An epidemic within a pandemic
Ryan Kroh would have been 30 this year. In 2010, he passed away from an opioid overdose.
By Terri Kroh, PharmD
Edited by Rebekkah Ranallo
It is hard to think of a more stressful event than this pandemic. COVID-19 has pushed us into feelings of fear, anxiety, and uncertainty. It has cut off many of our needed opportunities for human connections, and for many, caused an increase of mental health issues, suicide risk, drug use, and drug overdose.
While COVID-19 is at the forefront, it is not the only health crisis we are experiencing. I am not saying this to minimize its effects. However, statistically, we have all had our lives impacted by drug use in some way. You may have lost a loved one to a drug overdose, know a friend who has, or perhaps you struggle with drug use yourself. As the cases of coronavirus climb in the U.S., we cannot ignore the number of drug overdose deaths that also continue to rise.
In this time of uncertainty, we must come together to empower those struggling with substance abuse disorder and acknowledge that the opioid epidemic is ongoing regardless of minimal media coverage around the subject. When the COVID-19 pandemic began, the opioid epidemic never stopped.
Addiction is defined as a disease of isolation. It is often combined with mental health challenges. The opioid epidemic has taken the lives of 537,577 of our friends and loved ones in the past three decades. Experts fear the numbers will continue to increase due to the pandemic’s residual effects.
Recent data released from the CDC reports that opioid overdose deaths increased by 4.8% in 2019, claiming 70,980 lives. Evidence reported from the Overdose Detection Mapping Application (ADMAP) showed drug overdose increased by 42% in May 2020 compared to May 2019.
Recovery is not a one size fits all approach
As International Overdose Awareness Day approaches, I reflect on my son’s life. August 10th marked 10 years since my son died of an opioid drug overdose. Yes, I’ll be hanging my purple ribbons in honor of my son’s life and so many others. But I am also compelled to remind you how important it is to learn how to recognize and respond to a drug overdose. What is your opioid overdose safety and prevention plan?
We can prevent drug overdose by increasing access to harm reduction services, ensuring a safe supply, and providing access to mental health services. Drug overdose does not discriminate, and now more than ever, it is crucial to have a safety plan. All individuals who use, misuse, or abuse an opioid medication (or know someone who does!) should have a prescription for naloxone as part of their overdose safety prevention plan. Naloxone reverses drug overdose.
Your safety plan might also include non-opioid alternatives (scroll down for my tips on medical marijuana treatment for opioid use disorder) which can potentially treat chronic pain and minimize the symptoms of opioid withdrawal. We must understand that recovery and safety is not a one size fits all approach.
Mental Health, Suicide, Substance Abuse Referral Sources:
● Mental Health and PA Support & Referral Helpline 1-855-284-2494 (TTY: 724-631-5600)
● National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
● Línea Nacional de Prevención del Suicidio: 1-888-628-9454
● Crisis Text Line: Text “PA” to 741-741
● Veteran Crisis Line: 1-800-273-TALK (8255)
● PA Substance Abuse Hot Line: 1-800-662-435
Accessing Naloxone for Overdose Prevention:
Naloxone is available at your local pharmacy in Pennsylvania, thanks to a statewide standing order issued by Dr. Rachel Levine. A standing order prescription allows pharmacists in Pennsylvania to dispense naloxone without requiring an individual prescription. You can also contact Prevention Point Pittsburgh, who can facilitate access to naloxone through a partnership with Next Harm Reduction. Prevention Point Pittsburgh provides many life sustaining harm reduction services and supplies throughout the Pittsburgh area
Harm Reduction Reminders for those who use opioids:
● Do not use alone if you are injecting. Call someone close by so they can call 911 if you become unresponsive.
● If you have been off opioids and start utilizing them again, reduce your dose. Your tolerance has decreased, and if you use the same amount as before stopping, you are at risk of an overdose
● Be careful with combining drugs. Mixing opioids with alcohol, cocaine, benzodiazepines, or other combinations can increase your risk of overdose.
● Clean your pipes, use clean needles, and don’t share your works.
● Keep naloxone on your person. Save your friends, don’t walk away. Call 911, perform rescue breathing using a one-way rescue breathing mask
Medical Marijuana as a Non-Opioid Alternative:
The medical value of marijuana has been documented for decades, but it is not an approved FDA medication. To fully understand the benefits of cannabis as an opioid substitution, treating opioid withdrawal, and improving mental health, a reclassification of the plant as a Schedule 1 substance is necessary.
Through patient reports, industry experts, and research, medical marijuana has been shown to reduce opioid overdose, reduce opioid consumption, prevent the need for opioid dose increases, and prevent the development of opioid tolerance. Medical marijuana may one day be used alone or in combination with low dose opioids as a first-line option in pain management. Medical marijuana has also been shown to be effective in medication-assisted relapse prevention and reducing the symptoms of opioid withdrawal.
Our Maitri pharmacy team makes recommendations based on those expert reports. When working with patients trying to taper off of opioids through medical marijuana therapy, we recommend cooperation with your prescribing physician. Please do not hesitate to reach out to your Maitri Pharmacist to help formulate an opioid tapering plan that you can share with your provider and start the conversation.
DO NOT immediately stop your opioid dose; instead, strive for a gradual taper with your medical provider’s input. As you taper, your tolerance decreases, and it’s critical to remember if you increase your opioid dosage too fast, you could be at risk of an overdose.
Utilize two forms of medical marijuana: one fast-acting like a vaporized product, and one longer-acting like a tincture or a capsule (our recommendations will change depending on your current opioid formulation).
Focus on strains that are high in Beta-Caryophyllene, linalool and limonene. Beta-caryophyllene is a very potent anti-inflammatory agent. Linalool and limonene are good for anxiety and depression.
Consider starting with a 1:1 THC: CBD strain. CBD is non-intoxicating and has been shown to reduce the anxiety that can lead to drug cravings.
Remember, if using medical marijuana for opioid-sparing, you will test positive for THC on a urine drug screen, and this could be a violation of your pain contract, and your provider may deny additional refills. It’s important to taper in cooperation with your physician.
Staying connected
Everyone is fighting their own battle. Try your best to be socially connected even while physically distanced. Reach out to your friends and loved ones with a phone call, a drive-by, or Zoom call. If you use substances, please know that you may have a weaker immune system, breathing problems, and other health conditions that could increase your risk of COVID infection.
Finally, I want to tell you there is hope. We are stronger together. There is no vaccine to prevent drug overdose deaths or mental health issues. We must stand together to curb this epidemic. Every life is a life worth fighting for. Prevention cannot happen underground. It is time to develop your plan. Let’s have an honest conversation. Let’s ditch the stigma and keep each other safe!
One Love,
TK
Resources
Guidance For those who use substances on COVID-19
https://m.box.com/shared_item/https%3A%2F%2Fyale.app.box.com%2Fv%2FCOVID19HarmReductionGuidance
12 Steps.org
https://www.12step.org/social/online-meeting-calendar/ (Listing of online 12-step meetings on various platforms)
Al-Anon Electronic Meetings
https://al-anon.org/al-anon-meetings/electronic-meetings/ (This forum and recovery chat room for Narcotics Anonymous members features voice chat, Skype, and text chat meetings connecting people from around the world.)
Alcoholics Anonymous Online Intergroup
http://aa-intergroup.org/directory.php (Listing of online meetings from AA Intergroup.)
Smart Recovery
https://www.smartrecovery.org/community/calendar.php
https://www.smartrecovery.org/smart-recovery-toolbox/smart-recovery-online/ (Message board, chat room, online meetings, and online library.)
Adult Children of Alcoholics
https://adultchildren.org
Phone and Online Meetings
https://www.intherooms.com/home/ (An online platform supporting a wide range of 12-step and non-12 step meetings)
Bridge Club Virtual Meetings
https://www.jointempest.co/bridge-club-events?tag=Virtual%20Events (Meetings that are specifically focused on women and LGBTQIA+ folks who are sober or interested in sobriety. )
Refuge Recovery Online Meetings
https://refugerecovery.org/meetings?tsml-day=any&tsml-region=online-english
Families Anonymous Virtual Meetings
https://www.familiesanonymous.org/meetings/virtual-meetings (Online meetings for parents, grandparents, siblings, spouses, significant others, other family members and friends of those with a current, suspected or former drug problem.)
Life Ring Recovery
https://www.lifering.org/online-meetings
The Temper
https://www.thetemper.com/online-recovery-meetings-groups/ (An online publication/site that explores life through the lens of sobriety, addiction, and recovery. Includes links to resources.)
My Recovery
https://www.myrecovery.com/online-meeting/ (Online 12-step meetings)
Sober Grid
https://www.sobergrid.com (A free online social networking platform for people in recovery. Available in mobile app stores)
Narcotics Anonymous
https://www.na.org/meetingsearch/ (Listing of online meetings provided by NA.)
Overdose Signs and Symptoms
https://www.youtube.com/watch?v=wSuZZ9iIfXg
What to do if you think someone is overdosing?
https://www.youtube.com/watch?v=Duj0eM1v0SM
How to administer rescue breathing
https://www.youtube.com/watch?v=lGFieA8QC9A
How to Administer Naloxone Nasal Spray
https://www.youtube.com/watch?v=v26cDao4AcI&feature=youtu.be
How to Administer Naloxone (Luer Lock Nasal Spray)
https://www.youtube.com/watch?v=7VbWU3K7xyA
How to Administer Injectable Naloxone
https://www.youtube.com/watch?v=f4Hnzy10hYY
Prescribe to Prevent: Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists
https://www.scopeofpain.org/documents/naloxone_transcript_20160909.pdf
Applying CDC Guidelines for Prescribing Opioids
https://www.cdc.gov/drugoverdose/training/online-training.html