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API ImageWe at PAMEAS are very concerned about the toll the opioid crisis is having on individuals and communities across America. We have a history of developing practical, low-cost education programs with demonstrated results and are producing a series of programs we feel will benefit those suffering in this critical and urgent public health calamity.

Opioids are medications that act on opioid receptors in both the spinal cord and the brain to reduce the intensity of pain-signal perception. They also affect brain areas that diminish the effects of painful stimuli. The most common modern use of opioids is to treat acute pain, but they've been increasingly used to treat chronic pain, despite little evidence for their effectiveness when used long term. In fact, many patients experience a worsening of their pain or increased sensitivity to pain as a result of long-term treatment with opioids.

In addition to relieving pain, opioids also activate reward regions in the brain causing the euphoria the increases the potential for their misuse. Opioids are very similar to heroin, which was originally synthesized from morphine. Overdose is another significant danger with opioids because these compounds also interact with parts of the brain stem that controls breathing. Taking too much of an opioid can suppress breathing enough that the user suffocates. An overdose can be reversed and death prevented if the compound naloxone is administered quickly.

Prescription opioid medications include hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), oxymorphone (Opana), morphine (Kadian, Avinza), codeine, fentanyl, and others. Hydrocodone products are the most commonly prescribed in the United States for a variety of indications, including dental- and injury-related pain. Oxycodone and oxymorphone are also prescribed for moderate to severe pain relief. Morphine is often used before and after surgical procedures to alleviate severe pain, and codeine is typically prescribed for milder pain. In addition to their pain-relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) are used to relieve coughs and severe diarrhea.

Our education programs will be designed to support the efforts of everyone involved in this crisis including addicts, families, schools, community organizations, physicians, nurses, healthcare administrators, drug manufacturers, drug distributors, policymakers, law enforcement, and public health officials to drive practical, results-driven solutions.

Opioid pain medications are associated with significant risks of addiction, abuse, and misuse that can be fatal. Overdose deaths involving fentanyl, fentanyl analogs, and other synthetic opioids increased by 45% between 2016 and 2017, rising from about 6 deaths per 100,000 to 9 per 100,000.

We believe several steps can be taken to address the problem, including:

  • Limit opioid prescriptions to no more than three days and only when absolutely necessary as a last resort for pain management.
    • This will help limit unnecessary exposure to opioids and reduce the number of unused opioids that might end up in the wrong hands.
    • Physicians should receive specialized training and certification in order to prescribe opioid medications.
  • We believe that physicians should be trained in alternative programs options for the management of chronic pain for patients, including working with complementary care providers for techniques which have shown benefits in this area.
    • This includes acupuncture programs and other healing modalities
    • Pain management is a complex physiologic issue and the placebo effect is potentially significant. If a patient believes something will work in controlling their pain, it usually does.
  • We believe there should be a National Prescription Drug Monitoring Program (NPDMP) database which tracks controlled substance prescriptions which physicians and pharmacists can access before writing or dispensing any opioid prescription.
    • This will involve combining state PDMP programs.
    • This can be developed and deployed with existing, open-source, low-cost technology.
    • The system can be made securely available via web browsers for access and use.
  • We advocate the adoption of a secure open, electronic, blockchain-based based prescribing system for controlled substances that can’t be copied, altered, or forged.
    • This can be developed and deployed with existing, open-source, low-cost technology.
    • The system can be made securely available via web browsers for access and use.
  • Patients should receive better training in the safer storage of prescription opioids and what to do with any remaining or unused pills after someone stops taking them to prevent their abuse.
  • We are developing community and school-based prevention education efforts for all family members.
    • We want to help young people understand the risks of misusing prescription medications, including opioids
  • Aggressive efforts at expanding the availability and use of Naloxone
    • The opioid overdose-reversal drug naloxone is an opioid antagonist that can rapidly restore normal respiration to a person who has stopped breathing as a result of an overdose on prescription opioids or heroin. Naloxone can be used by emergency medical personnel, first responders, and bystanders.
    • Naloxone has been used since the 1960s and has a proven track record of effectiveness and safety.
      • Naloxone does not encourage more substance abuse.
      • There is nothing to indicate that naloxone discourages addicts from entering a rehab program.
      • Naloxone can be administered via syringe, auto-injector, or intranasal spray.
      • Naloxone is a relatively inexpensive drug.
      • The FDA recently held a meeting to discuss what steps would be needed in order to increase access to naloxone on a national level. Though legal policies vary by state, most are already providing increased access to the medication. Doctors, nurse practitioners, and physician assistants are generally allowed to prescribe naloxone to patients who are at risk of an opiate overdose. What’s more, a variety of community outreach programs now provide access to naloxone.
        • We are pursuing programs to educate policymakers to make Naloxone more available in all states.
    • More first responders should have specialized training in the use of Naloxone.
    • Naloxone should be more available to all that could use it.
      • Make Naloxone available without a prescription.
      • Explore over-the-counter availability to increase Naloxone utilization when needed.
    • Good Samaritan laws should be expanded to offer civil immunity to anyone assisting in a potential overdose situation.
  • We advocate for more research into the science of addiction.
    • One example is for astrocytes, which are cells in the central nervous system that support and regulate neurons. Although scientists have studied astrocytes for decades, very little is known about their role in the ventral midbrain, the region that houses dopamine-releasing neurons critical for reward learning and motivated behaviors.
      • Knowing more about how astrocytes act in this region of the brain is important for understanding how dopamine neuron function is altered in addiction.
      • These ventral midbrain astrocytes are physiologically distinct from astrocytes in other parts of the brain and may play an important role in opioid addiction.

Please contact us if you are interested in more information about our PAMEAS Opioid Programs or if you would like to participate or help support our efforts.