Dr. Gary Zaid, from Froedtert South’s Department of Emergency Medicine addressed the club about the U.S.s two opioid epidemics.  The first opioid epidemic in the 1960’s, was labeled the “French Connection” primarily because most of the heroin entered to U.S. from Afghanistan via France.
 
To battle the increasing incidences of addiction, Methadone was developed as an alternative to using heroin. The sharing of needles by addicts also led to the rise of HIV during this time.
 
Fast forward to today’s epidemic, Fentanyl is 1000 times more potent than heroin and is coming to the U.S. from Mexico, where it is being manufactured. It is much cheaper than it had been in the past because the source is so close to the U.S. and it is much easier to obtain.Users don’t know what they are getting as far a strength (dose) so overdoses are common.
 
Opioids work on opioid receptors in the brain to control pain but they also work on a part of the brain that regulates breathing which is a big part of the overdose problem.
 
Kenosha County has had over 50 deaths from opioid overdoses. There have been more U.S. deaths from this epidemic than the Vietnam War.
 
Causes – medical community, government, and drug companies. Medical community pushed to use opioids for pain control believing that there was not addiction if used for real pain. In some cases, it is appropriate to use opioids such as cancer patients in severe pain but it has become generalized to use for simple sprains etc. and the public began to think they should have opioids for all kinds of general pain.
 
The pain index was developed and used as a general practice by physicians and emergency rooms which gave the public the general impression that there should always be something given for pain. The drug companies marketed opioids as being able to safely take care of pain and believed that addiction was not an issue with these medications. The government exacerbated the problem by using Medicare patient’s evaluations to grade hospitals which were often based on the patient’s perceptions of how well their pain was addressed.
 
Emergency rooms were seeing patients coming in asking for pain meds for this that & the other thing with no way to track whether they had been at the hospital across the street the day before asking for the same thing. Development of new data bases & rules in Wisconsin now require that any prescription for more than 3 days of an opioid require that the patient be looked up using the database. Physicians are also required to have continuing education on  additional and/or other alternative medications and treatments.
 
Narcan is a newer tool in the fight which is very helpful in treating overdosing. It can help to block the respiratory suppression effects of the overdosed opioid. Narcan is easy to administer and works in a few minutes. The medical community is pushing to have Narcan available in as many locations as possible so it is available quickly for overdoses. It can even be given to patients who do require long-term opioid prescriptions for pain to have on hand in case they have a problem.
 
What do we do about the Fentanyl addicts? Methadone can still be helpful to suppress the heroin cravings. A new drug called Suboxone, another opiate with Narcan in it, can help. It is still difficult for physicians to prescribe this medication though. Only a few physicians in an emergency room can prescribe it for a 3-day prescription to help reduce the addiction. Vivitrol is another drug similar to Narcan but long-acting, for as long as a month. The benefit of this medication is that if people on Vivitrol who inject heroin will not get high. Needle exchanges can help to minimize the spread of HIV and Hepatitis for those addicts who are going to continue to shoot up no matter what.
 
What can we do to help? Get rid of old opioids because family members, workers in the home, etc. can get their hands on them.
 
ALTO – Alternatives To Opioids – Hospitals are suggesting and offering other meds as alternatives to opioids and also alternative treatments like acupuncture and PT. It only takes one injection of heroin to addict most people.
  
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