Legal Opioids More Restricted, But Heroin Abuse Grows

WHEELING — It’s the “catch-22” of contemporary medicine: As access to legal opioids is restricted, drug users turn to dangerous illegal substances, such as heroin, with potential deadly results.

To reduce misuse of narcotics, prescription painkillers have been reformulated and hospitals and doctors have adopted restrictive prescribing guidelines for opioids. Improper “pill mills” have been shuttered across the country, cutting off addicts from a supply of legal opioids.

A side effect of these efforts, though, is that people have turned to heroin, and bad batches of illegal substances have led to many overdoses.

“Unfortunately, heroin has emerged as dirt cheap … Heroin come on like a scorching plague, nationally, in the Ohio Valley, in West Virginia. The deaths have been very sadly alarmingly high and rising,” said Dr. Angelo Georges, chief medical officer at Wheeling Hospital.

The street price for opioids skyrocketed as pill-pushing doctors were put out of business. “Heroin filled the gap because it’s so cheap and plentiful. It’s an awful catch-22. We try to do one thing right and then another scourge comes in,” Georges said.

Dr. Neal Aulick, who practices emergency medicine at Ohio Valley Medical Center, said, “We’re doing excellent job of controlling legal narcotics, but people are turning to illegal substances.”

He said OVMC has seen an increase recently in the number of people being treated for drug overdoses. “Usually, there are one or two overdoses a day at least. It’s been gradually getting a little bit worse,” he said.

Aulick attributes the trend to users switching from abusing prescription drugs to heroin, which is cheaper but more dangerous. “Quality control isn’t there” with heroin and other street drugs, he said.

Lacing heroin with fentanyl “supposedly increases the buzz,” Georges said, but warned, “Fentanyl is a very, very dangerous drug anyways. To mix it with heroin, you might as well be putting a gun to your head.”

Mixing heroin with fentanyl and horse tranquilizers leads to more overdoses, and it can be a fatal combination. “We don’t know what it’s cut with it — narcotics and other substances. It’s something else we have to treat differently,” Aulick said.

If a person takes an overdose of a legal opioid, emergency room doctors know the general composition and strength of the medication and can treat the patient accordingly. Even in that situation, Aulick said, “We have to be careful. We never trust that the patient is telling us exactly what they took. We have a standard protocol to make sure we catch things.”

Some prescription painkillers, such as Percocet, contain acetaminophen, which can be harmful in excess. “If you take enough acetaminophen, it will kill your liver. You will go into liver failure,” he said.

At EMSTAR, “we haven’t lost anybody,” he said. “Most of the time, EMS does an excellent job and revives them in the field.”

Emergency medical technicians and other trained personnel can administer naloxone (Narcan) to a person who has overdosed to stimulate their respiratory system to start breathing again. However, when a person overdoses on extra-strong heroin, “that dose of Narcan is not going to be enough. They go back into respiratory depression and back to where they started,” Aulick said.

It’s important, then, for such patients to receive more Narcan and additional treatment. Aulick said, “We have to observe these people in a health care setting for six to 12 hours to make sure it’s cleared their system.”

Narcan puts a person who has overdosed into immediate withdrawal. “It can be pretty dramatic when that happens,” Aulick said. “It’s a little better in a hospital; it’s a little more dangerous for EMS workers.”

Patients’ responses to surviving overdoses vary. “For some people, it’s a wake-up call. We offer everyone services through Hillcrest or Northwood or outpatient treatment,” Aulick said, adding, “Access is a huge problem. There are not enough resources.

“Occasionally, we will get people who want to get help for their drug addiction. Frequently, we get people who just wake up and leave. They don’t want any help,” the OVMC physician said.

Georges said, “Yes, more people are getting treatment … (but) the volume of heroin users has escalated.

“It’s a difficulty,” Georges said. “They have drug courts, which are fantastic, in West Virginia. The drug courts can order you into treatment. They’ve been very, very helpful. But, as a whole, they (addicts) do their mandatory stuff and then walk out and use again.”


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