Mclean Hospital

A Crisis Point: Staving Off the Epidemic of Opiate Use

By Rocco A. Iannucci, MD

March 22, 2017

We have all heard about the recent rash of opiate overdoses that many have termed an “epidemic.” In 2014, numbers from the Minnesota Department of Health revealed that overdose deaths from opiates, including prescription painkillers and heroin, exceeded deaths from motor vehicle accidents in that state for the first time. These troubling figures underscore a major threat to public health and follow increasing reports of escalating overdose deaths in Massachusetts and throughout the United States. Nationally, overdose deaths have more than doubled overall, while overdoses on prescription painkillers have more than quadrupled, all in the period from 1999 to 2010. Every indication is that this alarming trend continues.

What Can Be Done?

Increased public awareness of deaths related to opiate use has spurred action. Many states have developed mandates to intervene to prevent deaths. Some have recommended use of naloxone, an antidote to opiates that trained laypersons can administer.

Signature Addiction Recovery Programs
Dr. Rocco Iannucci (right) at Fernside, a McLean Hospital Signature Addiction Recovery Program

Naloxone, typically given in intravenous or “IV” form, can quickly reverse the effects of opiate use. It has been used routinely in emergency departments over many years for just this purpose. Recently, distribution of intranasal naloxone to those struggling with opiate addiction, and to their loved ones, has been advocated as an overdose prevention strategy. Family, friends, and acquaintances may encounter the overdosed individual before he or she gets medical attention. Intranasal naloxone can then be immediately administered, hopefully reviving the individual while formal medical treatment is sought.

Is This Enough?

Intranasal naloxone is an important and potentially life-saving intervention for someone who has overdosed on opiates. Nonetheless, it is not a substitute for addressing the underlying problem of addiction. Many evidence-based treatments now exist, including medication-based and psychotherapeutic approaches to treat addiction to all major substances of abuse. All too frequently these interventions are underutilized. Often, this is related to a belief that addiction represents failure of willpower or a flaw in character. Most genetic studies of drug and alcohol use disorders reveal that at least 50% of risk for these conditions is heritable, meaning it can be passed on in families like eye color or diabetes. This argues for a strong biological basis for these chronic diseases, calling for clinical treatment based on best medical practices. Fortunately, clinicians can now support patients through efficacious, FDA-approved medications for treating opiate, alcohol, and tobacco addiction. There is also a strong scientific basis demonstrating benefit from particular forms of psychotherapy delivered by well-trained clinicians.

Getting Help

People do not die of character flaws, but of illnesses. If you or a loved one is struggling with the disease of addiction, speak to your own or your loved one’s physician, or consult one of the resources below.

For more information on getting help for yourself or your loved one:

This article can also be found on the HuffPost.

Rocco A. Iannucci, MD, is the program director of Fernside, a Signature Addiction Recovery Program at McLean Hospital, and an instructor in psychiatry at Harvard Medical School.

March 22, 2017

Back to top