Upper St. Clair program addresses U.S. opioid epidemic
Joann Seigel demonstrates how to admininster the intramuscular form of naloxone during the May 11 program about opioids held at the Community and Recreation Center at Boyce Mayview Park in Upper St. Clair.
Michael Zemaitis, professor at the University of Pittsburgh School of Pharmacy, speaks about “The Opioid Epidemic in the U.S.”
Naloxone products
As is the case with legitimate businesses, heroin dealers tend to label the stamp-sized bags they sell with the names and logos of certain “brands,” if you will.
For example, they might be called “Black Boot” or “Peace of Mind,” as some packets making the rounds in Washington County recently were marked. And sometimes, a particular brand causes multiple overdose deaths, often when the heroin is laced with the synthetic drug fentanyl.
“Other abusers immediately go to that dealer and try to get it,” Michael Zemaitis said about the lethal blend, “because the idea is ‘fly high or die.’ They push it to the absolute limit.”
Zemaitis, a professor at the University of Pittsburgh School of Pharmacy, presented an overview of such eye-opening information during a May 11 program on “The Opioid Epidemic in the United States,” held in partnership with the Upper St. Clair Youth Steering Committee.
Joining him was Joann Seigel, director of pharmacy operations for Washington-based Curtis LTC Pharmacy Services, who spoke about the growing availability and use of the overdose antidote naloxone.
From a historical perspective, Zemaitis pointed to the 1990s as a “perfect storm” of circumstances that led to a spike in the use of opioids, the term used for all drugs that are derived from opium.
While the Federal Drug Administration “didn’t see these drugs for what they truly are” – as Dr. David Kessler, head of the FDA from 1990-91, has admitted – certain organizations were stepping up the promotion of pain management.
“That really led to patient involvement, patient entitlement, going to the physician and saying, ‘I have pain. I don’t want to have pain. Give me something.’ The easiest thing to do was give them a morphine-like product, such as hydrocodone,” Zemaitis explained, referring to an opioid synthesized from codeine.
He said that the introduction around the same time of Oxycontin, a sustained-released tablet that was “marketed to physicians as a nonaddictive opioid,” helped lead to the situation this country faces today.
“The United States has about 5 percent of the world’s population, and we use 80 percent of the opioids produced in the world, and 99 percent of the hydrocodone,” Zemaitis said.
At some pharmacies, he said, 80 percent of the prescriptions filled involve controlled substances.
“The prescribing of opioids in the United States from 1999 until now has quadrupled, as have opioid deaths,” he continued. “Currently, about 80 people a day die in the United States of an opioid overdose. I can guarantee you that if 80 people a day were dying of the Zika virus or bird flu, something like that, there would be an absolute outcry from politicians and others.”
As it stands, law enforcement agencies – Zemaitis has worked with federal and local task forces – join lawmakers and the medical community in continuing to work toward addressing issues regarding prescription drugs.
“The consequence of this has been that prescription opioids are getting more expensive on the street,” Zemaitis said, citing the example of Oxycontin often selling for $1 per milligram, or $30 for a 30-milligram tablet. “Very tolerant users will take a half dozen, eight or 10 of those a day.”
As an alternative, they often can buy what is sold as heroin at a fraction of the price, which in turn leads to a growing number of overdoses.
That’s where naloxone enters the picture, as a substance with the sole purpose of reversing the effects of an opioid overdose, according to Seigel.
“It brings back breathing in two to four minutes. There are no side effects. It is not habit-forming,” she explained.
Seigel, an Upper St. Clair resident whose company works with treatment centers and halfway houses, said the availability of naloxone has grown in Pennsylvania since the passage of Act 139 of 2014, which addresses drug overdose prevention.
“It allows first responders the ability to inject naloxone into someone who is experiencing an opioid overdose,” Seigel said. “It also allows individuals who are friends, relatives, family members of someone who has an opioid problem the ability to get naloxone.”
The legislation also provides immunity from prosecution for those who assist overdose victims.
Pennsylvania also has a standing order for naloxone from Dr. Rachel Levine, the state’s physician general.
“It is a prescription that is written for the general public rather than a particular individual,” Seigel said. “The pharmacist is now permitted to dispense naloxone to you without a prescription.”
The substance can be administered by intranasal spray or intramuscular injection, and pharmacists provide training on proper use.
Lists of pharmacies at which naloxone is sold are available at www.overdosefreepa.pitt.edu/, a site that also includes substantial information and data about overdoses and their prevention, and at www.pppgh.org/.