Dr. Henry Paul, MD

Psychiatrist, Author and Educator

WHY SHOULD I GET NARCAN™ TRAINING?

April 4th, 2016

Narcan™ (naloxone) is an opiate antidote that saves lives! And, you should know how to use it because someday someone in your family just may need it.
Overdoses from painkillers and heroin, both opioids, are alarmingly on the rise in the United States. Opioids include heroin and prescription pain pills like morphine, codeine, oxycodone, methadone and Vicodin. When a person is overdosing on an opioid, breathing can slow down or stop, and it can be very hard to wake them from this state.

Who is at risk for overdose? Your grandmother who just had a knee replacement, your aunt who is dealing with chronic back pain, your teenage son or daughter who first takes painkillers while recovering from a sports injury. The list can go on and on. Sadly, painkillers are prescribed at alarming rates, and long-term use leads to addiction. These painkillers are often the gateway drug for heroin.

On Tuesday, President Obama announced a series of initiatives aimed at curbing America’s opioid addiction epidemic. The steps he outlined would make it easier to obtain medication-based treatment, expand Medicaid coverage and increase the availability of a drug that saves people from overdoses.

Narcan is a drug that can save people from overdosing. It can be delivered in the nostrils with the use of a mucosal atomization device (MAD) or intramuscularly with a syringe. Narcan is a non-patient specific prescription that is distributed through an authorized agency, such as a local health department, and given to individuals who have been trained in opioid overdose recognition and response consistent with that agencies registration with their state.

What does Narcan do? Simply, Narcan knocks the opioids out of the opiate receptors in the brain. Tom Ferraro, professor of biomedical sciences at Cooper Medical School of Rowan University in Camden, N.J. told Newsworks in an online article published in 2014 that it essentially “blocks the ability of opioids to do what they do at the molecular level.”
Ferrero went on in the article to explain, “The proteins in your brain have special receptors that, when unlocked, release certain biochemical reactions. Think of opioids, like heroin, as being special keys, says Ferraro. When they get in your brain, they seek out those receptors, ‘latch on’ and unlock the lock. When the drug opens and closes that lock repeatedly, it ‘triggers a cascade of biochemistry inside that particular cell.’” He says, “this is the basic mechanism of being high. The heroin repeatedly unlocks the lock, releasing euphoria, pain relief and addiction from that cell.”

Narcan, on the other hand, cannot be used to get a person high, and if given to an individual who has not taken opioids, it will not have any effect on them. For more information on Narcan visit FDA.gov

LINKS
Obama Pushes For More Treatment for Opioid Addiction
CVS to Sell Heroin OD Reversal Drug Narcan in More Pharmacies
The overdose ‘antidote’: how Narcan works

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription.

YOU CAN MAKE A DIFFERENCE IN THE GROWING HEROIN EPIDEMIC

March 2nd, 2015

“What we’re seeing now is the pendulum swing from the legislation that was developed around prescription medications,” said Mark Gilmore, senior investigator with the Putnam County sheriff’s office. “The e-prescription program went into effect and cut off the supply line of falsified prescriptions. And that,” he said, “has made addicts turn to a quick, cheap fix in the form of heroin.” Senator Murphy pitches plan to combat heroin. Amanda Purcell, Poughkeepsie Journal, 2/27/2015

For the past year, I have been blogging about the growing heroin epidemic in the United States. This growth is in large part due to the “gateway drugs” known as painkillers.

Elected officials in New York State have turned up the heat on the heroin epidemic (and it is an epidemic!) by forming coalitions and doing community education and outreach. Through awareness campaigns targeted at educating parents about the drug dangers facing their children, and at educating the children and the community at large, it is believed that we can fight this growing epidemic.

Heroin does not discriminate. From the wealthy to the poor, the cities to the suburbs, and the college campuses to the streets – heroin is big a problem.

Senator Terence Murphy (40th District) representing the New York City suburb communities in Westchester, Putnam and Dutchess counties said in a recent interview with the Poughkeepsie Journal (the Gannett daily newspaper) that, “I campaigned on this. I’m three weeks into my tenure here and I want to get out of the gate swinging,” Murphy said. The article went on to say, “Statewide, there were 89,000 heroin and prescription painkiller treatment admissions in 2013, 25,000 more than in 2004, according to Gov. Andrew Cuomo’s office. Locally, treatment facilities are full, or near to full, and recently, federal, county and local law enforcement arrested 21 and seized $1 million worth of the drug.”

After one of the biggest heroin drug busts in Westchester County in January, Westchester County Police Commissioner George Longworth said during a press conference announcing the arrests, “Some people may think that heroin is only an inner-city problem, but it’s not, Heroin is being sold on tree-lined streets. It is being used by — and sold by — young people who live in comfortable homes and circumstances. No community is immune.”

Senator Murphy is taking his message on the road saying that he intends to hold a forum every two to three weeks in his district. He held his first last week. If you have the opportunity to go to Senator Murphy’s forum or a forum in your district or at the local high school – GO! The more ALL of us understand this epidemic the better equipped we will be to stop it.

The specifics of Murphy’s plan include:

Sponsoring legislation to require insurance companies to cover drug treatment and rehab up to ninety days;
Using drug seizure proceeds to provide funding for NARCAN, a potentially life-saving overdose treatment, to all first responders;
To help with prevention, state funding for school resource officers (Police SROs) and Drug Abuse Resistance Education (DARE) in all area schools by restoring the Gap Elimination Adjustment school aid cuts made by Senate Democrats in 2010;
Forming an federal-interstate-local joint, inter-agency law enforcement counter-narcotics proliferation task force and removing legal barriers to data sharing, aspects of which are already underway;
A state grant program for a local narcotics units to provide stepped up enforcement against drug distributors;
Increasing penalties for major narcotics traffickers; and
Restoring funding cuts enacted by Senate Democrats to the NYS Office of Alcoholism and Substance Abuse Services (OASAS) to fund peer recovery advocate, addiction services and treatment programs.

Ten years ago, most people never knew a person who died from a heroin overdose. Today, most people know of someone – a friend of a friend, the girl up the road, the son of a friend at work, their niece, son, brother or sister – and the list goes on. More awareness outreach and more money for law enforcement are needed to combat the “heroin epidemic” on the streets. Find out how you can help in your community. We all can make a difference.

Previous blogs on heroin:

GOVERNOR CUOMO RECOGNIZES THE HEROIN EPIDEMIC AND IS DOING SOMETHING ABOUT IT

THE GROWING HEROIN PROBLEM IN AMERICA

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

GOVERNOR CUOMO RECOGNIZES THE HEROIN EPIDEMIC AND IS DOING SOMETHING ABOUT IT

June 16th, 2014

“I’ll be the first to say to you: New York State has a problem with heroin addiction, and it is a growing problem,” Mr. Cuomo said on Wednesday in a speech announcing the move, his first major address on heroin. “In the ’70s we had a heroin epidemic. This is worse than what we went through before.” The New York Times

I was glad to see New York Governor Andrew Cuomo address the heroin problem in the State. As I have been talking about in my blog, this is much more than an epidemic — It is a crisis! And, not just in New York State, but across the country. It is the result of many things, but much of the increase in heroin use among suburban teens and a growing number of adults coincides with a sharp rise in the use of prescription painkiller pills, which are quite similar to heroin.

According to the NY Times article, “the announcement comes as the resurgent abuse of heroin has been discussed intensively in Albany. For weeks, lawmakers have been meeting treatment providers, insurance companies and families who have lost relatives to overdoses to discuss heroin addiction and the opioid pill abuse that serves as a frequent gateway to heroin.”

Back in my April blog, I addressed the news stories that were coming out about young adults and teens struggling with heroin addiction, and the shock and awe that families felt when they suddenly realized that they had a loved one who was using. At that time, Vermont, Governor Peter Shumlin devoted his entire State of the State message to the heroin addiction. So I can say that I have seen this coming — the drugs are no longer just in the cities, but they are now in our suburbs, rural communities and high schools across the country. That is scary!

I am glad to see that the Governor’s legislation involves new officers being added to drug units around the state. It is a good start. I believe that Governor Cuomo’s efforts are a good start and can make a difference, but we ALL have to be vigilant, too. We must work together! The most important thing is for everyone, particularly parents and the healthcare community, to understand and recognize the symptoms of addiction, and to seek help if you suspect there is a problem. Here are some things that you need to know about heroin addiction:

Know the symptoms. These can include a change in personality, lying, stealing of money or medication, sudden drop in grades, depression, pinpoint pupils and signs of intoxication.
The first thing is to seek professional help. Treatment for heroin addiction, in addition to detoxification, sometimes includes the use of methadone, which is not intoxicating or sedating, but suppresses narcotic withdrawal. Methadone also relieves the craving for heroin. LAAM is a synthetic opiate that is used to treat heroin addiction.
Detoxification is necessary for most addicts. This is usually done in a residential center but sometimes in an out-patient facility.
Behavioral therapy is often effective, involving contingency-management therapy and cognitive-behavioral therapy. As with other drugs, 12-step programs can help reinforce the decision to stop using heroin once the addict has navigated the difficult straits of withdrawal.
Psychotherapy along with certain psychiatric drugs is also common and useful to control urges and yearnings, as well as to help with the many common underlying psychiatric disorders of addicts, especially mood disorders.

THE GROWING HEROIN PROBLEM IN AMERICA

April 4th, 2014

As a psychiatrist with over thirty years of treating children, teens and adults, I have seen all kinds of drug addiction. From club drugs like ecstasy, Special K, Molly, and crystal meth to marijuana, cocaine, beer, booze, LSD, and yes, heroin, I have seen these drugs destroy lives.

Just in the past two weeks there have been news reports about teens dying of a heroin overdose in quaint towns like New Milford, CT., that had eight opioid-related overdose deaths last year, four of which involved heroin. This got the attention of the residents and officials in this Litchfield County town who had to face the sad reality that this was an unexpected epidemic that they never saw coming.

How bad is it? Well, in January, Vermont, Governor Peter Shumlin devoted his entire State of the State message to the heroin addiction. “In every corner of our state, heroin and opiate drug addiction threatens us,” he said. Law enforcement authorities in Massachusetts recently reported that 185 people have died of heroin overdoses in just the past four months – which didn’t include numbers from the state’s three largest cities. Nationwide, according to the Federal Substance Abuse and Mental Health Services Administration (SAMHSA), heroin use among persons age 12 and older nearly doubled between 2007 and 2012.

Much of the increase in heroin use among suburban teens and a growing number of adults coincided with a sharp rise in the use of prescription painkiller pills, which are essentially identical to heroin. These painkillers, or opioids, are prescribed for things such as sports injuries, dental procedures, or chronic pain. In a disturbing number of cases, research is showing, they are leading to overdependence and often to addiction to the pills themselves, which can then lead to heroin use.

So what should you do if you suspect a loved one, friend or your child is using heroin?

The first thing is to seek professional help. Treatment for heroin addiction includes the use of methadone, which is not intoxicating or sedating, but suppresses narcotic withdrawal. Methadone also relieves the craving for heroin. LAAM is a synthetic opiate that is used to treat heroin addiction.
Detoxification is necessary for many addicts. This is usually done in a residential center but sometimes in an out-patient facility.
Behavioral therapy is often effective, involving contingency-management therapy and cognitive-behavioral therapy. As with other drugs, 12-step programs can help reinforce the decision to stop using heroin once the addict has navigated the difficult straits of withdrawal.

Users of opioid drugs like heroin have a much higher relapse rate than other drugs. However, many people never relapse and if they do they get better again. One last piece of good news is that there is now FDA approval for a drug that can be administered in the home for addicts who overdose and stop breathing. It is an old drug, naloxone, now available in a new and easy to use home form. More on this from USA Today.