Virginia governor declares opioid addiction crisis a public health emergency

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RICHMOND (WTVR) -– Following a recent landmark report by U.S. Surgeon General Vivek H. Murthy which equated drug and alcohol addiction with other public health crises, including smoking and AIDS, Governor Terry McAuliffe declared the Virginia opioid addiction crisis a public health emergency. A public health emergency is an event, either natural or manmade, that creates a health risk to the public and the administration feels there is a current threat to Virginia communities and the economy.

McAuliffe said the declaration came from the State Health Commissioner Marissa J. Levine, in response to the growing number of overdoses attributed to opioid use.

In 2014, for the first time in Virginia, more people died from opioid overdoses than fatal car accidents.

Dr. Levine said that on average, three Virginians die from drug overdose and more than two dozen are being seen in emergency departments every day due to drug overdose.

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Opioid painkillers capitalize on our body's natural pain-relief system. We all have a series of naturally produced keys ("ligands") and keyholes ("receptors") that fit together to switch on our brain's natural reward system — it's the reason we feel good when we eat a good meal or have sex, for example. But opioids mimic the natural keys in our brain — yes, we all have natural opioids! When they click in, we can feel an overwhelming sense of euphoria.

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Opioid painkillers can have effects similar to heroin and morphine, especially when taken in ways other than prescribed by a doctor.

When prescription painkillers act on our brain's pleasure and reward centers, they can make us feel good. More importantly, though, they can work to reinforce behavior, which in some people can trigger a repeated desire to use.

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You may also feel sleepy.

Opioids act on multiple brain regions, but when they go to work in the locus ceruleus, a brain region involved in alertness, they can make us sleepy. Why? The drugs essentially put the brakes on the production of a chemical called norepinephrine, which plays a role in arousal.

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Your skin may feel flushed and warm.

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You'll begin to feel their effects 10 to 90 minutes after use, depending on whether they're taken as directed or used in more dangerous ways.

Some drugmakers design versions of their medications to deter abuse. Extended-release forms of oxycodone, for example, are designed to release slowly when taken as directed. But crushing, snorting, or injecting the drugs can hasten their effects.

It can also be deadly. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, a report from the US Centers for Disease Control and Prevention found. The most commonly prescribed painkillers were involved in more overdose deaths than any other type of the drug.

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Your breathing will slow as well.

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Depending on the method used, the effect can last anywhere from four to 12 hours.

For severe pain, doctors typically prescribe opioid painkillers like morphine for a period of four to 12 hours, according to the Mayo Clinic. Because of their risks, it's important to take prescription painkillers only according to your physician's specific instructions.

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Overdosing can stop breathing and cause brain damage, coma, or even death.

2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths for this age group have exceeded deaths from firearms and car crashes.

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Combining them with alcohol or other drugs — even when taken according to the directions — can be especially deadly.

Since they slow breathing, combining opioid painkillers with other drugs with similar effects can drastically raise the chances of accidental overdose and death.

Yet they're often prescribed together anyway, according to the National Institute on Drug Abuse. "Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines [tranquilizers]," the institute said. In 2011, 31% of prescription opioid-related overdose deaths involved these drugs.

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Abusing opioid painkillers has been linked with abusing similar drugs, like heroin.

A CDC report found that people who'd abused opioid painkillers were 40 times as likely to abuse heroin compared with people who'd never abused them. The National Institute on Drug Abuse says that close to half of young people surveyed in three recent studies who'd injected heroin said they'd abused prescription painkillers before they started using heroin.

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You may also develop a tolerance for the drugs so that you need more to get the same effect over time.

Tolerance to opioid painkillers happens when the brain cells with opioid receptors — the keyholes where the opioids fit — become less responsive to the opioid stimulation over time. Scientists think that this may play a powerful role in addiction.

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Suddenly stopping the drugs can result in withdrawal symptoms like shakiness, vomiting, and diarrhea.

Taking prescription painkillers for an extended period increases the likelihood that your brain will adapt to them by making less of its own natural opioids. So when you stop taking the drugs, you can feel pretty miserable. For most people, this is uncomfortable but temporary.

But in people who are vulnerable to addiction, it can be dangerous because it can spurn repeated use.

"From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors," Yale psychiatrists Thomas Kosten and Tony George write in a 2002 paper in the Journal of Addiction Science & Clinical Practice.

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The number of emergency visits for heroin this year increased 89% in the first nine months compared to 2015. Levine added that fatal opioid overdoses are expected to increase by 77% compared to five years ago.

There were 4,036 deaths in the Commonwealth related to prescription opioid overdoses, from 2007-2015, according to the Virginia Hospital and Healthcare Association. Those numbers are part of a larger epidemic, according to the Centers for Disease Control, who said that 61 percent of U.S. drug overdose deaths in 2014 involved some type of opioid and resulted in 28,647 deaths.

State officials also expressed concern over evidence that Carfentanil, the highly dangerous synthetic opioid used to sedate large animals such as elephants, is being sold in Virginia, mainly in the Tidewater region.

Dr. Levine said Carfentanil is 10,000 times more potent than morphine and 100 times more potent than fentanyl.

"Too many families across Virginia and the nation are dealing with heartbreak and loss as a result of prescription opioid and heroin abuse epidemic," said Governor McAuliffe. "That is why I support Dr. Levine's decision to declare a public health emergency, to heighten awareness of this issue, provide a framework for further actions to fight it, and to save Virginians' lives."

Standing order makes life-saving drug available without prescription

Dr. Levine has issued a standing order that allows all Virginians to obtain the drug Naloxone, which can be used to treat narcotic overdoses in emergency situations.

The price will remain high, officials said, but "broadens our ability to get life-saving medication into Virginians' hands."

Officials also encouraged families to "take stock of their health and well-being" this Thanksgiving.

"Too many Virginia families have lost someone to opioid addiction," Levine said. "These actions today will not diminish their loss, but we owe it to them and each other to work together, watch out for each other and continue to combat the seriousness of this crisis."
Health officials also said that though it is difficult to know what to do when someone close to you is facing addiction, but there are simple things every Virginian can do to help those around them:

  • Know the signs of addiction and substance use: Signs of recent opioid use include pinpoint pupils, sleepiness, "nodding" and scratching. Common signs of addiction include constant money problems; arrests; track marks and infections from needle use; lying about drug use; irritability and, when drugs can't be obtained, physical withdrawal symptoms such as shaking, dilated pupils, nausea, diarrhea and vomiting.
  • Talk to your loved ones: If you suspect that your friend or family member is struggling with addiction and substance use, talk with them. The state's new website VaAware (http://vaaware.com/treatment-recovery/) offers resources on how to best discuss addiction with someone you love.
  • Properly dispose of medications: If you have unused, expired or unwanted medications and need a way to safely dispose of them, you can now get a drug disposal bag from your Local Health Department. The bags allow for you to safely deactivate and dispose of medications in the privacy of your own home. Additionally, you may return unwanted prescription drugs for destruction to one of the authorized pharmacies listed at dhp.virginia.gov/pharmacy/destructionsites.asp. Some local law enforcement agencies also collect and destroy unwanted drugs.
  • Obtain Naloxone: If someone in your life is struggling with opioid addiction, visit your local pharmacist to obtain Naloxone and keep it on hand for possible overdose emergencies. Naloxone is a medication that can reverse an overdose that is caused by an opioid drug (i.e. prescription pain medication or heroin). When administered during an overdose, naloxone blocks the effects of opioids on the brain and restores breathing within two to eight minutes. Naloxone has been used safely by medical professionals for more than 40 years and has only one function: to reverse the effects of opioids on the brain and respiratory system in order to prevent death. Family members and friends can access this medication by obtaining a prescription from their family doctor or by visiting a participating pharmacy that can dispense the drug using the standing order issued by Dr. Levine. More information on Naloxone can be found at getnaloxonenow.org.
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