Halting the
Opioid Crisis 2024
The Nation is in the midst of an unprecedented opioid epidemic. More than 136 people a day die from opioid-related drug overdoses.
Mental Illness, including addiction, is difficult to handle without a caring and compassionate treatment provider to offer support and guidance. At New Beginning Recovery, LLC we treat the mental challenges that fuel the underlying symptoms of addiction. We support and guide you through your journey with us to become who you want to be.
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what are opioids? Opioids include prescription medications used to treat pain such as morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone, and buprenorphine, as well as illegal drugs such as heroin and illicit potent opioids such as fentanyl analogs (e.g., carfentanil). Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract. In doing so, they diminish the body’s perception of pain. However, opioids can also have an impact on other systems of the body, such as altering mood, slowing breathing, and causing constipation. Opioid receptor binding causes the signs and symptoms of overdose as well as the euphoric effects or “high” with opioid use.
WHO IS AT RISK? Anyone who uses opioids for long-term management of chronic pain is at risk for opioid overdose, as are individuals who use heroin or misuse prescription pain relievers. Others at risk include those who: •
Are receiving rotating opioid medication regimens (and thus are at risk for incomplete cross-tolerance).
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Have been discharged from emergency medical care following opioid overdose.
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Need opioid pain relievers, coupled with a suspected or confirmed substance use disorder or history of non-medical use of prescription opioids or use of illicit opioids.
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Have completed opioid detoxification or are abstinent for a period of time (and presumably have reduced opioid tolerance and high risk of return to opioid use).
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Have been recently released from incarceration and have a history of opioid use disorder or opioid misuse (and presumably have reduced opioid tolerance and high risk of return to opioid use).
Types of Opioids: Some opioid drugs are made from naturally occurring plant compounds (alkaloids) that come from a specific type of poppy plant called an opium poppy. Other opioid drugs are synthetic, meaning they are humanmade substances created in a laboratory. Or, an opioid drug may contain both naturally derived and synthetic ingredients, including other drugs. samhsa.gov
Understanding the Epidemic Nearly 645,000 people died from overdoses involving any opioid, including prescription and illicit opioids, from 1999-2021. This rise in opioid overdose deaths can be outlined in three distinct waves. •
The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.
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The second wave began in 2010, with rapid increases in overdose deaths involving heroin.
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The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.
WHAT IS NALOXONE? Naloxone is an antidote to opioid overdose. It is an opioid antagonist that is used to reverse the effects of opioids. Naloxone works by blocking opioid receptor sites. It is not effective in treating overdoses of benzodiazepines, barbiturates, clonidine, GHB, or ketamine. It is also not effective in treating overdoses of stimulants such as cocaine and amphetamines (including methamphetamine and MDMA). However, if opioids are taken in combination with other sedatives or stimulants, naloxone may be helpful. Suspected fentanyl-involved overdoses should be treated with naloxone.17 However, because of the higher potency of fentanyl and fentanyl analogs compared to that of heroin, larger doses of naloxone may be required to reverse the opioid-induced respiratory depression from a fentanyl-involved overdose.11,15,17 Quicker oxygenation efforts and naloxone delivery may be warranted compared to heroin-only overdose. cdc.gov
Selecting Opioids and Determining Opioid Dosages
How does overdose occur? A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea and vomiting, severe allergic reactions (anaphylaxis), and overdose, in which breathing and heartbeat slow or even stop. Opioid overdose can be due to many factors. For example, overdose can occur when a patient deliberately misuses a prescription, uses an illicit opioid (such as heroin), or uses an opioid contaminated with other even more potent opioids (such as fentanyl). Overdose can also occur when a patient takes an opioid as directed but the prescriber miscalculated the opioid dose, when an error was made by the dispensing pharmacist, or when the patient misunderstood the directions for use. It can also occur when opioids are taken with other medications— for example, prescribed medications such as benzodiazepines or other psychotropic medications that are used in the treatment of mental disorders— or with illicit drugs or alcohol that may have adverse interactions with opioids. At particular risk are individuals who use opioids and combine them with benzodiazepines, other sedative hypnotic agents, or alcohol, all of which cause respiratory depression. samhsa.gov
When initiating opioids for patients with acute, subacute, or chronic pain, clinicians should: •
Prescribe the lowest effective dosage for opioid-naïve patients.
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Prescribe immediate-release opioids instead of extendedrelease/long-acting (ER/LA) opioids.
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Reserve ER/LA opioids for severe, continuous pain and only consider for patients who have received certain dosages of immediate-release opioids for at least one week. samhsa.gov
Recognizing an Opioid Overdose Signs of OVERDOSE, which often results in death if not treated, include: •
Unconsciousness or inability to awaken.
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Slow or shallow breathing or breathing difficulty such as choking sounds or a gurgling/snoring noise from a person who cannot be awakened.
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Fingernails or lips turning blue/purple.
If an opioid overdose is suspected, stimulate the person: •
Call the person’s name.
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If this doesn’t work, vigorously grind knuckles into the sternum (the breastbone in middle of chest) or rub knuckles on the person’s upper lip.
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If the person responds, assess whether he or she can maintain responsiveness and breathing.
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Continue to monitor the person, including breathing and alertness, and try to keep the person awake and alert.
If the person does not respond, call 911, provide rescue breathing if the person is not breathing on their own, and administer one dose of naloxone. samhsa.gov
How to Help Someone with Opioid Disorder We can all do our part to help Hoosiers affected by this disease. Here are five ways you can help: See the Person: Choosing to see the person, not just their addiction is the first step to ending the stigma around substance use disorder. When we reduce negative perceptions around the disease, people feel more comfortable seeking treatment. Start the Conversation: We give less power to shame and stigma when we speak up. Maybe you have a friend who is struggling with an addiction. Maybe a loved one doesn’t understand that addiction is a disease. Talk to them — you never know where a conversation could lead. Help Find Treatment: Does someone in your life have a substance use disorder? Without trying to fix the problem or force them into recovery, try talking to them about treatment options. Support those Living in Recovery: There are a lot of ways you can support Hoosiers living in recovery. Increase your knowledge about different substance use disorders, volunteer your time at recovery organizations, go to a support group meeting with a loved one, or attend local events.
Synthetic Opioids Fact sheet WHAT ARE SYNTHETIC OPIOIDS?
What do they look like?
Synthetic opioids are substances that are synthesized in a laboratory and that act on the same targets in the brain as natural opioids (e.g., morphine and codeine) to produce analgesic (pain relief) effects. In contrast, natural opioids are naturally occurring substances extracted from the seed pod of certain varieties of poppy plants. Some synthetic opioids, such as fentanyl and methadone, have been approved for medical use. Clandestinely produced synthetic opioids structurally related to the Schedule II opioid analgesic fentanyl were trafficked and abused on the West Coast in the late 1970s and 1980s. In the 1980s, DEA controlled several of these illicitly produced synthetic opioids such as alpha-methylfentanyl, 3-methylthiofentanyl, acetyl-alpha-methylfentanyl, beta-hydroxy3-methylfentanyl, alpha-methylthiofentanyl, thiofentanyl, beta-hydroxyfentanyl, parafluorofentanyl, and 3-methylfentanyl. As of 2013, there has been a re-emergence inthe trafficking and abuse of various clandestinely produced synthetic opioids, including several substances related to fentanyl. Some common illicitly produced synthetic opioids that are currently encountered by law enforcement include, but are not limited to, acetyl fentanyl, butyryl fentanyl, beta- hydroxythiofentanyl, furanyl fentanyl, 4-fluoroisobutyryl fentanyl, acryl fentanyl, and U-47700.
Clandestinely produced synthetic opioids have been encountered in powder form and were identified on bottle caps and spoons, detected within glassine bags, on digital scales, and on sifters which demonstrates the abuse of these substances as replacements for heroin or other opioids. These drugs are also encountered as tablets, mimicking pharmaceutical opioid products. Clandestinely produced synthetic opioids are encountered as a single substance in combination with other opioids (fentanyl, heroin, U-47700) or other substances.
What is Their Origin?
What are their overdose effects?
Synthetic opioids are believed to be synthesized abroad and then imported into the United States.
How are they abused? Abuse of clandestinely produced synthetic opioids parallels that of heroin and prescription opioid analgesics. Many of these illicitly produced synthetic opioids are more potent than morphine and heroin and thus have the potential to result in a fatal overdose.
What are their effects? Some effects of clandestinely produced synthetic opioids, similar to other commonly used opioid analgesics (e.g., morphine), may include relaxation, euphoria, pain relief, sedation, confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.
Overdose effects of clandestinely produced synthetic opioids are similar to other opioid
analgesics. These effects may include stupor, changes in pupillary size, cold and clammy skin, cyanosis, coma, and respiratory failure leading to death. The presence of triad of symptoms such as coma, pinpoint pupils, and respiratory depression are strongly suggestive of opioid poisoning.
Which drugs cause similar effects? Some drugs that cause similar effects include other opioids such as morphine, hydrocodone, oxycodone, hydromorphone, methadone, and heroin.
What is their legal status in the United States? Many synthetic opioids are currently controlled under the Controlled Substances Act. The DEA temporarily placed U-47700 and several other substances that are structurally related to fentanyl, such as acetyl fentanyl, butyryl fentanyl, beta-hydroxythiofentanyl, and furanyl fentanyl, in Schedule I of the Controlled Substances Act. In February 2018, the DEA temporarily placed fentanylrelated substances in Schedule I of the CSA. Other synthetic opioid substances may be subject to prosecution under the Controlled Substance Analogue Enforcement Act which allows non-controlled substances to be treated as Schedule I substances if certain criteria are met. The DEA has successfully investigated and prosecuted individuals trafficking and selling these dangerous substances using the Controlled Substances Analogue Enforcement Act. www.dea.gov
New action taken to increase naloxone access in federal facilities D
uring his first State of the Union Address, President Biden announced beating the overdose epidemic as one of the four pillars of his Unity Agenda. Since then, the administration has worked to strengthen not only the whole-of-government response, but the whole-of-society response to address this public health and safety crisis head-on, noting the critical role housing providers play in ensuring that all public spaces have lifesaving medications on-hand with people trained to use it. In support, the U.S. Department of Health and Human Services (HHS) and the General Services Administration (GSA) announced a new guidance recommending that all federal facilities across the nation include overdose reversal medications on-site in their safety stations. The recommendation will make lifesaving medications like naloxone more readily available in case of an emergency. The updated guidelines expanded the concept of an automated external defibrillators (AED) program by introducing the “safety station,” which would enable anyone located within a federal facility to access the necessary tools quickly and easily to respond to an emergency. Also under the new guidance, anywhere that an AED was previously located can and should be converted to a safety station. Each safety station is recommended to include an AED and supporting equipment at a minimum. It is now highly recommended that each station also includes either a bystanderempowered opioid reversal agent or hemorrhagic control component – or both. Earlier this year, the FDA also approved certain naloxone nasal sprays for non-
prescription, over-the-counter purchase. Now, for the first time ever, naloxone is available at grocery stores and pharmacies across the country. Other opioid overdose reversal medications are also available with a prescription and may be covered by health insurers. Expanding access to overdose reversal medications is a key part of President Biden’s National Drug Control Strategy, and the Biden-Harris Administration has taken historic action over the past three years to deliver on this priority. It has invested historic amounts of funding in the State Opioid Response (SOR) grant program for states and Tribes to make overdose-reversal medications available to their residents at no cost. It supports HHS’s Overdose Prevention Strategy, which is designed to address the overdose crisis by increasing access to the full continuum of care and services for people who use substances that cause overdose, including increasing availability of overdose-reversal medications. Using federal SOR grant dollars, states have purchased nearly 9 million naloxone kits and helped reverse more than 500,000 overdoses. The ONDCP, HHS and the U.S. Department of Housing and Urban Development (HUD) called on public health departments and health care systems to partner with housing providers, community-development organizations and other housing agencies to help expand access to naloxone and other life-saving overdose reversal medications in the communities they serve. The ONDCP also teamed with the U.S. Department of Education for schools and educators to have overdose reversal medications on-site, and ensure their students and faculty are trained to use it in the event a drug poisoning or
overdose occurs. Over the past three years, the administration has taken historic action to increase access to this lifesaving tool, including: •
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Convening U.S. drug manufacturers who have FDA-approved overdosereversal medications to discuss ways to increase access and affordability. Launching a campaign to educate young people on the dangers of fentanyl and the lifesaving effects of naloxone with the Ad Council Facilitating the availability of naloxone to harm-reduction organizations to support expanded public access to this critical medicine Supporting states through enhanced technical assistance, policy academies and convenings to ensure existing State Opioid Response funds are used to saturate hard-hit communities with naloxone Delivering funds directly to states so they can purchase opioid overdose reversal medications Calling for an additional $100 million for harm-reduction services, like naloxone, in the FY24 budget request. hhs.gov
Addiction Overdose Anyone who takes prescription opioids can become addicted to them. In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. Once addicted, it can be hard to stop. In 2016, more than 11.5 million Americans reported misusing prescription opioids in the past year. Taking too many prescription opioids can stop a person’s breathing—leading to death. Prescription opioid overdose deaths also often involve benzodiazepines. Benzodiazepines are central nervous system depressants used to sedate, induce sleep, prevent seizures, and relieve anxiety. Examples include alprazolam (Xanax®), diazepam (Valium®), and lorazepam (Ativan®). Avoid taking benzodiazepines while taking prescription opioids whenever possible.
Help prevent opioid-related overdose Recognizing an Opioid Overdose Recognizing an opioid overdose can be difficult. If you aren’t sure, it is best to treat the situation like an overdose—you could save a life. It is important that you don’t leave the person alone and make sure you call 911 or seek medical care for the individual. Signs may include any of the following:
Small, constricted “pinpoint pupils” Falling asleep or loss of consciousness Slow, shallow breathing Choking or gurgling sounds Limp body Pale, blue, or cold skin
Do you know what you can do to help? Learn more about opioids so you can help people who are most at risk for opioid use disorder and overdose in your community. Provide tools and information for health care professionals working on overdose prevention and treatment. Help those struggling with opioid use disorder find the right care and treatment. Increase awareness and share best practices with providers and patients in your community. As a patient, a health care provider, or a member of a community you can ensure that the best information is being shared and understood to prevent overdose deaths.
How to Find Opioid Treatment Programs Help is available to successfully overcome opioid addiction. Research shows that, for some people, the integration of both behavioral and pharmacologic (medical) types of treatment is the most effective approach for overcoming opioid addiction. A common misconception is that medications used in medication-assisted treatment (MAT) substitute one drug for another. The National Institute of Drug Abuse (NIDA) provides a helpful fact sheet summarizing effective treatment options for opioid addiction.
For a list of recovery groups in Jackson County, visit: www.jacsy.org/ treatment-recoveryresources HHS.GOV/OPIODS
Centerstone implementing mobile opioid crisis response team in Jackson County
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rug addiction and overdoses continue to take lives and destroy families. The opioid crisis has taken its toll here and across the state, but communities are not giving up. Centerstone, a local not-for-profit health care organization providing mental health and substance abuse treatment, education and support in Indiana and several other states, is bringing a new resource to Jackson County. By developing and implementing a mobile opioid crisis response team here, the agency wants to meet people where they are and help them get where they want and need to be, said Amanda Grella, program manager for the opioid crisis response team at Centerstone of Indiana. The team is responsible for engaging community members, including law enforcement, health care workers and clergymen, to make referrals for anyone who has experienced a drug overdose and has been administered the opioid overdose reversal medication naloxone, commercially known as Narcan.
Once the referral is made, Centerstone then provides recovery coaches and community-based access to services to support recovery. Recovery coaches are people who guide and support a person in recovery to help prevent relapses. Oftentimes, they are former drug and alcohol users who are now clean and sober but truly understand how hard recovery can be. Staff take an active role to provide counseling, coaching, sponsorship and connection to recovering addicts. Recovery coaches can help clients find transportation to treatment and work with them to get proper insurance coverage to help pay for addiction treatment services. “These recovery coaches talk to the clients to figure out where a person is and where they want to be on their recovery journey and works with them to get there,” Grella said. Contact is to be made with the clients within 24 to 72 hours of their overdose to reach people when they are most vulnerable and receptive to help. Once they are willing to accept that help, Centerstone sets up a meeting between the client and
one of its therapists. There also is a nurse practitioner on staff that can help with medication-assisted treatment if appropriate and recommended. Funded through the 21st Century Cures Act, Centerstone’s opioid crisis response team also serves Bartholomew, Brown, Jennings, Lawrence, Morgan and Monroe counties. Centerstone provides its communities with materials about substance abuse and recovery and access to its 24-hour hotline and other ways for people to reach out for help. According to data from Indiana’s NextLevel Recovery initiative, Jackson County had 90 opioid prescriptions per 100 people in 2016, higher than the state average of 84. Grella said Centerstone is not stepping in to take over for the Jackson County Drug-Free Council and Jackson County United Way’s United Against Drugs initiative but is working with those groups to make an impact and bring more people to recovery. “Jackson County is poised and ready to take action, so it’s the perfect time for us to partner with local stakeholders and help,” she said. IN-35156547
Addiction is a chronic illness. It destroys families, ends careers and ruins lives. But there is hope. There are comprehensive, effective treatments including outpatient, residential treatment and recovery housing available at Centerstone. Centerstone utilizes Medication Assisted Treatment (MAT), the use of medications in combination with counseling and behavioral therapies to treat substance use disorders. Our programming uses evidence-based individual and group therapy paired with recovery coaching.
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We can help with your mental health, addiction and counseling needs. Call 1-877-HOPE123 (1-877-467-3123) or visit www.centerstone.org
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