Tie a Purple Ribbon today for Somebody’s Someone

  


Tie a Purple Ribbon today for Somebody’s Someone

By Terri Kroh, Chief Medical Officer, Maitri


On International Overdose Awareness Day (IOAD) August 31, 2021 tie a purple ribbon for “somebody’s someone. "IOAD is the world's most extensive annual campaign to end overdose. Remember without stigma those who have died and acknowledge the grief of the family and friends left behind”  Time to Remember. Time to Act.- 


The opioid epidemic isn't contagious, but it spreads across the US, taking far too many lives. Across the United States, overdose deaths rose 30% in 2020, up from 21,000 in 2019 to 93,331 in 2020. Pennsylvania ranks 8th in state overdose deaths up 16% from 2019. Governor Wolfe recently signed the 15th Opioid Overdose Emergency Disaster Declaration since it was implemented in 2018. Pennsylvania is one of the few states recognizing opioid use disorder as a qualifying condition for medical marijuana. 


I am the mother of one of the 900,000 lives lost since the opioid epidemic began in 1999. No one wakes up one day and decides to develop a substance abuse disorder, and no one who is facing this disease ever thought it would happen to them. No family is immune. Overdose does not discriminate. The stigma of substance abuse is crippling and will only be changed through compassion, non-bias education about drugs, decriminalization, and ending the war on drugs.


Opioids include medications like oxycodone, hydromorphone, codeine, morphine, and illicit substances like heroin. Did you know that statistics show that 80% of new heroin users transitioned from prescription pain medications because it is cheaper and more accessible? Their pain didn’t go away. The unregulated and tainted drug supply is killing people. Not everybody who uses opioid drugs will develop a substance abuse disorder. Still, everyone who uses, misuses, or abuses an opioid medication is at risk of overdose.


These deaths may be preventable by having Narcan in your first aid kit. Narcan (Naloxone) is an opioid reversing medication available to all Pennsylvania's through a state-wide standing order signed by our state Medical Director. This allows anyone to fill a prescription for Narcan at any pharmacy in Pennsylvania. If you are uninsured, contact Prevention Point Pittsburgh, who is facilitating 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.  https://nextdistro.org/pennsylvania

As a prohibition mom turned Medical Marijuana pharmacist, I see the impacts of MMJ through a different lens now. Most important from my point of view is the cannabinoid receptor is found in lower amounts in the brainstem cardiorespiratory centers versus the opioid receptor this means that MMJ does not cause a life-threatening respiratory depression like the opiate drugs. It won’t kill you.

 

Because MMJ is a schedule 1 drug it is not FDA approved for the treatment of any condition. Let's continue the conversation started on WMBS radio with Dr. Lane, offer our compassion, end the stigma, and know it's okay to talk about the guilt, the trauma, the blame associated with a substance abuse disorder. It is also okay to talk about the grief that comes with losing a loved one to a drug overdose. We're in this together. 


If you missed the broadcast, you can view it here; https://www.facebook.com/WMBS590/videos/1276044606153225/?__so__=channel_tab&__rv__=all_videos_card


Harm Reduction

Yes, medical marijuana (MMJ) is a drug. Some may see trading opiates of any kind for MMJ as just drug substitution, and that is true. Still, harm reduction aims at reducing the negative consequences associated with drug use. Harm reduction strategies include replacing a harmful substance with a safer one, teaching people who misuse or abuse drugs how to do so safely and increases access to naloxone and recovery services. https://harmreduction.org/about-us/principles-of-harm-reduction 

 

The Science of Substance Abuse Disorder 

The Opioid and Cannabinoid receptors are both present in the areas of the brain that affect addiction and reward-seeking behaviors. Simply put, they make us feel better. But over time, consistent drug misuse leads to overstimulation in the reward center. The brain tries to solve this problem by decreasing dopamine production and the receptors. The consequence is that it takes more of the drug to satisfy the craving that seemingly leads to the reward. Opioid addiction changes the brain's chemistry and is a complex disease involving many factors. 

What is interesting regarding MMJ is studies indicate that in low doses, it can stimulate the dopamine receptors. At the same time, high chronic use can decrease dopamine receptors. But, when stopping MMJ use, the dopamine receptors return to normal, especially when comparing MMJ to other substances. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123717   

 

Medical Marijuana as a Non-Opioid Alternative for Pain

According to the National Academies of Science report in 2017, the committee reviewed over 10,000 from 1999 and found “substantial” evidence that marijuana effectively treats chronic pain. The report offers suggestive evidence that MMJ can safely reduce and replace opioid medications in patients with chronic pain. https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state

 

Medical Marijuana as an Opioid Sparing Alternative – Reduction of Opioid Doses 

MMJ may increase the effect of the opioid without increasing the harmful side effects. There is an indirect increase in the effects of opioids at the opioids binding site when used together.  MMJ may help reduce the dose of opioid medications needed to control pain. Decreasing the dose of the opioid leads to less accidental overdose. MMJ when combine with opioid pain medications may prevent opioid tolerance-building and lessen the need for opioid dose increases. 

https://pubmed.ncbi.nlm.nih.gov/30152161/ 


Medication-Assisted Therapy (MAT)

Methadone and Buprenorphine are two opioid drugs that traditional medicine uses as harm reduction in treating opioid use disorder. Anecdotal patient reports suggest that people are using MMJ to reduce more harmful substances like opioids. We know that MAT is 50-80 % effective. When MMJ is used in conjunction with MAT medications it may help with the withdrawal symptoms, reduce anxiety, improve sleep, reduce the cravings for opioids, help prevent relapse, and increase retention to (MAT) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135562/pdf/can.2018.0022.pdf-

 

Medical Marijuana for Opioid Withdrawal 

Withdrawal symptoms usually happen six to twelve hours following the last dose of a short-acting opioid and thirty hours after a long-acting opioid. Symptoms include muscle aches and pain, agitation and anxiety, nausea, gastrointestinal upset, increased heartbeat, runny nose, tearing eyes, chills, sweating, and insomnia. Some symptoms may last for weeks to month and can  include irritability, fatigue, decreased body temperature, cravings, and insomnia. 

 

MMJ may alleviate the symptoms of opioid withdrawal. Evidence from two small trials with the FDA-approved drug dronabinol investigated the ability of dronabinol, a synthetic THC, to minimize opioid withdrawal side effects. They suggest that dronabinol was able to reduce withdrawal symptoms , but the result is likely weaker than opioid-based withdrawal therapies which keep people dependent. 

https://www.researchgate.net/publication/317252828_The_endocannabinoid_system_as_a_target_for_addiction_treatment_Trials_and_tribulations/link/5991ba40a6fdcc53b79a93e5/download

 

Relapse

New data is emerging on CBD to reduce the incidents of relapse. A randomized clinical trial with 42 participants found that Epidiolex, an FDA plant-derived CBD medication, may reduce the craving for heroin after being exposed to drug cues. This may suggest CBD's role in relapse prevention by reducing drug cravings.https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.18101191

Recovery 

Recovery is not one size fits all and should incorporate the advice of medical, psychiatric, mental health, and substance abuse professionals, harm reduction principles including a safe supply, access to Medication-Assisted Treatment, and naloxone along with social supports. 

Medical Marijuana may be an effective adjunct in the toolbox of therapies to save more people caught up in this epidemic. Let’s continue this conversation and # End Overdose.

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

Resources :

How to Respond to an Overdose: 

Harm Reduction Reminders for those who use opioids: 

  • Do not use alone if you are injecting - if you have a cell phone 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. Avoid mixing opioids with alcohol, cocaine,

benzodiazepines, or other combinations can increase your risk of overdose.

  • Reach out to Prevention Point Pittsburgh for fentanyl test strips

  • Use clean needles, Don’t share your works and clean your pipes.

  • Keep naloxone on your person. Save your friends, don’t walk away. Call 911, perform rescue breathing using a one-way rescue breathing mask

 

It is suggested that any attempts to decrease your opioid dose utilizing Medical Marijuana be made in collaboration with your prescribing physician. Please do not hesitate to reach out to your Maitri Pharmacist to help formulate an opioid tapering plan which you can share with your provider. 

One Love -TK 

Marisa maraugha