

Finally, if you are faced with a child—or a spouse for that matter—who develops an opioid dependence, remember that it is first and foremost a disease, one that requires treatment and detox, not judgment. The faster the disease is treated the faster your family can move past it. Be aware. Communicate. And be wary.

Sources:

“Stop Opioid Abuse.” FultoncountyGA.gov. 15 Mar. 2019. http://www.fultoncountyga.gov/soa-home

Gurell, Jessica. “Inside Georgia’s Opioid Crisis.” GPB News. 15 Mar. 2019. https://www.gpbnews.org/term/inside-georgias-opioid-crisis

Reevell, Philip. “US Opioid Epidemic: ‘This Is Bigger Than This Town’” BBC News. 8 Nov. 2018. 15 Mar. 2019. https://www.bbc.com/news/world-us-canada-46036629