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Anatomy of an Opioid Overdose

By: Jason Plichta


To say it is an “epidemic” is a vast understatement given the facts seen in, for purposes of this article, the United States.


What is an opiate? According to Merriam Webster, an Opiate is “a drug…containing or derived from opium and tending to induce sleep and alleviate pain.” I think A layman definition would be “something that ruins and takes lives, because users can become addicted way too easily.” They do not just go after the poor, the rich, the white, the black, those that have been lifetime drug users, or those just starting off. There is no “group,” no “stereotype” of an opiate user. The opiate user could be a construction worker who hurt his back on the job and ran out of Vicodin, it could be a long time cancer patient who is now in remission but still wants an OxyContin high. Line up a group of people and you will notice one similarity: they are all different.


Some commonly used opiates: (1)


- Morphine and Codeine – Naturally derived from opium poppy plants

- Heroin – Synthesized drug from Morphine

- Hydrocodone and Oxycodone – Semi-synthetic manufactured in labs with both natural and synthetic ingredients

- Fentanyl – Fully synthetic opioid; 100 times more powerful than morphine

- Methadone – Fully synthetic opioid; given to recovering heroin addicts to help with withdrawals


According to the Centers for Disease Control during 2017, it is estimated that over 72,000 overdose deaths occurred. Of those deaths, over 49,000 involved an opioid drug (2). The Department of Health and Human Services (DHHS) states that more than 130 people died a day, from opioid overdoses in 2016 and 2017. During that same time 11.4 million Americans misused prescription medications (3).


According to the DHHS records dating back to 1990 is when opioid pain relievers began being prescribed at higher numbers, as the “pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers (4).” Unfortunately once these prescriptions were given out, they began to get misused due to their seemingly “positive” effects on the user. The emerging downfall of this misuse is that when those who needed more OxyContin or Vicodin were unable to get it from their doctors, they got it from their friends and families. However, once those resources could not get them, people tried getting those medications in the streets. What further complicates and exacerbates the issue is that those medications are not as easily found on the streets as in the pharmacy. However, heroin, and the even more potent fentanyl and carfentanil, are easier to get and less expensive.


In 2017 there was a public health emergency announced by the DHHS as a result of the downfall of individuals using and abusing opiates. Below are the results of studies on opioid use in the United States. Take a look at the numbers and decide for yourself if it really is a problem.








In 2016 there were more than 42,000 deaths, with roughly 40% involving prescription opioids which is up from approximately 21,000 in 2010 (6).


As a police officer for over 10 years there were many times I was dispatched to calls involving someone who had overdosed on an opioid. The problem police officers face is that, from my experience, these “Opioid Overdoses” need to be reclassified into “Heroin” or “Fentanyl” overdoses. I cannot recall an overdose I was sent to in which it was a prescription opioid.


In 2008 there was a drastic difference in how I, as an officer, was able to respond to an “opioid” overdose. I remember being sent to my first overdose call at a house where my partner and I were the first ones to arrive, beating the ambulance. When we were taken to an upstairs bathroom we found a younger woman lying on the floor with no shirt on. Her friends had tried to cool her off in the shower, after her heroin injection before calling 911. All my partner and I could do at that time was to try CPR. Fortunately in this instance, rescue came in not long after us. The hard part of the story is that this woman ended up dying. When it was time to make the notification to family I learned that the woman had just been released from an inpatient drug treatment, and this was reportedly her first time using heroin after getting out.


Fast forward to 2017, I received a call for a reckless driver who was all over the road on a major thoroughfare through the county I worked in. This driver was unable to stay in his lane and even struck the center median barrier. After locating the vehicle stopped in the lane of traffic, my partner and I approached the vehicle, rescue was still enroute. In the vehicle was a single occupant in the driver’s seat who was unresponsive with shallow and infrequent breaths. After getting my AED and first aid kit, I was able to deploy a tool that nine years ago I did not have, Naloxone.


Naloxone is known as an opioid antagonist, which means it temporarily “reverses” the effects of opioid use/overdose. It does this by binding itself to the opioid receptors in the brain. When this occurs, it thus blocks the opioids from being absorbed. As such, this “blocking” allows the subject who has overdosed to stop the continued absorption of the opioid. This usually takes place within minutes after the Naloxone is dispensed to the subject. Sometimes multiple doses need to be used on a subject, depending on how their body reacts to each continued dose as well as being based on what they may have taken. While Naloxone is not a cure-all, this does give the body (for a period of time)a chance to come back out of the overdose until further medical treatment can be attained, or until more Naloxone is needed.


Going back to the call, while my partner was trying to talk with the subject, I prepared what turned out to be, life-saving doses of Naloxone. I was able to administer one dose of Naloxone into the subjects nose (we had the nasal dispensers). After the first dose, there was no change in the man. A second dose was administered, and ultimately a third dose. It was not until after the third dose that the man started to come out of his overdose status. Rescue in the meanwhile was pulling up and took over from there. Rescue later confirmed, as I did with the man at the hospital, it was an opioid overdose. This man, much like the woman who was not so lucky many years ago, was just released from prison and was a long time heroin addict who needed another fix, which was almost ended up being his last.


As I stated earlier, the only similarity between these two people was that they were different. One was a young white female, and the other was an older black male. Both were addicted to the same kinds of drugs. Drugs are an equal opportunity life-changer.


A life saved in 2017 thanks to Naloxone was only one of the plethora of lives saved throughout the United States. I am not advocating for this drug, I am merely showing a couple things:


1) Its use can save lives

2) Per the DHHS, they recommended to clinicians that Naloxone be prescribed with opiates to patients and that risks associated with the drugs, and how to use Naloxone, be talked about with those patients (7)

3) There are trainings people can get in order to aid those going through overdoses


What are signs of an overdose? Here are a few*:


1) Slow or Shallow breathing

2) Unconscious/difficulty waking up

3) Blue/purple fingernails

4) Cold, clammy skin


*these are not all-inclusive of what you may see on an overdose patient. (8)


Opioid use is more than just an epidemic, it is something that is literally reshaping the world. What were once used as medications to heal are now going past that and are being used, in basic terms, because people cannot get past the “healing” and need that continued feeling. It is a slippery slope that those addicted to opioids are on and unfortunately it is one that there does not seem to be much headway being made on fixing the addictive nature of the drug, but rather is focusing on “fixing” what happens after someone has already gone too far.

To say it is an “epidemic” is still a vast understatement.


References

[1] CNN (Opioid Crisis Fast Facts)

[2] Center for Disease Control

[3] Department of Health and Human Services

[4] Department of Health and Human Services

[5] (Image) “What is the U.S. Opioid Epidemic” - Department of Health and Human Services

[6] Department of Health and Human Services

[7] Department of Health and Human Services

[8] Drug Recognition Matrix; SAMHSA Opioid Prevention Toolkit

About the Author

Jason Plichta has been a police officer over 10 years. He became certified as a Drug Recognition Expert (DRE) in 2013 and an instructor in 2015, and was the first DRE ever at his original agency, the Lake County Sheriff's Office in Illinois. His primary focus was on impaired drivers and crash investigations. Jason Led the department in DUI arrests over many years while there.

Jason recently transferred to an agency in southern Illinois where he continues to try and focus on impaired drivers in order to get them off the roads to make everyone's travel safer.

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