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Hidden Victims of the opioid epidemic

Hidden Victims of the opioid epidemic

By Dr.Fourkan Ali

America is experiencing one of the most concerning epidemics in its history. Opioid-abuse issues are reaching pandemic levels. In fact, over 10 million people reported non-medical use of these drugs in 2014. The following year, 33,000 deaths were attributable to opioid abuse. The risks to users are clear but the collateral damage - which is also worrisome - is much less apparent. Take, for example, the recent story that made national headlines. A 5-year-old boy awoke to find both of his parents unresponsive on the floor. He ran two blocks to his grandfather's home, declaring his parents were dead. The grandfather called 911, and they raced back to the home. The father was reportedly responsive after one dose of naloxone, used to treat opioid overdoses, but after seven doses with no response, the mother was transported to the local hospital. During a search of the home, the boy's 3-month-old sister was found in the car, screaming in her car seat. Tales like this one are becoming more mainstream, with images going viral of children in cars while their parents are unconscious from drug use. Children of opioid abusers suffer in many ways. Infants are often born addicted, a phenomenon known as neonatal abstinence syndrome, or NAS. In fact, in 2012, one baby with NAS was born in the U.S. every 25 minutes, a statistic that quadrupled in a 15-year span. Every day, babies are admitted to neonatal care units suffering from NAS. Picture a newborn, 7 pounds and hours old, exhibiting all kinds of symptoms: tremor, irritability, sleep issues, excessive or high-pitched crying, increased muscle tone and reflexes, seizures and yawning among other signs. The treatment requires prolonged stays in neonatal care units lasting weeks to months, as well as drug weaning using morphine and methadone. These babies cannot tolerate stimulation and generally cannot be cuddled or loved. That's not the way we would expect little ones to enter the world. The societal costs of stories like these are also significant. For most people addicted to drugs, use can lead to increased episodes of domestic violence, poor self-esteem and loss of life. Overdose is only one cause of death in these parents. Violent death from drug deals gone wrong and infections from needle use such as hepatitis C or HIV can lead to deaths. If not death, the potential for abuse and neglect of children is widespread, leaving children functionally without their parents anyway. The opioid crisis has caused more children than ever to be placed into the foster care system. In 2015, 428,000 kids were known to be in foster placement. Add to that those placed with relatives or who are still in abusive or dysfunctional homes but not formally in the system, and the estimate is probably more like 2.5 million children are in foster care - or should be removed from their parent's homes. Of all these cases, about a third of children are removed for substance abuse by parents and 18 percent of these kids are less than a year old. What's more, the epidemic, just like most others in history, has epicenters, with five states responsible for 65 percent of the increase seen in children needing services: Arizona, Florida, Georgia, Indiana and Minnesota. Given all of these statistics documenting the tragedy that stems from opioid abuse, it seems we should have a handle on the situation, including a solid plan of attack. Rather, it appears almost the opposite is happening: Efforts to date have actually worsened the situation rather than tempered the opioid epidemic. The Drug Enforcement Agency, or DEA, actually predicted the issue with some certainty. The U.S. is responsible for about 80 percent of the world's opioid consumption. In 2015, nearly 300 million pain prescriptions were written and filled, resulting in a $24 billion market. In an effort to put the squeeze on this drug use, new laws were enacted to limit the pain medication prescriptions that could be written. These regulations are substantial and were embraced by the medical community. Yet the abuse rages on. Why? Out of the attempts to control the epidemic, there have been several unanticipated consequences, including substitution of heroin for the previously prescribed opiates. The unfortunate fact is that heroin is extremely addictive and frequently overdosed. Lots of additional high-risk behaviors are associated with heroin use such as needle sharing, sex for drugs and high-risk interactions with dealers. These contribute to additional fatal infections and violence. Prescribed opioids such as Vicodin and Oxycontin are hitting the black market and synthetic drugs that are illicitly manufactured, such as fentanyl, are increasing. These designer drugs and heroin have increased 426 percent since 2014 and deaths have increased by 79 percent. Despite the best efforts by the DEA and medical community, not only does the abuse go on, it is getting more dangerous. How can we even begin to fight abuse of pandemic proportions? The answers are neither easy nor inexpensive. Several steps have been enacted, some of which, like needle exchange programs, make society feel uneasy. Perhaps we need to re-evaluate the prescribing of opioids to put in a better weaning program and avoid the substitution with heroin. Lastly, maybe health care reform needs to take a good hard look at covering addiction treatment programs. Maybe these things will work; possibly not. But we have to try something. So, back to our 5-year-old and his baby sister. They should wake up every morning with someone to get their cereal and make sure they have their shoes on and their backpack ready for school. They should be able to look to their parents as role models, people who show them how to grow up and be productive citizens. Instead, they may be destined for a life in the system, haunted by the visual of waking to parents they were certain were dead and a frantic dash for two blocks for help. Until perhaps they begin to use heroin and the cycle repeats itself. We count on every generation doing better than the one before - will that be in the form of even more accomplished addicts? If that is not where we want to end up, we have to find a way to stop the merry go round. Right now. The writer Teacher & Columnist 01611579267 dr.fourkanali@gmail.com

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