COLUMN: Facing the opioid epidemic in Snohomish County

At the end of March, the Obama administration announced it would take stronger action against an issue that strikes to the heart of many American families ' the prescription opioid abuse and heroin epidemic.

According to a January 2015 Snohomish County Health Department report, one in five heroin deaths in the state occurred locally, and in 2013 alone heroin and prescription opioid deaths represented two-thirds of the 130 accidental deaths in Snohomish County.-á

While the national attention is a step forward, in order to make progress, we as citizens may need to change our view of opioid use disorder (OUD) and accept it as a chronic relapsing brain disease.

As a family physician, I know the treatment of chronic disease requires a long-term approach different from treating acute disease. As an addiction specialist, I know OUD is a complex disease that involves both primitive portions of the brain (craving) as well as physical dependence (withdrawal).

Like many chronic diseases, appropriate use of medication both reduces death rates and improves the quality of life. The different thinking is that many patients may need to be treated with these medications for a longer time than we previously considered. The step forward is that efforts are in place to make these medications more accessible to those who suffer than ever before.

At The Recovery Center at EvergreenHealth-Monroe, we regularly see patients with OUD. We see many individuals who have had multiple detoxification experiences without formal treatment. We see many persons who have had multiple treatment experiences without the use of abstinence medications. And we see patients who have been treated and failed abstinence medications because the medication was not combined with treatment or an ongoing personal recovery program.

We strive to evaluate each patient in the context of their disease and tailor a treatment plan that most supports their personal success. This plan includes management of withdrawal, considering medical and mental health issues, encouraging motivation to change, evaluation for abstinence medications and addressing the family and environment for recovery.

Understand the disease

While many people are exposed to mood-altering substances without becoming addicted, exposure to addictive substance places all who use at risk of substance use disorder (SUD).-á The substances most likely to develop into a substance-use problem include alcohol, benzodiazepines, opioids, cocaine, amphetamines, marijuana and nicotine.

Risk for the disease includes prior substance-use problems, family history of substance-use problems, co-occurring pain and mental health conditions, potency of the substance, age of first use and other environmental factors.-á

OUD is a complex brain disease. Anyone who takes opioids regularly will develop tolerance.-á This means the need to use more of the substance or more potent substances to have the same effect. As tolerance progresses, people develop physical dependence. Once this physical dependence occurs, individuals experience withdrawal symptoms, which accelerate the longer the person is without the drug.-á These symptoms peak around three days after the last use of short-acting opioids.

Physical dependence is different from addiction. Addiction involves features like loss of control, preoccupation with use, use in spite of negative consequences and distortion of thinking, and treating physical dependence is medical detoxification and abstinence medications. Treating addiction involves a psychosocial treatment program directed at maintaining abstinence and changing behaviors. It may also include the short- or long-term use of abstinence medication.

Relapse is when the person uses again. It is common in the disease of SUD. If the person falls back to using, the cycle starts again. Individuals who keep trying often are ultimately successful and many persons have long-term recovery without relapse.

Does a loved one need help?

If you suspect a friend or loved one of using, it's important to watch for changes in their typical demeanor and recognize that often people won't openly discuss substance abuse. Some symptoms and signs that a person might be abusing substances include a change in their friends or peer groups, increased lack of care with grooming and upkeep, loss of interest in favorite recreational activities, changes in sleeping and eating habits and declining job performance. Symptoms of withdrawal, which are common in opioid dependence, include yawning, anxiety, sweating and goosebumps, nausea vomiting and diarrhea. These are all potential warning signs of opioid abuse, and indicate it's time for a person to seek outside help.-á

Where to start

It is very common for friends and family to be a strong factor in helping people into recovery. The old thinking of "they have to hit bottomGÇ¥ and "they're just not readyGÇ¥ is not necessarily true. Those suffering from SUD can be helped in changing their motivation toward treatment and recovery.-á -á

The National Institute on Drug Abuse offers comprehensive resources for approaching the topic and next steps to explore in seeking treatment.

The Washington Recovery Helpline (866-789-1511) provides a variety of resources.

If this person is unwilling to cooperate, keep in mind that sometimes people are more receptive to advice from professionals rather than concerned friends or family members. All treatment centers provide an evaluation by a Chemical Dependency Professional (CDP). These individuals are trained and licensed by the state to assess the situation and recommend treatment options. They also provide the majority of professional psychosocial treatment.

Health providers are often willing to see the individual and suggest treatment options. They provide medical clearance and follow-up care for persons before and after treatment. When scheduling an appointment, consider you might request a longer appointment as these problems can often take more discussion than a simple medical office visit. Seeing your provider before treatment also sets the stage for medical aftercare following treatment.

John D. Patz, D.O., is the medical director at The Recovery Center at Evergreen Health-Monroe