Welcome to “Ask the Expert,” a UTHealth Houston newsroom series in which leading experts examine pressing health challenges. In this edition, we address opioid overdoses and substance use.
According to numbers calculated from the CDC, approximately 80,000 people died last year from a drug overdose, which represents about 21 deaths per 100,000 residents in the U.S. alone. Overdose deaths are preventable, and in most of the cases we see, they are completely accidental. If you are the parent, partner, or friend of someone who has experimented with illicit substances, your first precaution is to be aware that no illicit drug is safe, regardless of the source.
What are opioids?
Opioids are potent drugs that relieve pain. This class of drugs results in most of the drug overdose fatalities nationwide. Medically prescribed opioids, such as oxycodone or codeine, are safe and effective when used properly. But some people continue to take opioids even when not under the care of a physician. More importantly, synthetic forms of these drugs are manufactured and sold illicitly on streets and in neighborhoods everywhere.
After someone begins using a drug, the pleasurable or relieving effects may lead them to continue using it more frequently or in larger amounts over time. As tolerance develops, increasing amounts of the drug may be needed to achieve the same effect, raising the risk of dependence, other serious health consequences, and potential overdose.
Drugs that illicit suppliers make are not compounded in a pharmacy. They are made by illegal suppliers who might combine other substances to create different effects. One of these substances could be fentanyl, a highly lethal opioid that is 50 to 100 times stronger than morphine. Even small doses combined with marijuana, cocaine, or another opioid could be enough to cause an overdose.
Signs of opioid use disorder
Substance use disorders are generally characterized by increased consumption of a substance (like an opioid, marijuana, or cocaine) followed by cravings, increasing tolerance, dependence, and continuous use despite negative consequences and severe risks.
People with opioid use disorder often have difficulty with cognition and behavior. You might notice somebody in withdrawal, where an individual feels worse after a period of abstaining from a substance. Sweating, nausea, diarrhea, vomiting, and pinpoint pupils are usually present. Pain is the most common indicator, both physical and emotional. Breathing tends to slow with the presence of opioids, so rates of respiration and breathing might be significantly lower. In an overdose situation, breathing slows significantly and might even stop altogether. At a relationship level, you might see people start to withdraw from social engagements, lose their jobs, or struggle financially. If you see behavioral or cognitive changes in somebody, that is your sign to get involved.
The importance of rapid treatment
Once in treatment, there is no guarantee of success. Many factors contribute to someone’s recovery, including biology, genetics, altered metabolism, mental health, and even the environment. It is quite common to have a recurrence of use, or relapse. This is expected, and there is not always a linear path to recovery.
Think about a diet where you might want to avoid ice cream. Having one scoop might set you back for a day, but it doesn’t have to derail your overall diet plan. That’s the same with all types of addictions. What’s most important is that the individual continues their recovery and treatment path. We take recovery one day at a time. In most drug treatment programs, rates of recurrence are very high, around 90%. This might suggest different strategies or interventions. The key is to stay engaged, move forward, and get back on track.
It is nearly impossible to recover from opioid use disorder without medical and behavioral interventions and changes in the environment. Medical treatment can help alleviate the pain and withdrawal symptoms, making it easier to go about your daily life and engage in work and other activities. Behavioral treatments can help you learn new tools and strategies for living without substances. Groups can help create community. Together, individuals can recover. Timely treatment is important, though.
Resources for help
In 2017, recognizing the need for additional capacity in this area and with the goal of proactively identifying and recruiting new patients into treatment using 911-guided data, UTHealth Houston developed the Honor’s Houston Emergency Opioid Engagement System (HEROES) program to provide accessible, outpatient-based outreach and treatment for people in the greater Houston area.
Through unique partnerships with first responders and local emergency departments, we help provide timely initiation of medications and rapid treatment and recovery resources to people in their time of need. Through grant funding, we have since expanded statewide. After a transformative gift from the Wallace family, our program was renamed earlier this year in memory of Honor Wallace, who lost her life to an overdose. .
Recovery is possible
After working with thousands of people across the state with drug disorders, we have found that it is completely attainable to regain careers, family, friendships, and a normal daily life. Recovery is possible. Hope can be restored.
Participants in Honor’s HEROES have reported approximately a 20% improvement in quality of life following treatment. People often notice improvements when they abstain from substance use, such as improved emotional stability, staying focused on their goals, gaining meaningful employment, rebuilding their family and relationships, and improving their housing stability. Several of our most successful patients are now some of our best employees, serving as peer coaches providing support and guidance to navigate their own recovery journey.
Recovery is possible, and help is available. If you or someone you know needs help with a substance-related disorder, please reach out to us at 713-500-3597 or visit https://sbmi.uth.edu/heroes.