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BY DR. ALFREDO E. TAULE, NMS MANAGEMENT SERVICES The Return of the Old Dragon!


opioids for chronic pain, and asked primary care providers to help patients make “more informed decisions about treatment.”2 Te use of opioids as a painkiller isn’t new. References to the


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medical use of opium date back at least to 4000 BCE, and it has been used to treat a range of ailments including poor eyesight. Today in the United States, opioids are prescribed not only for serious pain caused by major diseases like cancer, but also for chronic pain. Aside from its medical applications, we know that opiates—heroin in particular—are highly addictive, and addicts who manage to get clean are always at high risk for relapse. Although heroin addiction isn’t a new phenomenon in the United


States, what is new—and disturbing—is the alarming increase in users in the United States, and not just in urban or low-income areas. Tere have been statistically significant increases in heroin use among women, as well as people with higher incomes and higher degrees of education. Te number and types of opioid medications being prescribed has increased beyond morphine and codeine to Norco, Vicodin, Dilaudid, Percocet, Actiq . . . the list goes on and on. As noted in the Winter 2015 issue of DATIA focus, “. . . sales of prescription opioid painkillers in the U.S. have risen a shocking 300


34 datia focus


ast month, in response to “the epidemic of overdose deaths,”1


percent from 1999 to 2010.”3 the Centers for Disease Control and Prevention (CDC) issued a recommended guideline for prescribing


Tose who are taking these medications


are at a 40% higher risk for heroin abuse and/or dependency.4 What the current television ads about opioid use don’t tell


you is that occasional constipation is the least of your worries. According to current statistics, over 40 Americans die daily from painkiller overdoses, a rate that CDC director Dr. Tom Frieden believes is doctor-driven.5


For many, the first pill is actually


the first step on the road to addiction, and when patients can’t get refills (even if they no longer need the drug for its initial application), life becomes a daily search for any available—and usually illegal—sources like heroin. Tat’s where suppliers, backed by drug cartels, are all too


happy to supply what the addict’s body craves. Tese cartels exist worldwide, with intricate social and economic hierarchies that keep the supply flowing into the Americans who use opioids to control pain, want fast service and good product, but when desperate, resort to lower grades of heroin which are oſten cut with various compounds that make the drug cheaper and more deadly. Te cartels will answer the demand and provide instant delivery of potent and dangerous products. Nurtured by the law of supply and demand, these providers range in location from Mexico to Afghanistan and will undoubtedly continue to prosper so long as people have addictions that need to be fed.


summer 2016


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