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The Journal Gazette

  • Illustration by Gregg Bender | The Journal Gazette

  • Samuel Hoffman | The Journal Gazette Allen County Health Commissioner Dr Deborah McMahan

Sunday, October 23, 2016 4:53 am

Opioids' insidious embrace

Dr. Deborah McMahon

First, I would like to thank the staff at The Journal Gazette for its in-depth reporting on the opioid issue. Frankly, this is one of the most significant public health issues we have faced. In writing this, I am not sure whether I am hoping to provide a new perspective for the folks who have not had to personally or professionally confront this issue or the folks who are struggling silently in the shadows.

For many people, their image of someone who has become a misuser or abuser of drugs and/or alcohol is shaped by movies and reality shows, and this can create a stigma surrounding the issue. That can stand in the way of effectively treating the problem. Ignoring a problem of this magnitude is not economically sustainable. I would like to provide a viewpoint from the medical side that you might not have considered.

We now know that at least 50 percent of the susceptibility to addiction is genetic. You may not know that about yourself when you take your first prescription opioid. We also know that some underlying medical conditions can increase your risk of becoming more easily addicted to otherwise therapeutic medications. Medical issues such as undiagnosed depression and anxiety can make you more susceptible to the addictive effects of opioids and other drugs.

Sadly, while we are getting better at screening and identifying more people for mental health conditions, many go undiagnosed, and therefore they are more vulnerable, for years, to addiction. We also know that older folks are more susceptible to depression and just pass it off as a function of getting older rather than seeking treatment.

You break a hip, tear an ACL, get dental work done, are in an accident or some other pain-generating issue occurs, you get a prescription for pain meds and for the first time you feel better – not just due to pain relief, but just plain better. And when the current need for pain medicine is resolved, you still feel better. I think many people do not realize why they are feeling better; they just finally feel good for the first time in years.

The science tells us that continued use of opioids (and other illicit drugs) causes important changes in the brain in terms of the ability to experience pleasure from normal activities – you just can’t reproduce the unnatural high from drugs with simple pleasures anymore. In addition, we now know that the prefrontal cortex, the big decision-maker of the brain, does not function as well, either. All of this contributes to the constant feeling bad and poor judgment of the chronic drug abuser. But there is hope.

When we better understand the medical consequences of drug addiction, we are better able to treat it. Most experts believe a combination of medication-assisted treatment and mental/behavioral treatment can effectively resolve this complex health issue. In physical and mental health medicine, we are still learning about these treatment regimens, but there is hope.

And for those who are quietly waking every day dreading another day of addiction or anxiety or depression, speak up and talk to your doctor or look for info on a great website like lookupindiana.org.

This is not an easy or fast journey, but like everything else, it begins with the first step.