In the late 90s, pharmaceutical companies advertised that painkillers, containing opioids, would not be addictive. Yet, 20 years later, opioid addiction and overdose is at its worst in American history, and is partially due to the recent medical trend of overprescribing painkillers.
On average, 130 people in the United States die each day from opioid overdose. Additionally, according to the National Institute on Drug Abuse, the healthcare and criminal justice industries lose about $78.5 billion a year from opioid overdose, and opioid-based painkiller prescriptions have a 4 to 6 percent chance of resulting in heroin use and addiction.
On Monday, April 29, Medlife, a student group that encourages community access to medicine, education and development, and Alpha Phi Omega, a community service fraternity, hosted its second panel in the past year on the realities of opioid overdose.
To explore the neuroscience, policy and healthcare of the state of the opioid crisis in rural New York, Medlife and APO invited experts in each of these sectors to hold an open discussion with students.
“[What] mattered to all of us was bringing more awareness to students about what is happening right here in Ithaca,” Winnie Ho ’19, a member of APO, explained as she introduced the panelists with Delmar Fears ’19, Engaged Ambassador, and Matthew Guo ’20, president of Medlife. “We are aware of what’s going on in our own lives but we fail to see what is happening around us.”
Speaking at the event were Prof. Ronald Harris-Warrick, neurobiology and behavior, Liz Ryan, leader of primary care programs at REACH, a progressive local patient-centered and harm reduction healthcare facility and Katherine Celentano , a locally-based drug policy expert with experience at local, state and federal levels.
Each panelist spoke about issues related to their areas of expertise. When asked about the substance dependence, Warrick explained how opioid addiction evolves.
“With regard to opiates, a lot of people try them because they need them medically,” Warrick said. “The problem is what happens next: opiates are an example of addictive drugs like alcohol, nicotine and cocaine.”
As Warrick explained, opioids in prescription drugs, heroin and fentanyl bypass what is known as the dopamine reward pathway. “All of these drugs have a common initial mechanism which makes them extremely pleasurable,” Warrick said.
In other words, opioids are so addictive because they signal pleasurable experiences without requiring the same input of work or deliberation that normally lead to these experiences. The second step in simplifying the addictive nature of opioids is that remarkably simple, commonplace events become cues to the dopamine reward pathway.
“What is unexpected becomes the cue,” Warrick said. “What happens to these poor addicts is that they are surrounded by cues that remind them of heroin and this is very, very difficult to get over.”
Warrick made a clear distinction between the biochemical processes that occur in the brain of opioid addicts and the societal stigma associated with addicts’ morality.
“Once a person becomes addicted, they no longer have the full amount of free will that you are born with. The biochemistry is important. At that point, we have to do everything we can to help people struggling with addiction,” Warrick said.
And yet, despite the awareness among biologists and neurologists of how opioids affect the brain, healthcare and public policy is still behind in treatment methods for opioid addicts.
Ryan touched upon some of the shortcomings of drug-use, mental health and medicated healthcare.
“There is a lot of harm associated with using any kind of drug,” Ryan said.“The harm is the shame that keeps you away from your family, [or] using a dirty needle and getting Hep C, even if that is not a rational choice.”
Ryan was adamant in explaining that the multi-faceted impacts of drug-use are often not acknowledged by traditional healthcare practitioners. Extending the impacts beyond personal wellbeing, Ryan commented on the complex context in which drug addiction emerges.
“[Patient-centered harm reduction] takes into account socioeconomic status and political questions like racial relations and the ways you’ve been treated in the past,” Ryan said.
Celentano clarified how deeply rooted drug-use, mental illness, and interpersonal relations are in America’s history.
“Drugs were not made illegal because of the different harms associated, but because of the different people they were associated with in history,” Celentano said.
Celentano elucidated the history of drug mentality in the United States, underscoring that opioids and marijuana were made illegal at periods of high racism towards Chinese immigrants and black people, respectively. Celentano claimed that by incarcerating certain types of people for drug use, rather than treating them, politicians were able to change national perspectives towards ethnic and racial groups.
As Ryan and Celentano concluded together, American healthcare and criminal justice systems are flawed because they over-simplify the drug use problem. Healthcare treatment emphasizes that patients quit using drugs immediately, despite the dangers of relapse and overdose, the panelists said, and the justice system emphasizes that people who use drugs are immoral. Both of those programs ignore the complexities and broader societal ills that motivate drug use and subsequent drug addiction.
Both Ryan and Celentano were adamant that changes in public policy and healthcare were necessary; however, the majority of the panelists were optimistic.
Warrick noted the development of a new painkiller that is not addictive and set to enter the market in the next year, while Ryan encouraged pre-med students to explore patient-centered treatment methods.
The panel ended with narcan training, which is a medication that treats opioid overdose. Narcan training is the simplest way to help someone who is overdosing and an important skill. Warrick, Ryan and Celentano emphasized the power of students understanding the opioid crisis in its historical and social context.