Painkiller Crisis

On Thursday, Nov. 9, over 150 students and community members gathered for an interdisciplinary presentation about America’s opioid epidemic from four professors.

The panelists were Professor Chrysan Cronin, Director of Public Health, Dr. Jeremy Teissere, Professor and Director of the Neuroscience Department, Dr. Kate Richmond, Associate Professor of Psychology and Rachel Hamelers, Science Librarian.

Cronin led off with a presentation about the epidemic in its broadest sense.

Opioids are a class of drugs that are used to reduce pain which can also produce a euphoric experience for the user that extends beyond the pain relief. These drugs are often prescribed legally, like oxycodone, codeine, morphine and fentanyl, for example.

Concerns arise with respect to either illicit consumption, manufacturing and sales (in the case of fentanyl) or when it is rendered into a recreational drug like heroin; in 2016, over 11 million Americans misused prescription opioids and there were approximately 64,000 overdose deaths involving opioids.

But the magnitude of America’s opioid crisis is not limited to the addict, Cronin noted, and that is where public health figures into the puzzle.

“In public health, we look past the addict. We think about the families and communities because it places a strain on a variety of government and non-government organizations,” said Cronin. Some of those organizations include healthcare systems, social services, police departments, prisons and even the economy — the annual impact of the epidemic is $78.5 billion, Cronin added.

Some of the current public health interventions include advocating for methadone treatment program and safe injection sites, as well as new prescribing guidelines and labeling requirements. Cronin concluded by acknowledging that although there are interventions available, “we absolutely need to do a better job of ensuring access.”

Teissere spoke about the science of opioids and their physiological effects on humans.

Some opioids are more fat soluble than others, which allows them to pass through the blood-brain barrier more efficiently, Teissere said. “Some can remain in the body for weeks, which contributes to longer-lasting effects and a detectability similar to cannabis.”

But these longer-lasting effects can also contribute to a condition known as opioid-induced hyperalgesia, which occurs when endorphin signaling in the brain alters the way the individual processes pain. This increased tolerance means that the affected individual feels more pain when an opioid is not actually in their body.

Teissere also explained an interesting relationship between opioid tolerance and the environment in which they are consumed. Essentially, if the individual goes to an identical location to consume opioids, their body “remembers” the act of traveling and physiologically speaking, anticipates consumption. This process heightens the effects of hyperalgesia, leading the individual to seek new methods of consumption — either the location or type of opioid — that their body is less sensitized to.

“These drugs are changing our body’s memory, which may also alter the environment in which the drugs are taken,” said Teissere.

In moving from neuroscience to psychology, Richmond discussed how the biopsychosocial model is affecting the opioid epidemic in the United States.

“The truth is that people around the world have pain. The United States is the only country dealing with a crisis of this magnitude,” said Richmond. “What is it about American culture that has contributed to this epidemic?”

Richmond explained that stressors like economic recessions and subsequent job loss contribute to an individual’s lack of personal identity; this is compounded by the lack of social services available for the disabled, pregnant and elderly when compared with other developed countries.

According to Richmond, our country stigmatizes and places barriers to accessing mental health treatment. This leads individuals to seek pain medication to treat pain, which often is the physical manifestation of stress and could otherwise be addressed with more robust mental health infrastructure, Richmond said.

“I think of this crisis as one of mental health and not of solely addiction,” said Richmond. “But therapy takes time and is expensive. Pills have always been a quick solution.”

Richmond believes that addressing some of the underlying stressors of American culture — war, political issues and economic concerns — lies at the heart of actually addressing the opioid crisis.

The last panelist to present was Hamelers, who addressed scientific literacy and its role in the epidemic.

The United States is the only country dealing with a crisis of this magnitude.

In the 1980s, Hamelers said, prescribing habits in the United States changed dramatically following a ‘letter to the editor’ in the New England Journal of Medicine. The correspondence, which was not a clinical trial or epidemiological study, stated that among 12,000 patients at the Boston University Medical Center receiving narcotics, only four were considered addicted.

In the following decades, the letter has been cited thousands of times by pharmaceutical companies and physicians alike to justify prescribing synthetically produced opioids.

“The pharmaceutical companies were not concerned about the patients or the science, they were concerned about the profits,” said Hamelers.

In April, the Department of Health and Human Services outlined a five-point plan to address the opioid epidemic and two components are related to data collection and research; the Trump Administration has also recently declared the crisis a public health emergency.

Specifically, Hamelers argued that it will be essential to designate federal money to actual prevention and treatment strategies, instead of an anti-opioid ‘just say no’ campaign akin to the 1980s War on Drugs. “This is probably not the best way to spend our public health dollars,” said Hamelers. “It won’t work.”

Although the panelists come from different academic backgrounds, they agreed that the opioid epidemic has resulted from a variety of intersecting societal and physiological issues. Ultimately, it will be up to the public health and healthcare communities to earnestly address the crisis and help the millions of Americans who desperately need assistance.