Be a super hero and save a life! Save opioid overdose deaths.
We need a hero! People are dying at alarming rates. Who is your favorite superhero? Have you ever dreamed of being a superhero? Can you picture yourself as a hero? [I’m curious, in your vision, are you wearing a superhero cape? What color?]
The need for a hero
The rate of overdose and overdose deaths is rising rapidly. It is hard to even fathom this epidemic. In particular, overdose rates with opiates are skyrocketing. Opiates are pain medications such as oxycodone, Percocet®, Oxycontin®, hydrocodone, Vicodin®, methadone, Fentanyl®, and more. An illegal opiate that is readily available is heroin. Now there are batches of heroin that are ‘cut’ with other drugs such as fentanyl and carfentanyl (used to sedate elephants). These mixtures are getting more and more dangerous.
The way these drugs are fatal are that they stop the breathing process. At low doses, for the treatment of pain, most people take prescription opiates and are fine. As the pain lessens, the use of the opiate should lesson. However, for some people the brain starts to beg for more and more. As the brain gets huge amounts of excitement through neurotransmitters such as dopamine, the rest of the body says, ‘Whoa, that is way too much!’ The body stops making its own supply of these neurotransmitters and it shuts down the receptors that move them along. So, it takes bigger and bigger doses to get the same effect. And, if someone suddenly stops taking the drug, withdrawal starts. This is a terrible feeling with nausea, vomiting, chills, agitation, anxiety, muscle aches, yawning, and more.
Not everyone who takes an opiate for their pain will ever feel this rush of excitement and have their brain demand more. One of the many problems right now, is there is no way to know who will get this rush of excitement that can lead to addiction and who won’t. People with a risk for addiction some in every age, gender, size, race, financial pattern, level of education, and geographic area.
There are many available statistics. Here are some from the Centers for Disease Control (CDC):
In 2014, almost 2 million Americans abused or were dependent on prescription opioids.
As many as 1 in 4 people who receive prescription opioids long term for noncancer pain in primary care settings struggles with addiction.
Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids.
How you can be a hero
To be a hero, you just need to carry and know –
When
Why
How
to give Narcan® to someone who has overdosed on an opiate.
Naloxone is a medication that can block the receptors to opiates. When given, it puts the person is immediate withdrawal. If someone has overdosed and is either sound asleep and can’t be woken or has stopped breathing, naloxone can block those receptors and wake them up. If the overdose very recently occurred, it can help breathing start again. Naloxone can save the life of someone who has overdosed!
Outside of a healthcare setting, there are two products regular people are likely to use to save a life.
If you suspect an overdose, try to wake the person. When they don’t respond to shaking and talking to them, try rubbing their breastbone with your knuckles. If no response, TREAT!
The sudden withdrawal from the medication might cause the person to vomit or two be very surprised and angry. It does not feel good to be in sudden withdrawal.
It DOES feel good to be alive!
Call 911 to continue the person’s care and to help them into rehabilitation.
Note, depending on the opiate dose that was taken, after 2-3 minutes the person might need another dose if they go back to sleep. This is SUCH a brief description. Call us to talk about this in more detail at 410-472-5078, or e-mail me at michelle@medsmash.com, or contact us at www.medsmash.com/contact.
BIBLICAL APPLICATION
What is our role in this sad, alarming epidemic? Why is this happening? What are so many people struggling with addiction?
Are addicts bad people? Are they being punished? Are they ‘those people’? Before the addiction, were they different from you and your family?
I know many have these opinions about ‘them’.
I challenge you to respond with compassion and love for all people. Until a discovery is made of the ‘addiction gene’ or addiction identifier, each and every person prescribed an opiate beyond the time or dose needed for their pain or experimenting with an opiate could find him/herself instantly struggling with addiction.
I know some of you will disagree with the following, and I would love to hear from you.
I wonder how much of the current opiate addiction overdose epidemic is a sign of our stressed out time and how much is a challenge for us to demonstrate the length we will go to be compassionate and care for each other.
And the word of the Lord came to Zechariah, saying, “Thus says the Lord of hosts, Render true judgments, show kindness and mercy to one another, do not oppress the widow, the fatherless, the sojourner, or the poor, and let none of you devise evil against another in your heart.”
I encourage you to rise to the occasion to show compassion, learn more, and save lives. You can contact me at michelle@medsmash.com
Have you heard the term ‘medication reconciliation’? Probably not, it’s an insider’s term within medicine. But it’s an important concept, and I want you to know about it. I want you to ask about it any time you find yourself going into the hospital, going to the emergency department (ED), coming out of the hospital, going into rehab, switching doctors, having any major changes in either your health or who is monitoring your medications.
The term medication reconciliation (abbreviated ‘med rec’) means taking your whole medication list and understanding, how you are taking it and when you are taking. It is about making sure that information goes with you any time you are making a transition. So ideally, at the moment you enter a hospital someone figures out exactly what you take, how you take it, and when you take it. It is awesome if you come with this information. You could carry that information with you and have it ready to share with your health team. It is a huge safety factor in your care. If they know exactly what you take, how you take it, when you take it, they will make much more informed decisions in your care. This is true in the emergency department, the hospital, moving to rehab, moving to assisted living. I applaud the pharmacists who do this well in hospitals, clinics, and other settings around the country.
If you come in with it ready, you have saved them a lot of time and effort. And, you’ve helped assure your own safety. This important information will help guide the next phase when they will make any modification depending on why you are in the health system and what your needs are at that time.
If you’re in the ED or the hospital for a particular reason, there may very well be a need for a new medication to treat the reason you’re there. It is important that any of those changes are communicated all throughout your stay within and beyond the health system.
Formulary
A little caveat that’s important is another important term to understand – formulary. There can be a number of different medicines that do the same thing. We call them medication classes, and each class could have several medications that do the same thing in the same way. Rather than carry every medication on the market, a hospital will carry a few in each category. It is possible that the one you typically take is not on their formulary. They will switch you while you are in the hospital to one that is on their formulary. The name, color, and size might not look familiar to you. Be sure to ask questions when you don’t recognize your medicine. This is not harmful; it will not put you in danger. Medicines within the same class work the same way as the one your doctor had you on at home. But, it is a source of confusion when you go home or move to another part of the health system. It’s one of the reasons this medication reconciliation process is so important.
It is critical that you know that another medication, similar to the one you take at home, is being used in the hospital. You want, when you go home, to be switched back to the medicine you came in on, the one that was prescribed by your own primary care provider.
Many, many patients have run into difficulty when they go home on the medication the hospital gave them and they continue to take the one they have at home. This is called duplication of therapy. You are getting twice the amount you need – you have the one you have at home and the on the hospital gave you that do the exact same thing. So, using blood pressure as an example, if you are taking the medicine you have at home plus the one in the same class that you got in the hospital, you could lower your blood pressure too much. You want to avoid duplication of therapy; be sure for that class of medicine you are on just one.
Be sure to ask at the hospital if you can go back on the one you were familiar with at home that does the same thing as the one you got while in the hospital.
It is important that several people know exactly the medicines you take when you go back home or get to your next destination. You are one of them, of course. It is also important that anyone involved in your care such as your spouse, child, or caregiver involved in your care; your primary care doctor; any specialists; and your pharmacist know exactly how your medications have changed while you were in the hospital.
It is important that any intermediate step before you go home, such as rehabilitation, knows your entire current medication regimen. But, it is most important that you understand exactly what to take when you get home.
Medication changes while you’re in the hospital
What if problems related to your medication led to you going to the hospital? That is very often the case. Then, the medicines that led to your admission will be stopped or changed. If the problem that took you to the hospital was something new, then it’s likely that new medicines were added to your regimen. Again, it is important that you know what changes were made, why they were made, and exactly what you should do when you get back home. Ideally, ask your questions while you’re in the hospital, but if you get home and have questions, don’t hesitate to reach out for answers.
Medication reconciliation is something we often do at Meds MASH. People get home and realize they don’t really understand what they are to do. They have a list from the hospital, a list from rehab, and their home list. They wonder if anyone has looked at all of the medicines – the old ones, the new ones, and some from other doctors. At Meds MASH we look at all of the medicines and make sure they are all safe together. We catch those duplications and clear them up with your doctors. One of the things we will do, with your permission, is get information from all of your doctors and from the hospital and pull it all together. Then, after the thorough analysis, any changes will come from your primary care doctor who is the gatekeeper and the one person responsible for all of your medicines.
Three doctors recently wrote an important articleabout the need for accurate medication reconciliation. And they note that this process must be thorough to be meaningful. Several partial versions have been tried, and if it isn’t complete, it’s not helpful. It’s not going to keep people safe if it is not done right.
If a thorough medication reconciliation can keep you safe and healthy, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.
BIBLICAL APPLICATION
This Biblical application might feel a little less associated with the health part. With medication reconciliation we are talking about making sure all of the information related to medication use is clearly communicated. If it is not done completely it isn’t effective. What about our compassion and how we reach out to others? How complete and effective are we?
Something has been weighing very heavy on my mind in the last week. It is the decisions we make about where our compassion lies. Who we can forgive and who we can’t. How do we spend our money and give our support and where we do we not? The thought that has been raised in my mind is – when we know someone is in need, and we do not know their sins, it seems to me it is easier to reach out and provide support for those needs. The example that got me thinking this is the refugee crisis. When you know there are millions of people who have been displaced, a lot of people have compassion for that and for their circumstances. What can we do to help those people and their dire circumstances?
The other things that made me think of this were more local. What are the needs of people who are making choices that are leading them to being in dire circumstances? It might be behavioral and lifestyle choices; it might be financial management choices; it could be self-care choices that lead them to circumstances where their life is not as secure as it might be. Their difficult circumstances are a ramification of lifestyle and self-satisfaction choices they have made.
I am connected to a place right now that serves the LGBTQ community and the HIV population. Some Christians find it easy to be very judgmental of this population and not share their compassion in this direction. Rather, they choose to share their compassion in other circumstances where the reasons and the choices are less known. Is this what Christ calls us to do? Are we called to show compassion or walk away?
Consider the story of the woman caught in adultery in Luke Chapter 8.
Jesus went across to Mount Olives, but he was soon back in the Temple again. Swarms of people came to him. He sat down and taught them.
The religion scholars and Pharisees led in a woman who had been caught in an act of adultery. They stood her in plain sight of everyone and said, “Teacher, this woman was caught red-handed in the act of adultery. Moses, in the Law, gives orders to stone such persons. What do you say?” They were trying to trap him into saying something incriminating so they could bring charges against him.
Jesus bent down and wrote with his finger in the dirt. They kept at him, badgering him. He straightened up and said, “The sinless one among you, go first: Throw the stone.” Bending down again, he wrote some more in the dirt.
Hearing that, they walked away, one after another, beginning with the oldest. The woman was left alone. Jesus stood up and spoke to her. “Woman, where are they? Does no one condemn you?”
“No one, Master.”
“Neither do I,” said Jesus. “Go on your way. From now on, don’t sin.”
Her choices were well known, and she was being very degraded. She was called before the council having been caught in the act. The council members were ready to stone her. Jesus said those without sin could cast the first stone. We are so quick to categorize sins, but it doesn’t seem Jesus categorizes sins. What are we called to do as Christians? I am struggling with this and I’m challenging others to struggle with this, too. This is not a blog with answers. It is a blog with challenging questions. I would love to hear what people think.
“Judge not, and you will not be judged; condemn not, and you will not be condemned; forgive, and you will be forgiven;
It has become clear to me as a practitioner that sex as defined in the Bible, as designed by God does not lead to trauma, whether emotional or physical, and it does not lead to disease transmission or to promiscuity.
But in society, especially in the current waive of rules avoidance and focus on self, sex is being used in a lot of other ways. When used outside the way described by God, it does lead to a lot of issues. We create our own problems when we are outside this definition.
Another example heavy on my mind is substance abuse. The numbers of people caught in addiction and dying of overdose are astounding. This is a tragedy of great proportion! Yet the local rescue mission is struggling to stay funded. People who have been caught up in abuse and addiction who are now reaching out for help to leave that lifestyle are encountering limited spots available for rehabilitation. Yet Christians are looking for meaningful outreach and missions opportunities.
I am in full support of refugee aid, international response to crisis, local response to crisis, support of children in underserved areas, teens on mission trips, college students on mission trips, medical missions, and so much more. In addition to all of this wonderful outreach, I encourage us to search our hearts and God’s leading for our attitudes about reaching those in circumstances in our own community that are harming them.
I propose when we limit our compassion or draw a line for how we will consider using our resources, it is similar to an incomplete medication review. Completeness and effectiveness are limited.
Changes come with aging – some impact best medication use.
You are aging. No matter your overall health, your lifestyle choice, your beliefs about the medical system, you are aging.
If you do EVERYTHING right when it comes to healthy living, will aging stop? No.
Here are some changes that occur in all of us with aging.
Kidney function starts a very gradual decline in your late 30’s or early 40’s.
Liver size and blood flow to your liver diminish. The number of cells shrinks. There is less activity of the enzymes that break down medications.
Food and medications move through the intestine more slowly.
The volume of urine that the bladder can hold decreases. Bladder muscles weaken.
For men, the prostate gland increases in size.
For women, the urethra shortens and becomes thinner. So, risk of urinary tract infection goes up.
Muscles weaken as growth hormone levels decline.
Aldosterone levels decrease, so risk of dehydration goes up.
The immune system slows down. So, risk of infection and cancer go up. Also, it can take longer to treat an infection.
Heart muscle and blood vessels get stiffer. This can increase risk of high blood pressure. Also, with exercise, the heart can’t pump as much blood or speed up as much as it did at younger ages. So, exercise capacity is lower.
The muscles involved in breathing weaken. There is a decline in the number of small sacs in the lungs where oxygen is passed to the blood.
The amount of water in the body goes down while the body fat goes up.
This is not intended to alarm or depress you. With aging also comes wisdom, experience, tolerance, and the benefits of many life lessons. So, celebrate the process with its good and challenging elements.
As a pharmacist, I want you to understand how and why medications should be prescribed differently at different ages. Any medical conditions; habits such as smoking or excess alcohol consumption; excess weight; and other factors can further impact how medication actions change over time.
The first step of a medication’s actions comes when it is presented to the body. Most often it is swallowed and then has to be absorbed. Absorption is not impacted very much by normal aging, but it is impacted by medications that lower stomach acid, change the rate of the gastrointestinal tract, or by stomach or intestine procedures.
The second step is distribution. The medication, once absorbed, is distributed throughout the body. Some medications prefer fat and other prefer water. As we age, we have more body fat and less body water. So, medications that love water are more concentrated in the overall smaller total amount of water. The medications that love fat are distributed to more places and can be harder to gather it all back together to get rid of it.
The third step is metabolism. This is how the medication is broken down in the body. Some medications have to be broken down in order to get rid of them. Others have to be broken down in order to reach their more active form. Metabolism happens in the liver. Over time, the liver becomes less active, so it takes longer to break down some medications.
The fourth step is elimination. This is how the medication leaves the body. Most medications are either eliminated through the urine or through the feces (stool). So, any decrease in kidney function will slow down the elimination through the urine. Any slowing, shortening, or other issues with the intestines and colon can impact the elimination through the feces.
The important point of mentioning all of this is to make you aware that medications act differently in your body as you age. The medication, the dose, the timing that was good for you 10 years ago might not be the best for you now. Your doctor shouldn’t prescribe medications in the same way for a 70 year old person as prescribed for a 30 year old person.
I encourage you to ask your doctor and your pharmacist to carefully review your medications to be sure all are correct for your age and your unique set of medical conditions.
We would also be happy to provide that very thorough assessment for you. You can contact us at www.medsmash.com.
BIBLICAL APPLICATION
A life of faith is a long pursuit. It often takes time to develop perseverance and character, hope and joy in all circumstances.
Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance;perseverance, character; and character, hope.And hope does not put us to shame, because God’s love has been poured out into our hearts through the Holy Spirit, who has been given to us.
Throughout the Psalms and Proverbs age is revered with dignity and honor.
The righteous flourish like the palm tree and grow like a cedar in Lebanon. They are planted in the house of the Lord; they flourish in the courts of our God. They still bear fruit in old age; they are ever full of sap and green, to declare that the Lord is upright; he is my rock, and there is no unrighteousness in him.
Learn the facts about safe use, natural physiologic changes when you take opioids, and addiction.
There is a lot of information in the news about narcotics, opioids, overdose, death, and a heroin epidemic. Now there is new legislation to try to stop this downward spiral. Have you found it confusing? If you say yes, you are not alone!
First, narcotics = opioids
The correct medical term for these pain medicines is ‘opioid’. This refers to the way they work. These pain medications interact with the mu-receptors and other opioid receptors throughout the brain (and the gastrointestinal tract). As they trigger the mu-receptors, they block pain sensations. They can also cause euphoria, dysphoria, or sedation. So, they can make you feel really good, really laid back, or really sleepy.
There are several medicines that fall in this category of opioids. Here are a few (and some brand names):
Morphine (MS Contin, Avinza)
Hydromorphone (Dilaudid)
Codeine – combined with acetaminophen (Tylenol #3)
Hydrocodone – combined with acetaminophen (Lortab, Norco, Vicodin)
Oxycodone (OxyContin, Roxicodone)
Meperidine (Demerol)
Fentanyl (Sublimaze, Duragesic)
Methadone (Dolophine)
These medications have been used for decades to treat moderate to severe pain. Pain relief is important in many instances not only for your quality of life but also to get you moving again after a painful event. For instance, it is critical that you get moving again soon after a knee replacement, back surgery, or other similar surgery. As you get moving again you increase your chance of really getting back to full function. You also decrease the risk of a blood clot from lack of use. But, those surgeries are painful. The opioid medication helps relieve that pain allowing you to start your rehabilitation.
When used short term for pain, addiction is not likely
Addiction is usually associated with long term use and/or use for the feeling you get from the medication beyond the pain relief. It is also associated with using more than you are prescribed. To safely use opioid pain medication, use the lowest dose that allows you to move through your pain. Also, use it for the shortest time possible. As the pain level decreases, you can move from an opioid to a nonopioid pain medicine. Work with your prescriber to determine when you are ready for this change and which option will work best for your pain.
Key terms
The body contains a wonderfully complex system of signals and receivers to transmit and control pain sensations. The body and these communication pathways in the brain and the central nervous system are well organized. When the pain signals are too distressing and an opioid pain medicine is added, the normal body signals and receivers adapt to the effect of the opioid pain medicine. There are natural, physiologic changes that occur in your body as these medicines are used over time. I want you to understand these changes. When they occur, they do not mean you are addicted!
Physical dependence – As the body lets the medicine treat the pain, the body’s normal pain process relaxes.
Tolerance – When you take an opioid pain medicine over time, those nerve transmitters (signals) in your body adapt. Over time doses have less effect and last a shorter period of time. So, over time, the dose needed for the same pain relief goes up.
Withdrawal – When the opioids are suddenly taken away, the body can’t take over the pain control immediately. If this sudden stopping of the medicine happens, you will feel body aches, irritability, fast heart rate, weak. and have difficulty sleeping. You might also yawn, shiver, and have an upset stomach.
These are the body’s normal reaction to having the opioid pain medicine take care of the pain. When your pain level drops to mild to moderate pain, your prescriber will start to slowly decrease your dose of opioid pain medicine. This will allow your body’s normal process to take back over in controlling your pain.
Next week we will cover more about addiction and steps being taken to stop the current epidemic of opioid pain medicine abuse. Addiction involves continued use over time, inability to control drug use, compulsive drug use, continued use even when you know the drug is hurting you, and craving of the drug.
These opioid medications can play a very healthy role in controlling your pain when dosed appropriately and used for the shortest time possible.
If you would like to know more about opioid pain medicines and how they affect you, please contact us at www.medsmash.com.
BIBLICAL APPLICATION
Addiction is so very complex. It is one of many examples of how something good for you can become something bad for you.
It is not possible to look at someone and say, ‘He is an addict.’ Or ‘She is likely to be an addict.’ It is not true that ‘bad people’ become addicts while ‘good people’ avoid that outcome. Parts of the addiction process seem to be within our control while others take us by surprise. We will go in to more detail next week.
So, this is a key area when we can share our compassion and the love of Christ.
It is also a reason to reflect on our self-control. This is one of the fruits of the spirit.
But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control; against such things there is no law.
We are all tempted by various things. One of Christ’s messages to us is to let Him be our strength and shield. This was shared by Paul as he was explaining why and how we should stay away from idols and temptations that lead off the path to Christ.
No temptation has overtaken you that is not common to man. God is faithful, and he will not let you be tempted beyond your ability, but with the temptation he will also provide the way of escape, that you may be able to endure it.
For this very reason, make every effort to supplement your faith with virtue, and virtue with knowledge, and knowledge with self-control, and self-control with steadfastness, and steadfastness with godliness, and godliness with brotherly affection, and brotherly affection with love.
How often do you feel “snowed”? Do you feel a lack of motivation? Is your thinking sharp? Is it hard to get the energy to get off the couch? Do you nod off when you sit down? Does your thinking seem fuzzy? Do you have trouble keeping up with conversations?
Your ‘snowed’ feeling could be a result of your medication. Many of the medicines used to treat these problems have this side effect. This is especially true if you take more than one or if the dose is too high.
Sometimes there are other medicine or non-medication options that will avoid these side effects. At least a trial of a lower dose might help.
Be sure to discuss your concerns with your doctor before making any changes.
Do you wonder if you might be taking one of these medicines or experiencing this type of side effect? Contact us at www.medsmash.com.
As you might imagine, where I live we had about 30 inches of snow recently. Everywhere we look we see snow. It is beautiful for a while. It is fresh and clean and bright. The ability to take a break is refreshing. When you know you can’t go anywhere, it is easier to give yourself permission to read a book or relax in front of a favorite movie.
There are times, especially with certain injuries or emotional traumas, when medication-induced relaxation is warranted. In these cases, extra care for safety from falls and avoidance of driving are important.
But, this is not a long-term desirable state. So, again, if you are experiencing this ‘snowed’ feeling on your regular daily medication regimen, let’s see what can be done to wake you back up.
BIBLICAL APPLICATION
Do you feel like you’re lacking focus and clarity?
Are you distracted by negative thoughts and/or worries?
Do you find you are working from one to-do to another with no time to think or plan?
Do distractions and daily activities override prayer? This is a common excuse for not spending time with God and in the Bible. I have certainly made this excuse and continue to do so.
Yet, there is more than enough evidence day after day that walking closely with God, daily prayer, surrendering worries is how we are designed to live. Life is more joyful. There is much more peace. Worries don’t slow you down.
There are many Bible verses that reassure us that this is exactly what we are called to do.
Likewise the Spirit helps us in our weakness. For we do not know what to pray for as we ought, but the Spirit himself intercedes for us with groanings too deep for words.
I challenge you to dedicate time each day to God. I challenge myself as well.
God knows you, everything about you, and loves you no matter what. So, hand it all over, accept the peace that is yours, and take a break from the worries.
yourhealthandsoul 