Friday November 16, 2018

Naltrexone and the Opioid Epidemic

Anyone addicted to opiates should seek professional help and consider going to treatment

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Naltrexone
Naltrexone simply blocks any euphoric feelings of alcohol and opioids. It also decreases cravings and the risk of an overdose. Pixabay
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Naltrexone is a medication used to treat alcohol and opioid addiction. It’s commonly prescribed and sold under the brand names Revia or Vivitrol. The medication works by blocking opioid receptors in the brain and prevents these receptors from producing reinforcement from endorphins. Naltrexone simply blocks any euphoric feelings of alcohol and opioids. It also decreases cravings and the risk of an overdose.

Naltrexone was first synthesized in 1965, but it took nearly 20 years for it to be approved by the FDA for preventing relapse in opioid-addicted patients. Over the past ten years, naltrexone has become an increasingly popular medication. People who enter drug or alcohol rehab centers are sometimes presented with the option to use the medication as a medicated-assisted treatment. Naltrexone should always be used as prescribed and it is suggested to be implemented as part of a complete treatment plan.

What Caused The Opioid Crisis?

The United States has been dramatically impacted by opioid addiction and is currently in the middle of an opioid crisis. The CDC reports that opioid-related deaths are still rising in nearly every segment of the country. The US has faced its share of drug issues in the past, but nothing compares to the severity of what we are currently facing. In 2016, there were approximately 64,000 deaths from opioid overdoses in the United States.

Percocet, Vicodin, morphine, methadone, codeine, hydrocodone, heroin and fentanyl are all in the opioid family. All of these drugs, minus heroin, can be obtained legally with a prescription from a doctor or physician. When used as prescribed over a short period of time they are very beneficial. Sadly, these meds have a very high potential for abuse and are highly addictive both physically and mentally. The true devastating power of these substances was revealed in the mid-2000’s. Medications like OxyContin and Hydrocodone were being prescribed by the millions every year.

These pills soon flooded the streets and became very popular recreational substances. The rise of “pill mills” rose exponentially, especially in South Florida. 93 of the top 100 oxycodone-dispensing doctors in the United States were located in Florida. These places had doctors who would happily write a huge prescription for anyone who had cash on hand. Some even filled the prescription on the same premises and rarely accepted insurance. People traveled from every corner of the country to Fort Lauderdale, Delray Beach and Miami to visit these clinics. They would then bring the pills back to their hometown and sell them. It wasn’t long before opiates became a national concern.

In 2010, more than 650 million oxycodone pills were shipped to Florida. In 2011, Florida had a total of 856 pain clinics. Hillsborough County alone had over 100 of them. In 2010, oxycodone caused 1,516 overdose deaths in Florida; that is nearly 5 fatal overdoses a day. Opiates were killing more people than any other drug and overdose deaths started to increase rapidly nationwide.

In 2011, new laws were put into effect in Florida to help reduce the dramatic loss of life. One action taken by the Drug Enforcement Administration was “Operation Pill Nation,” which targeted corrupt pain clinics throughout the state. Pill mills started to close, crooked doctors were arrested and the number of pills that were available on the black market declined. According to the DEA, the number of oxycodone pills that were shipped to Florida dropped to under 527 million in 2011.

Naltrexone
Representational image. Pixabay

The Rise of Heroin

The demand for prescription opioids remained, but there wasn’t a supply to back it up. A lot of those struggling with addiction issues turned to heroin. Over 70% of current heroin addicts report that they started using prescription opiates before they ever used heroin. Heroin slowly became a drug of choice for many opioid addicts.

Recently, drug dealers started mixing fentanyl and carfentanil into their heroin. Fentanyl is 50-100x stronger than heroin. Carfentanil is frequently used to tranquilize elephants and can be 10,000x stronger than pure heroin. Overdoses related to heroin use and these synthetic opioids has become increasingly common. In 2016, there were over 100 deaths per day in the United States and this number continues to rise.

Using Naltrexone to Treat Opioid Addiction and the Side Effects

Naltrexone can be taken orally on a daily basis or it can be given once a month using a timed release injection. It should not be used by anyone who is actively addicted to and using opiates. If they are to use it while under the influence they can instantly enter withdrawal. There are some side effects that can occur when someone uses naltrexone. The following information was provided by Micromedex, a collection of evidence-based clinical references, and powered by Truven Health Analytics.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare Side Effects

  • Abdominal or stomach pain (severe)
  • Blurred vision, aching, burning, or swollen eyes
  • Chest pain
  • Confusion
  • Discomfort while urinating or frequent urination
  • Fever
  • Hallucinations or seeing, hearing, or feeling things that are not there
  • Itching
  • Mental depression or other mood or mental changes
  • Ringing or buzzing in the ears
  • Shortness of breath
  • Swelling of the face, feet, or lower legs
  • Weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More Common Side Effects

  • Abdominal or stomach cramping or pain (mild or moderate)
  • Anxiety, nervousness, restlessness or trouble sleeping
  • A headache
  • Joint or muscle pain
  • Nausea or vomiting
  • Unusual tiredness
Naltrexone
Representational image. Pixabay

Less Common Side Effects

  • Chills
  • Constipation
  • Cough, hoarseness, runny or stuffy nose, sinus problems, sneezing or sore throat
  • Diarrhea
  • Dizziness
  • Fast or pounding heartbeat
  • Increased thirst
  • Irritability
  • Loss of appetite
  • Sexual problems in males

No one should ever use Naltrexone without it being prescribed by a licensed doctor or physician.

Conclusion

Naltrexone has helped in relapse prevention, but there needs to be enhanced efforts in preventing the drug abuse from occurring in the first place. This is a critical time to combat prescription fraud and illegal drug trafficking. Communities need to unite and share vital information and tools to combat drug abuse with the goal of minimizing its social and economic impact.

Anyone addicted to opiates should seek professional help and consider going to treatment. Once a person is properly detoxed and has made it through an inpatient program, they have just begun their journey in recovery. When a person gets ready to leave treatment it’s crucial to set up a substance abuse aftercare plan. Naltrexone is commonly prescribed to people in treatment and it is a great component to consider in an aftercare program.

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Zimbabwe Officials Trying to Fight Cholera Clash With Street Vendors

A cholera outbreak is the second since a 2008-09 epidemic claimed almost 5,000 lives.

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Zimbabwe, Cholera
Zimbabwe police was in streets of Harare on Sept. 16, 2018 removing vendors as part of efforts to fight cholera outbreak which has killed more than two dozen people over the past two weeks. VOA

Zimbabwe police Sunday clashed with vendors who were resisting being removed from streets as part of the country’s efforts to fight the cholera outbreak, which has claimed more than two dozen lives in the past two weeks.

Vendors were alerting each other of armed riot police and municipality officials coming to confiscate their wares Sunday in Harare. As soon as police officials left, the vendors would resume their business.

One of them is 34-year-old Maria Mange, a mother who three children who says unless she gets employed, she will remain selling vegetables and fruits in Harare’s CBD.

Zimbabwe, Cholera
Vendors in Harare say they not leave their business as they have no other sources of income with Zimbabwe’s unemployment rate said to be around 85 percent. VOA

“I am refusing to leave the streets on the basis that we cause the spread of cholera,” she said. “Our wares are cleaned or boiled before being consumed. It is dirty water which causes cholera, their failure to collect refuse, plus flowing sewage in the streets and blocked sewer pipes. Why concentrate on vendors and not criminals?”

Another vendor is Ronald Takura who says he has to find a way to make a livliehood.

“No, vendors are not causing the cholera. You are disturbing [our] search for money in our country,” he said. “I do not have a job and I do not have work to do. So do not send us out. I do not understand what is happening in this city. E.D. Mnangagwa, we supported, we do not see what he is doing for us.”

Zimbabwe, Cholera
Obediah Moyo Zimbabwe’s minister of health says there is no going back on vendors in streets, in Harare. VOA

He adds in Shona language, Zimbabweans voted for President Emmerson Mnangagwa in the July 30th elections, but he is not supporting the vendors.

But Zimbabwe’s minister of health, Obediah Moyo, says there is no going back.

“The issue of food vending is another issue, we all agreed that has to stop, especially in the area of epicenter [of the epidemic], that the police are helping us to stop the vending of food,” he said.

Zimbabwe, Cholera
In Zimbabwe trash can go for days or weeks without being collected which experts is one of the factors for spreading cholera outbreak in Harare. VOA

Zimbabwe’s cholera outbreak has since spread to several parts of the country from its epicenter in Harare’s densely populated suburbs.

Also Read: Video- Zimbabwe’s Newly Appointed President Calls For Unity

International organizations such as UNICEF, WHO, and MSF have since moved in with assistance. But critics say the long-term solution is improving water supply, sanitation and regular waste collection by Zimbabwean authorities.

A cholera outbreak is the second since a 2008-09 epidemic claimed almost 5,000 lives. (VOA)