Transcription:
A National Crisis: The Opioid Addiction Epidemic

Melanie Cole (Host): Opiate addiction is a major issue in the US, with prescription opiate addiction being one of the biggest drug problems in the country today. It’s estimated that 78 people a day die from overuse of opioids. Use of these drugs has skyrocketed in recent years. My guest today is Dr. Kyle Vincent. He’s a board-certified family medicine physician and a member of the medical staff at Temecula Valley Hospital. Welcome to the show Dr. Vincent. What are opiates? What is this class of drug?

Dr. Kyle Vincent, MD (Guest): Well good morning everyone and thank you for having me. So, the class of opiate is a class of medication that acts on your nervous system that really just dull and block pain receptors from being transferred, is the main way that they act on the body which is why they are given to patients post-surgery, after a car accident, and other major traumas that obviously would send a lot of pain signals to the body.

Melanie: Why are they so addictive?

Dr. Vincent: So, they are addictive for a number of different reasons. The one reason is they do a good job of dulling the pain. That’s one of the reasons. And when I gave the talk at the hospital; pain in and of itself is a difficult thing to be objective about simply because there are no lab tests, there is no image, there is no real objective way to tell someone else how much pain they are in. So, because of that dynamic of what it is treating, you don’t want patients to be in pain. So, you can give them something that will block the pain receptors that will obviously make them have pain relief. Now the reason they are addictive is because while yes, they are blocking pain receptors, they are also signaling your body that that process doesn’t have to occur as often and your body does become adaptable to that and therefore, it doesn’t take all that long for your body to just get used to those – to that particular medication and crave that and that becomes your body’s new normal, despite even whether it is corrective surgery or anything else, to where you wouldn’t necessarily have pain, but because your body is now used to it, that is why they are addictive. And our bodies they do work in cycles, they do work in receding cycles to where something that you have become accustomed to will just become a part of your day to day, your daily life and that is why they become addictive.

Melanie: So, what are some of the short-term and long-term effects of taking opiates, if someone has to take them for a good amount of time and also does everybody that takes them for a longer period of time, do they become addicted?

Dr. Vincent: So, the short-term effects is how they should be used. The really are not designed nor should they be used for any extended period of time; maybe two weeks at the very maximum. The whole purpose of the way that they should be used is to like I said, just dull the pain or block the pain receptors, but hopefully, a corrective surgery or rehab or transitioning to a lower – a different class of pain medication albeit Tylenol or Advil or something like that, that should take place in one to two week period so the pain can be controlled and managed without becoming addicted. Now, as far as who is at risk for becoming addicted, that’s pretty much everybody who takes them. There is not an addictive personality, there is not a family history of addiction necessarily that makes one group more predisposed than the other. Because it is acting on your central nervous system, as far as the mechanism of the medication, everybody who takes it can become addicted. But the goal is and this gets to just having some expectation management; you really shouldn’t probably use it longer than a couple of weeks at the very most and then hopefully either you have had something corrected while you are experiencing some pain or we have transitioned to a different medication class that is not addictive, that is not harmful to your body and you would be able to manage your pain like that going forward.

Melanie: Dr. Vincent, what are some red flags, signs and symptoms for yourself or a loved one that you might notice in somebody if they are becoming addicted to opioids?

Dr. Vincent: So, the signs and symptoms really are similar to addictive behavior regardless of what the addiction is, whether it’s alcohol, illicit drug use, the same would call for – what would be the same for opioids in that any sort of withdrawal, any sort of isolation from previous social activities and things that you would enjoy or that they would otherwise enjoy, those types of behaviors are red flags. Working and attempting to get opioids in different ways, multiple ER visits, to just continuously and consistently get a different prescription and they would always – the red flag would be that they would have to be different ERs because they wouldn’t be able to return to the same ER to get more and more of the same type of prescription. So, just finding out and dedicating more time as to how they can get a new prescription, that in and of itself is a red flag. And then, overall social, work, financial, just your day to day types of activities not being as good at those as you previously were. Slacking off on your job, not being as attentive at home, and all of those types of things would be big red flags as far as addiction.

Melanie: How is it diagnosed and how would you suggest people start that conversation to get someone into a physician to get diagnosed?

Dr. Vincent: So, the diagnosis is a clinical diagnosis albeit, it is getting information as far as how someone’s behavior is and then we also get an extended history of the medication use, how long they have been using the medication, what has been done in that time period as far as what would be done to address the pain. I mean it all starts because they were given that particular medication because they had some report of pain. So, we would want to know what has been done about that, what are we doing about that and if there is anything else that we can do to treat the source of the pain, not merely blunt the pain signals from transferring. So, it’s a clinical diagnosis and then the biggest thing and kind of a good principle in all of that is it is a lot easier to stop a problem before it really begins. So, anyone that is going to start to take an opioid for a short-term period of time, or that have been prescribed that, you know what family members, the patient themselves, the doctor that is prescribing it, they should have the expectation that this should not be a long-term situation. Coming back from pain or surgery or anything that requires physical therapy, they should be encouraged to do a lot of other things that would address the pain and address the causes of the pain that they are feeling as opposed to just numbing the pain response and treating it that way because that in and of itself is not a necessary treatment.

So, some expectation management is the one big thing as far as when the prescription is first prescribed and then on the flip side, if they are already addicted, well then really just laying out the harmful effects of addiction which go into obviously death as you mentioned, being less of a functioning member of society with jobs, your family life and how all those different people they are affecting and making them aware of that and really getting on a road for detox and everything else, so they can get back to their normal lifestyle and everything.

Melanie: So, Dr. Vincent, people hear about opioids and they think about overdose, but according to a recent study in JAMA, more people are dying of heart and breathing problems caused by opioid use than accidental overdoses. What would you like the listeners to know? I mean this kind of goes back a little bit to the long-term and short-term affects of opiates, but it can cause heart problems, yes?

Dr. Vincent: Yes, it can. So, it gets a little more into the pathophysiology of it all, but essentially what occurs is you have two compartments of your nervous system. Your parasympathetic and your sympathetic nervous system. Your sympathetic is what you use when you are excited, is what you use when you exercise, it is what you use pretty much throughout the day. You are responding, you are reacting, you are doing a lot of things consciously to trigger your brain, your muscles and everything else to move. Your parasympathetic nervous system is the part of your system that you don’t necessarily think about. You don’t remind yourself to breath. You don’t remind yourself to have a heartbeat. You don’t actively do any of those things. The opioid’s act on that parasympathetic part of your nervous system and they make that - they hype your parasympathetic nervous system in the sense of they slow down everything else. So, they slow down your breathing. They slow down your heartrate. And that is when you get tolerant of a particular dose or of opioid medications in order to receive the response that one is receiving when they become addicted, they have to take more. And taking more of those opioids then slows down your heartrate that much more. It slows down your breathing that much more. And then therein lies the complications from your heart and your lungs and everything else simply because you have heightened that parasympathetic nervous system so much, that it slowed it down almost to a halt.

Melanie: And what treatment options are available today? What are you looking at to help people with this addiction and for their families to get involved as well?

Dr. Vincent: So, the treatment options. It is something that you have to – it is pretty much broken down into two parts is how the treatment option would work. One is that you have to go into an intensive detox period. And that is something where you have to slowly wean yourself off of the opioid and that is something that cannot be done abruptly simply because if you just cut it all off, cold turkey so to speak, then your nervous system and your body is going to react in a very volatile way that puts you also more at risk for heart and lung complications. So, you would have to get in an inpatient facility where they would have a medical doctor on staff and pharmacists and really have a lot of hands on deck to really monitor you as we break patients out of that acute phase of really being addicted. So, that would be a slowly weaned process. Once that process is complete, well then there is the whole counseling side to it, there’s behavior sides to it because it does become a behavior depending on how deep and how long the patient has become addicted. I am sure that they would have adapted or learned or become part of different social circles that have enabled them to maintain this addiction for an extended period of time. So, then there would be a part in that.

So, the main thing as far as where to go to get treatment, I would look at inpatient rehab first and then a large part to make sure that the rehab works and the rehab is effective and that it completely stops patients from using opioids is that there is a large counseling component to it, all of which is supervised under a medical doctor simply because they can monitor the opioids, they can monitor any other medication the patient may be taking and then obviously the behavior in and of itself would have been improved and changed for the better as that’s a large component to addiction as a whole.

Melanie: So, wrap it up for us, Dr. Vincent. What would you like the listeners to know about the opioid epidemic in this country and why they should come to Temecula Valley Hospital for their care?

Dr. Vincent: I would like everyone to know that the epidemic is very real, and it does not discriminate necessarily. I can affect anyone who has been given an opioid. And because of the power of the medications, it really is not that hard to become addicted to them. That being said, coming to Temecula
Valley Hospital for very good expectation management, having the tools and the resources and the people that are there to address your pain in a much different, safer way; these are the best ways to steer clear of that potential of that risk and it is something that is affecting a loved one or someone is happening to be addicted, then it is something that we would definitely be able to do the inpatient portion and really, really hone in and make sure the patient gets to the right place, the right facilities to really get rid of their addiction so they can go on and live a nice healthy life.

Melanie: Thank you so much Dr. Vincent, for being with us today and for such great and important information for listeners to hear. You’re listening to TVH Health Chat with Temecula Valley Hospital. For more information, please visit www.temeculavalleyhospital.com that’s www.temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.