Education

What Are Opioids?

An opioid is a narcotic analgesic that depresses the central nervous system. Natural opioids are derived from the poppy plant. Synthetic opioids are manufactured medications or drugs designed to mimic the effects of naturally derived opiates. Opioids include the illegal drug heroin as well as powerful prescription pain reliever medications. Common medications that fall within this class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, morphine, fentanyl, and related drugs.

Prescription Opioids

Prescription pain medications reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus. Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injury-related pain. Morphine is often used before and after surgical procedures to alleviate severe pain.

Codeine, on the other hand, is often prescribed for mild pain. In addition to their pain-relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for example—can be used to relieve coughs and severe diarrhea. Opioids work by attaching to proteins called opioid receptors which are found in the brain, spinal cord, gastrointestinal tract, and other parts of the body. When these drugs attach to their receptors, they reduce the perception of pain.

Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but they are frequently misused (taken in a different way or in a greater quantity than prescribed, or taken without a doctor’s prescription) because they produce euphoria in addition to pain relief. Due to how opiates impact the body, however, they are highly addictive. Regular use—even as prescribed by a doctor—can produce dependence. Taken in large quantities, opioids can cause slow breathing and death.

Prescription opioid medications can have effects similar to heroin when taken in doses or in ways other than prescribed, and they are currently among the most commonly abused drugs in the United States. Research suggests that abuse of these prescription drugs may open the door to heroin abuse.

Heroin

Heroin, which is derived from morphine, can be injected via a needle, smoked in a water pipe, mixed into a marijuana or tobacco cigarette, or snorted nasally. All routes of administration deliver the drug to the brain very rapidly, which contributes to its high health risks and to its high risk for addiction. Addiction is a chronic relapsing disease caused by changes in the brain and characterized by uncontrollable drug-seeking no matter the consequences.

Heroin often comes in small packages, and sometimes in small balloons. Since it is frequently cut with other drugs, particularly fentanyl, users do not know exactly what they are buying, which can result in overdose and possibly death. Recently, a synthetic opioid, carfentanil, has been mixed with heroin. This is a very powerful opioid, and often results in overdose.

Heroin is known by a variety of nicknames such as Big H, Black Tar, Horse and Dog. Heroin usually appears as a white or brown powder or as a black sticky substance, known as ‘black tar heroin.’

Fentanyl AND Carfentanil

The recent spike in overdose deaths in Ohio over the last few years can be partly attributed to the powerful narcotic fentanyl. Fentanyl is a narcotic that can be prescribed to treat severe pain over a long period. It is 50 times stronger than heroin.

Carfentanil is an extremely powerful opioid that is used to tranquilize elephants. It is 100 times stronger than fentanyl and 10,000 times more powerful than morphine. When mixed with heroin, the result can mean dramatic increase in overdoses.

When fentanyl or carfentanil is present and causes an overdose, it usually requires more than one dose of the overdose reversal medicine Naloxone (or Narcan) to revive the person.

Fentanyl and Carfentanil Awareness:

1. Know the Signs of Overdose Spotting an overdose and responding quickly can help save a person’s life. Some of the common signs include:

Hard to wake
Blue/gray skin
Choking/vomiting

2. Call 911 ASAP
A person who is overdosing on fentanyl or carfentanil will likely need extra Naloxone and medical help. It is very important to call 911 if you think someone is overdosing.

3. Naloxone Can Help But They May Need Extra Doses
Administering Naloxone can help but due to its strength, the person may need more than a normal dose.

Opioid Misuse

How Do I Know if Someone is Misusing Opioids?

There are physical signs and behaviors to look for if you are worried someone is misusing opioids. These signs and behaviors may include:

Constricted pupils
Red or bloodshot eyes
Appearing tired or drowsy
Itchy skin
Nausea or vomiting
Poor memory and concentration
Anxiety
Constipation (may try to acquire remedies)
Slowed breathing
Slow movement and reactions
Mood swings
Apathy and depression
Change in appearance
Reduced social interaction
Deceitful or secretive behavior

Other Signs

Once the person becomes addicted to the opioid, you may notice lifestyle and behavioral changes. The

Once the person becomes addicted to the opioid, you may notice lifestyle and behavioral changes. These may include:

Leaving short straws and rolled dollar bills laying around, along with small mirrors if they are crushing pills and snorting them.
Leaving pipes around, if a person smokes the drug.
if they are injecting the drug, leaving syringes, rubber tubes, syringe caps, and droppers laying around
Spending all of their money on drugs so they may not have the required items that they would normally be expected to have.
Having unexpected money or expensive items if they begin to sell drugs to support their addiction.
Preoccupation with obtaining drugs and maintaining their addiction. Contact with family and friends may decrease. They may have a new set of friends who are drug users.
Committing illegal acts to get money for drugs and possibly being arrested.
Neglecting work and school.
Changes in overall attitude, including temper outbursts.
Talking more about partying or drinking.
Appearing jittery and secretive.
Deterioration of personal grooming and physical appearance.
Asking for money loans.
Missing items from the homes of family members or loved ones.
Wearing long-sleeved clothes if the person is an intravenous drug user.

For more information on the signs of opioid misuse go to the National Institute of Drug Addiction: www.drugabuse.gov.

Marijuana

Marijuana, also known as pot, grass or weed, is the most commonly used addictive drug after tobacco and alcohol in the U.S. The use of marijuana continues to grow as states make the use of the drug legal. Use of marijuana is widespread among young people.

Marijuana use has real risks that can seriously impact a person’s health and wellbeing. Today’s marijuana is stronger , and people can and do become addicted to it. Despite the harm associated with use, the perception of how harmful marijuana use is continues to decrease.

Marijuana consists of dried leaves, flowers, stems and seeds from the Cannabis sativa or Cannabis indica plant. The plant contains the mind-altering chemical THC and close to 500 other chemicals. Marijuana can be smoked in hand-rolled cigarettes, in pipes, vapes, water pipes or blunts (emptied cigars that have been partly or completely refilled with marijuana). Marijuana can also be eaten in food (edibles) such as brownies, cookies and candy, or brewed as a tea. A newly popular method of marijuana use is smoking or eating different forms of THC-rich resins (called dabbing). Most use marijuana for pleasure, but an increasing number of doctors prescribe it for specific medical conditions.

Approximately 1 in 10 people who use marijuana will become addicted. When the person starts using before age 18, the rate of addiction rises to 1 in 6. Over the past few decades, the amount of THC in marijuana has steadily climbed and today’s marijuana has three times the concentration of THC compared to 25 years ago. The higher the THC amount, the stronger the effects on the brain. Marijuana has both short and long-term effects on the brain.

Visit the SAMHSA Website to learn about the risks of marijuana use.

Click here to print an infographic on the risks of marijuana.

How Can You Tell if Someone is Using Marijuana?

How can you tell if someone is using marijuana?
Loss of focus during a conversation
Increased appetite
Lack of energy and loss of motivation
Possession of drug paraphernalia
Inappropriate laughter
Legal or financial problems
Paranoia

(Sources: National Institute on Drug Abuse (NIDA) www.drugabuse.gov/publications/drugfacts/marijuana

and

Substance Abuse and Mental Health Services (SAMHSA)

https://www.samhsa.gov/marijuana. )

Stimulants

Stimulants are a group of drugs that can be either prescriptions or illegal drugs. Some of the most commonly misused stimulants include cocaine, methamphetamine, and prescription stimulants such as Ritalin, Adderall, and Concerta. Stimulants can be referred to as “uppers” since they increase levels of dopamine in the brain and enhance performance, increase energy, and cause euphoric effects.

Methamphetamine

Methamphetamine, or “meth” is a synthetic stimulant that affects the central nervous system. Meth is a highly addictive stimulant that has significantly Increased in popularity in Clermont County in the past few years and is often mixed with fentanyl causing an increase in overdose risk. Meth is most often a powder or crystal and can be smoked, snorted, swallowed, or injected, intravenously.

People abusing or addicted to Meth will exhibit a variety of behavioral and physical symptoms. Some of the most common signs of Meth use include:

Hyperactivity
Twitching, facial tics, jerky movements
Paranoia
Dilated pupils
Noticeable and sudden weight loss
Skin sores
Rapid eye movement
Reduced appetite
Agitation
Burns, particularly on the lips or fingers
Erratic sleeping patterns
Rotting teeth
Outbursts or mood swings
Extreme weight loss

Another telling symptom of Meth use is “tweaking” – a period of anxiety and insomnia that can last for 3 to 15 days. Tweaking occurs at the end of a drug binge when a person using Meth can’t achieve a rush or high any longer. Tweaking can cause psychological side effects, such as paranoia, irritability, and confusion due to the desperation to use again. Tweaking from Meth can also cause people to experience hallucinations and become prone to violent behavior. This is called “meth-induced psychosis”.

Another sign that someone is using Meth is the crash phase. During this period, the body is deprived of the dopamine that Meth was previously supplying which causes extreme exhaustion.

Cocaine

Cocaine is an addictive drug made from the South American coca plant. Cocaine usually comes in the form of a fine white powder that is snorted. Crack cocaine or “crack” comes as crystallized rocks, and is typically smoked.

Some signs of cocaine use include:

Decreased sleep
Excitability
Dilated Pupils
Nosebleeds
Runny Nose
Weight Loss

Prescription Stimulants

Prescription stimulants are medicines generally used to treat attention-deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD) and narcolepsy (uncontrollable episodes of deep sleep). These medicines increase alertness, attention and energy.

Common prescription stimulant medications are dextroamphetamine (Dexedrine), dextroamphetamines/amphetamine combination product (Adderall), methylphenidate (Ritalin, Concerta).

Prescription stimulants increase the activity of the brain chemicals dopamine and norepinephrine. Dopamine is involved in the reinforcement of rewarding behaviors. Norepinephrine affects blood vessels, blood pressure and heart rate, blood sugar, and breathing.

Most prescription stimulants come in tablet, capsule, or liquid form, which a person takes by mouth.

Misuse of a prescription stimulant means:

Taking medicine in a way or dose other than prescribed
Taking someone else's medicine
Taking medicine only for the effect it causes—to get high

Repeated misuse of prescription stimulants, even within a short period, can cause psychosis, anger, or paranoia. If the drug is injected, it is important to note that sharing drug injection equipment and having impaired judgment from drug misuse can increase the risk of contracting infectious diseases such as HIV and hepatitis.

Can you overdose on prescription stimulants?

YES! An overdose can occur when the person uses enough of the drug to produce a life-threatening reaction or death. Signs of an overdose can include restlessness, tremors, overactive reflexes, rapid breathing, confusion, aggression, hallucinations, panic states, abnormally increased fever, muscle pains and weakness, irregular heartbeat leading to a heart attack, nerve problems leading to a seizure, abnormally high or low blood pressure, circulation failure, and various stomach issues.

Dangers of Multiple Drug Use

Make sure you tell your doctor and pharmacist about other medications you are taking. This is very important when you are taking benzodiazepines such as Ativan, Klonopin, Valium, or Xanax. These drugs are known to cause overdoses when mixed with other common drugs including prescription pain killers such as Dilaudid, Percocet, Vicodin, or even illegal drugs like heroin.

Mixing these drugs with alcohol is also a bad idea as alcohol increases the chance of a deadly overdose. When mixed, these drugs can cause the body to slowly shut down, where the heart beats slower and breathing to become harder. That is why it is important that you always tell your doctor and pharmacist what other medications you are taking.

Benzodiazepines (pronounced ben-zoh-die-as-a-pins)

Benzodiazepines are prescription drugs. Usually prescribed to people to help with anxiety or sleep troubles, benzodiazepines work by slowing the central nervous system’s messages to the brain and body. They do not necessarily make a person feel depressed. Other examples of depressants are things like alcohol, marijuana and heroin.

Mixing Benzodiazepines
Taking benzodiazepines with other depressant drugs like alcohol can make it difficult to breathe and lead to death. If benzodiazepines are taken with stimulants such as amphetamines or ecstasy, the body can have difficulty dealing with two different kinds of drugs at one time.

Other Commonly Misused Substances

There are other commonly misused substances. Alcohol is one of the most common types. For more information on other common misused substances, please see click on the links below.

Information obtained from: Commonly Used Drugs Charts | National Institute on Drug Abuse (NIDA)

Clermont County Daily Statistics

Ohio, like most of the United States, is in the midst of an opioid overdose epidemic. The link below connects to a dashboard which presents a snapshot of how drug overdose, primarily due to abuse of opioid drugs, is impacting Clermont County, Ohio. In order to estimate the size of this impact, Hamilton County Public Health has developed this data tool to provide information on ED visits and 911 dispatches due to overdose. Overdoses here are defined as a medical emergency due to the use of drugs of abuse, primarily opioids. Not all overdoses presented here involve opioids (the majority do) and not all overdoses result in death (the majority don't). ED visits here are defined as overdoses among Clermont County residents treated in any Ohio hospital or certain hospital systems outside Ohio such as St. Elizabeth's in Kentucky. 911 dispatches are defined as dispatches to a location within Clermont County due to an overdose incident.

View Clermont County Daily Statistics

For more information about statistics in Clermont County, please contact the Clermont County Mental Health and Recovery Board at (513) 732-5400.

For More Information:

National Institute of Drug Addiction: www.drugabuse.gov

Drug Policy Alliance: www.drugpolicy.org

Substance Abuse and Mental Health Services Administration: www.SAMHSA.gov/opioids