9781422274286

PAINKILLERS THE SCOURGE ON SOCIETY OPIOID EDUCATION

OPIOID EDUCATION

FENTANYL: THE WORLD’S DEADLIEST DRUG HEROIN: DEVASTATING OUR COMMUNITIES PAINKILLERS: THE SCOURGE ON SOCIETY ALTERNATIVE TREATMENTS FOR PAINMANAGEMENT HOW FIRST RESPONDERS AND ER DOCTORS SAVE LIVES AND EDUCATE TREATMENTS FOR OPIOID ADDICTION UNDERSTANDING DRUG USE AND ADDICTION

PAINKILLERS THE SCOURGE ON SOCIETY OPIOID EDUCATION

AMY STERLING CASIL

MASON CREST PHILADELPHIA | MIAMI

Mason Crest 450 Parkway Drive, Suite D, Broomall, Pennsylvania 19008 (866) MCP-BOOK (toll-free) • www.masoncrest.com

© 2020 by Mason Crest, an imprint of National Highlights, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, taping, or any information storage and retrieval system, without permission from the publisher. Printed and bound in the United States of America. CPSIA Compliance Information: Batch #OE2019. For further information, contact Mason Crest at 1-866-MCP-Book. First printing ISBN (hardback) 978-1-4222-4381-7 ISBN (series) 978-1-4222-4378-7 ISBN (ebook) 978-1-4222-7428-6 Library of Congress Cataloging-in-Publication Data on file at the Library of Congress Interior and cover design: Torque Advertising + Design Interior layout: Tara Raymo, CreativelyTara Production: Michelle Luke Publisher’s Note: Websites listed in this book were active at the time of publication. The publisher is not responsible for websites that have changed their address or discontinued operation since the date of publication. The publisher reviews and updates the websites each time the book is reprinted.

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CONTENTS

Chapter 1: Who Uses Painkillers? . ........................................... 7 Chapter 2: History of Painkillers ............................................. 23 Chapter 3: How Opioid Painkillers Work ................................ 41 Chapter 4: The Long-Term Effects of Painkiller Abuse . ........ 55 Chapter 5: Treating Addiction to Painkillers . ........................ 69 Chapter Notes ............................................................................ 85 Series Glossary of Key Terms ................................................... 88 Further Reading . ....................................................................... 90 Internet Resources .................................................................... 91 Index . .......................................................................................... 92 Author’s Biography and Credits .............................................. 96 K E Y I C O N S T O L O O K F O R : Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills. Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news coverage, moments in history, speeches, iconic sports moments, and much more! Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.

Some people inaccurately refer to all drugs as narcotics, but only opioids can be properly classified as narcotic drugs. Pictured here is hydrocodone, an opioid pain medication sold under the trade name Vicodin.

WORDS TO UNDERSTAND

chronic — an illness that persists for a long time. epidemic —a widespread occurrence of a disease or affliction. over-the-counter (OTC) medication —a medicine that can be sold to the public without requiring a doctor’s prescription. prescription —an instruction written by a medical professional authorizing a patient to receive a medication. scourge —a person or thing that causes great trouble or suffering.

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Painkillers: The Scourge on Society

1 CHAPTER

Who Uses Painkillers? Shortly after 1 pm on January 22, 2008, in an apartment in New York’s SoHo neighborhood, Heath Ledger’s housekeeper Teresa Solomon heard the twenty-eight-year-old actor snoring. This seemed like good news, as Ledger had told family and friends that he was having trouble sleeping. The problem had begun a few months earlier, around the time he finished filming what would become one of his most famous roles—the disturbing and deranged villain Joker in The Dark Knight . At 2:45 pm, Ledger’s massage therapist Diana Wolozin arrived for a scheduled treatment. She found the actor in bed, his body cold and unresponsive. Heath Ledger was never going to wake up again. An autopsy determined that Ledger had died after taking several powerful drugs, including the painkillers OxyContin and Vicodin, and the sedatives (sleeping aids) Xanax and Valium.

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Who Uses Painkillers?

Award-winning actor Heath Ledger died of an accidental overdose of opioid painkillers. He was only twenty-eight years old.

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Painkillers: The Scourge on Society

Although doctors had instructed Ledger to take the prescription painkillers, he should not have been taking them together. These medicines depress the central nervous system, slowing a person’s breathing and heart rate. If too much is taken, those systems will simply stop working, resulting in death. Kim Ledger, Keith’s father, told reporters that his son “mixed drugs for a chest infection with sleeping tablets and that is literally what slowed his system down sufficiently enough to put him to sleep forever.” The tragic accidental death of a talented actor focused attention on the scourge of opioid painkillers. Accidental drug overdoses involving opioids have become the leading cause of death in the United States. An American is more likely to die of a painkiller overdose than they are to die in a car crash, according to the National Safety Council. “From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids,” reported the Centers for Disease Control and Prevention (CDC) in 2018. “Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.” Medical authorities within the federal government have called the abuse of opioids a serious epidemic that threatens the health of the nation. Opioid Painkillers Painkillers are medicines for relieving pain. Today, this term often refers to a class of powerful prescription drugs called opioids. Some of these drugs, such as morphine and codeine, are created from a natural source, the opium poppy. Others have been chemically formulated in a lab, but they affect the brain and central nervous system in the same way. The most commonly prescribed opioid painkillers today include oxycodone, hydrocodone, and meperidine. These are sometimes combined with other drugs.

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Who Uses Painkillers?

Opioid painkillers are prescribed by doctors to treat acute pain after surgery or injuries, or to relieve longer-term pain from chronic , serious illnesses. A group of opioid painkillers called narcotics include codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, and tramadol. Codeine is a commonly prescribed narcotic that suppresses coughs and can also treat pain. It is sometimes combined with acetaminophen and is used in many prescribed medications for cough and cold. Codeine is only one-tenth as strong as morphine. Tramadol is a synthetic opioid which is similar to codeine. Both codeine and tramadol are less potent than other opioid pain relievers and have less risk of dependency or addiction and withdrawal. Hydrocodone is also combined with acetaminophen, often under the brand name Vicodin, and prescribed for moderate to severe pain.

Acute pain is the term for the sensation that accompanies a sudden injury, such as a broken bone. This is pain that tells the body that damage is occurring, or has occurred, and usually doesn’t last very long. As the injury heals, the acute pain recedes.

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Painkillers: The Scourge on Society

OVER THE COUNTER PAIN MEDICATION

In addition to opioids, there are other drugs that are used to relieve pain. Many of these pain relievers, or analgesics, are over-the-counter medications that can be purchased in a drug store or grocery store. They include drugs like acetaminophen (sold as Tylenol), as well as a class of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen sodium (sold under the brand name Aleve). More than 100 billion aspirin tablets, over 30 billion doses of other NSAIDs, and 25 billion doses of acetaminophen are sold each year. Although attention is generally focused on the negative health effects of opioids, other pain-relieving drugs can also have negative side effects. Overuse of NSAIDs can lead to high blood pressure and damage to the kidneys, stomach, liver, and intestines. Each year nearly 500 people die from side effects of taking products containing acetaminophen. One of themwas nineteen-year-old University of Oklahoma student Madalyn Byrne. When she was troubled by a toothache, she used extra-strength Tylenol to relieve the pain. Madalyn was taking more than the recommended amount—about nine pills a day over a period of more than a month. One day, Madalyn’s roommates discovered her unconscious. They rushed her to the hospital, but there was nothing the doctors could do. The acetaminophen had damaged her liver, leading to a heart attack.

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Who Uses Painkillers?

The strongest group of narcotic painkillers are prescribed only for patients who have already taken weaker opioids and need more pain relief, or used in hospital settings, such as post-surgical pain relief. Hydromorphone (sold under the brand name Dilaudid) and meperidine (Demerol) are more powerful opioid painkillers. They, along with morphine, are often given in hospital settings. Oxycodone (often sold as OxyContin) and fentanyl are both strong opioids and are usually prescribed for severe pain, especially cancer. Fentanyl can be up to 100 times stronger than morphine and is prescribed only in patch or lollipop form. It is also used in combination with other drugs for surgical anesthesia. Who Is Most At Risk? About 50 million people in the US undergo outpatient surgery each year and receive prescription painkillers. The National Safety Council reported in 2016 that at one time or another, 99 percent of US doctors prescribed opioid painkillers for a period that exceeded the federal government’s recommended three-day dosage limit. The government established the three-day recommended limit because research into millions of patients had uncovered a sobering statistic: patients receiving prescription narcotics for more than six days had a much higher chance of becoming addicted or dependent. It is estimated that more than 3.3 million Americans misuse prescription painkillers every year. The rate of fatal prescription overdoses is highest among men between the ages of twenty-five and thirty-four, with a rate of 25.9 deaths per 100,000 people. Older adults are at risk of prescription drug abuse and overdoses, often unintentionally. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that

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Painkillers: The Scourge on Society

about three out of every ten people between the ages of fifty- seven and eighty-five have at least five different prescriptions. They also may see different doctors who can prescribe medications that are dangerous in combination. The body also changes with age and risk of addiction or overdose increases even if the person has been taking a drug safely for a long time. Projections of painkiller risk aren’t good for older Americans. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that more than 2 percent of older Americans are projected to abuse painkillers by 2020, twice the number abusing the drugs in 2004. SAMHSA based its projections on analysis of data from the federal government’s Medicare health care program that revealed that more than half a million older people on Medicare received high amounts of opioids. The Some patients suffer from long-term health conditions or diseases that force them to live with chronic pain for months or years. Chronic pain can be caused by inflammations of tissue (for example, arthritis), or by damage to nerves caused by diseases like diabetes. Sometimes, the cause of chronic pain can’t be determined. Increased use of opioids to treat chronic pain was an important contributor to the current epidemic.

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Who Uses Painkillers?

average amounts of prescription painkillers for this group exceeded the manufacturers’ recommended doses. “Patients with mental health or substance use disorders are at increased risk for nonmedical use and overdose from prescription opioids,” said Thomas Frieden, director of the Centers for Disease Control and Prevention. These patients may receive prescriptions for the drugs and are at high risk of combining them with other legal and illegal drugs and/or alcohol. Prescription opioids were responsible for more than 17,000 deaths in 2017, and other synthetic narcotics, prescribed or illegal, killed more than 28,460 people. Women’s Risk Is Increasing More men than women die from prescription painkiller overdoses, but the rate of women dying from painkillers has increased more than 400 percent since 1999, according to the CDC. For every woman who loses her life due to a prescription painkiller overdose, thirty go to the emergency room for help from overdoses or abuse. The CDC reports that between 1999 and 2010, almost 48,000 women died from overdoses of prescription painkillers. Every year since 2007, more women have died from drug overdoses than from car accidents. Dr. Kirtly Parker Jones reported in the University of Utah’s Healthcare Scope broadcast that about 4.5 million women in the US have a drug abuse problem, and that women become more quickly addicted than men. Women are more often diagnosed with pain and anxiety and physicians more often prescribe not only painkillers, but anti-anxiety drugs like benzodiazepines (Xanax). In combination, painkillers and drugs like Xanax can be deadly. Geisinger Health System in Pennsylvania has conducted several long-term studies of prescription opioid use and misuse using records frommore than 1.2 million patients. Geisinger

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Painkillers: The Scourge on Society