MAYHEM AND MYTHS SURROUNDING OPIOID TREATMENT.

• Author: Strach, Patricia
• Position: MEDICINE & HEALTH

WHEN WE FIRST started this project in November 2017, we had little knowledge of opioids beyond the basic understanding that they were responsible for the current public health crisis. As political scientists, we wanted to know how opioids affect local communities and what government was doing about it.

To date, we have conducted more than 100 interviews with doctors, nurses, social workers, lawyers, peer advocates, activists, people in recovery, and more. We have listened to people talk about the challenges rural communities face (like limited transportation and fewer treatment options) and how people navigate their way around them (for example, by leveraging the criminal justice system to get loved ones into treatment).

We have learned a lot just by speaking with individuals in their communities but, like us, many still have questions about what kinds of treatment are the most effective and where to go for help. There are a number of myths surrounding drug use and abuse. Here, we look at five of them:

You cannot die from opiate withdrawal. When people dependent on opioids go to the hospital for detox, they often are turned away on the grounds that withdrawal will not kill them. "There's no real danger coming off of heroin," one hospital social worker explained. However, "when it's alcohol and benzos... chances are we are probably going to admit."

When people suddenly decrease or stop consuming either alcohol or benzodiazepines--psychiatric medications commonly prescribed to treat anxiety and depression--they are at risk for experiencing life-threatening seizures and delirium tremens. For this reason, patients dependent on these substances typically are admitted to the hospital for detoxification, whereas people dependent on opioids, who often experience severe flu-like symptoms, are not.

This tendency to underestimate the dangers of opiate withdrawal and turn people away results from the common misperception that "no one dies" from it. Failure to monitor and treat the symptoms of opiate withdrawal can (and does) result in death.

Withdrawal symptoms may include nausea, fever, sweating, vomiting, diarrhea, and hypertension, among others. If left untreated, persistent vomiting and diarrhea can result in heart failure caused by hypernatraemia (elevated blood sodium levels) as well as severe dehydration.

Patients with comorbid conditions--such as coronary artery disease, congestive heart failure, HIV, or liver failure--also are at increased risk of death. Aside from the physical complications of opiate withdrawal, the desperate actions people take to relieve their symptoms (such as buying more illicit opioids) are life threatening.

A hospital cannot provide detoxification services unless it has a detox unit. Given the risks associated with opioid withdrawal, hospitals play a key role in saving lives. Oftentimes, people present at the Emergency Department either seeking detoxification by their own free will or, more commonly, following an overdose reversal with Narcan.

Between 2016-17, Emergency Room visits for opioid overdoses increased by nearly 30%. A psychiatrist at one hospital estimates that they see two to three overdoses a day, some even in the parking lot. Like most hospitals, though, it does not have a certified detoxification unit...