The spread of the opium epidemic
Un report torna a far luce su una delle più grandi minacce alla salute pubblica che da anni imperversa negli Usa: la crisi degli oppioidi, che rischia oggi di fare più vittime degli incidenti.
Unfortunately, the opioid crisis in the United States remains news. It does so with the publication of the National Safety Council report on the avoidable death risks for the American population.
In fact, the document shows that not only the risk of death from accidental overdoses of opiates ranks fifth in the order of preventable mortality (due to cardiovascular diseases, tumors, and chronic respiratory diseases), but it first exceeded the risk of remaining victim of a car accident: 1 in 96 vs. 1 in 103 (data show 2017).
The crisis is worsening, according to a memorandum issued by the same National Security Council, especially because of the illegal use of fentanyl.
Although the crisis of opioids – a wide class of opioids or natural, semi-synthetic or synthetic substances, which act on receptors on the cells of the nervous system – not only illegal drugs but also prescription drugs.
In fact, as the Ministry of Health overseas reminds us, in fact, the abuse of opiates may have roots in the 1990s. Then, reassured by pharmaceutical companies that ruled out the dangers of opioid dependence, doctors began prescribing drugs in large quantities.
The prevalence of use, and therefore misuse and misuse – of prescribed and non-prescribed opioids over the years would have provided its calculation
Opioids are an important resource for the management of acute pain – especially for short periods, for example after surgery or in the case of tumors or chronic non-cancerous diseases – but like all drugs, they are not immune to risks, especially in the long run. Quite the contrary.
In addition to the side effects of nausea, vomiting, depression, confusion, drowsiness, and the use of prescribed opiates can stimulate tolerance to medications, increase sensitivity to pain and may cause addiction, the US Centers for Disease Control and Prevention reports.
With the risk of getting the same pain relief, you need larger amounts of the drug (prescribed substances such as morphine, codeine, oxycodone, methadone, tramadol, and fentanyl are prescribed). All this, coupled with the fact that opiates not only relieve pain but also stimulate euphoria, can increase the risk of addiction, with prolonged uses, beyond the indications.
At high doses, opioids cause respiratory problems and can lead to death and increase the risk of alcohol and tranquilizers fade in the mix.
Specifically, there has been an increase in overdose mortality over the years in which he spoke of the opioid pandemic, one of the most serious public health problems of our time, as some experts and Trump himself have described.
The first CDC identified the first wave of opioid overdose mortality in the increase in opioid prescriptions in the 1990s – also used to treat pain such as those associated with arthritis or back pain.
Heroin before and the proliferation of synthetic opioids at the time, especially the illegal fentanyl that we said, would have characterized instead the second and third waves of the epidemic, recently. In total from 1999 to 2017, deaths from an overdose of opiates, from prescription or not, we’re close to 400,000.
Estimates of the past year alone range from 43,000 to 49,000 deaths: on average, the opium mortality rate in 2017 was six times higher than in 1999.
Between 2000 and 2012, the number of children infected with newborn withdrawal syndrome, children born to mothers Use opioids during pregnancy (misuse), with low birth weight and respiratory complications.
“From 2016 to 2017, overdose mortality increased for all opiates and synthetic opiates, but deaths from prescribed opiates and heroin remained stable – you read a report released just last month – the epidemic of an overdose of opiates continues to deteriorate and evolve because of the continuing increase in deaths associated with synthetic opioids. ” In particular, fentanyl, a substance that also scares Europe, is linked to replace heroin and oxycodone in the order of the most deadly opiates over the years.
Fentanyl is a drug, adopted as an analgesic drug, extremely strong: 80-100 times morphine, 25-40 times stronger than heroin, 20 milligrams represents a possibly lethal dose.
Despite the risks related to the incorrect use of prescription preparations, the main risks are associated with the use of illegal substances, which may also be mixed in the market with cocaine and heroin.
In fact, the fentanyl family is a family in which similar molecules with similar structures and effects are calculated, with variable strength, less in some cases, much larger than fentanyl in others (up to 10,000 times morphine is used in this case of carfentanil, lethal to a few dozen Of micrograms).
The interim data for 2018 seems to indicate an improvement in the situation, but it is still too early to say. We soon understand whether a large number of projects, studies and initiatives developed to try to stop this long-term epidemic have borne fruit.
What seems clear is that such a complex problem can not be addressed on a single line.
Prevention strategies can not only aim to improve doctors’ education on the appropriateness of prescriptions (which have shrunk with the prevalence of legal cannabis) and the fight against the illegal market but should expand and include efforts to break the misconceptions about it.
To identify the most at-risk groups (by separating the casual group from the intended group), and therefore more in need of assistance, to make access to emergency treatments against overdose and the use of other analgesics, where possible, more rapid and faster to promote research on pain management, with the development of new drugs, with Improved safety profile and reduced risk of addiction.
The idea of research that aims not only to find safer options should not be excluded, but this also highlights, for example, the true long-term effects of opioid therapy and verifies the effectiveness of other methods of pain management, even non-pharmacological.
And why not, it would also be desirable to highlight the links between the marketing of producers and opioid prescriptions.
If the fear in our parts is that sometimes these drugs can be prescribed very little, according to some, we would be wrong to view the United States as a distant country and the opioid epidemic as a problem that does not concern us at all. “If it is true that in Italy we have not been experiencing an epidemic of opioid mortality affecting the United States for years, it is true that the problem can also come from us and that toxicology units sometimes relate to cases of problems related to opioid use – said Guido Manioni of the University of Florence To the extent that the Italian Society of Pharmacology (Sif) and the Italian Society of Toxicology (Sitox) have recently signed a position paper on the therapeutic appropriateness and fear of opioid dependencies for the treatment of chronic pain.
Take advantage of “It is true that there are many guidelines on this subject, but the purpose of this document is to provide useful tools to avoid similar situations in Italy,” appeals Mannoni, who resumes Together with Patrizia Romualdi of the University of Bologna, he coordinated the action – once prescribed opioids only for the treatment of pain associated with tumors, no longer today, they also suffer from chronic non-cancerous pain.
In addition, Italy came later: With us only since 2010 under Law 38, prescriptions of opiates have become simpler, even for general practitioners. In the United States, access is starting first. What we want is to avoid what we have seen elsewhere.
The development of the opium problem in China… Download PDF