Dr. Paul Christo Sounds the Alarm About Rising Opioid Deaths
According to the Center for Disease Control, a record 93,000 people died last year from drug overdoses in the midst of the pandemic. That spike in deaths, a 27 percent increase from the 72,000 drug overdose deaths reported in 2019, is raising alarm among many in the health care community who believe not enough is being done to address this epidemic. Dr. Paul Christo, Associate Professor, Division of Pain Medicine, Johns Hopkins Medicine, in Baltimore, and Host, “Aches and Gains” on Sirius XM, is speaking out about the high levels of deaths related to synthetic opioids.
“The Covid-19 pandemic has worsened the number of opioid related deaths, unfortunately, and I think it’s really due to two things,” he says. “The economic hardships that a lot of the people have encountered and also the psychological hardships. They’ve seen a lot of friends and family members get sick, be hospitalized, and some have died. So that’s very traumatic.” These two factors have increased stress and led more people to use opioids as well as methamphetamines and stimulants, he says.
While the pandemic is far from over, rising vaccine rates have resulted in decreases in the numbers of people being hospitalized and dying from the virus. Yet there doesn’t seem to be a renewed focus on combatting this opioid epidemic which continues to claim too many lives. “I agree It doesn’t have the urgency that it needs,” says Dr. Christo, “but I’m happy, though, to see there is more about it in the media. I’ve been interviewed more and more about this topic for the last several months coming out of the deepest darkest period with respect to Covid. The pandemic required a lot of resources to save lives, develop the vaccine, and, as a result, the opioid crisis was left by the wayside temporarily. But I do see a resurgence.”
Dr. Christo’s credentials and experience make him the perfect medical expert to be speaking out about the opioid crisis. He is a board-certified pain specialist and anesthesiologist, and associate professor in the Division of Pain Medicine at the Johns Hopkins University School of Medicine. He was honored by the American Society of Pain Educators as Pain Educator of the Year for his transformational work on public education through the media. On his award-winning SIRIUS XM radio talk show, he has interviewed many celebrities about their battles with pain, including Naomi Judd, Joe Montana, and Montel Williams. His books include Aches and Gains: A Comprehensive Guide to Overcoming Your Pain.
Dopesick, streaming on Hulu based on Beth Macy’s bestselling book, has played a role in refocusing attention on the epidemic. (The final season of Goliath, available on Amazon Prime, also has a plot about the opioid crisis.) Both of those productions, however, play up the corporate greed by drug companies (the real life Purdue Pharma in Dopesick, and a fictional company in Goliath), that led to sales reps promoting opioids to physicians who, in many cases, overprescribed the pain killers, resulting in many patients becoming addicted.
Purdue Pharma, whose aggressive marketing of the highly addictive opioid OxyContin is largely blamed for creating this crisis, was dissolved in a bankruptcy settlement on September 1. The settlement has been widely criticized for letting the Sacklers, owners of Purdue Pharma, off the hook with none of the family members being charged with a crime. While CDC provides guidance for physicians about prescribing opioids to patients, many states have actually passed laws setting limits on opioid prescriptions.
Because of these restrictions on prescription painkillers, synthetic opioids like fentanyl, are now responsible for most of the overdose deaths. “That’s an important distinction,” says Dr. Christo. “In the past it was felt that the opioid prescriptions to patients in pain were otherwise leading to deaths, but now it’s synthetic fentanyl that people are buying off the street.”
Dr. Paul Christo
Dr. Christo says that what he is seeing in Baltimore mirrors what is happening all over the country. “We’re really seeing, not just deaths related to opioids, but opioids and cocaine is the big one,” he says. “And not only in adults, but in adolescents. These are kids ages 13 to 25. These are not necessarily patients in chronic pain, but people in the community who are turning to these substances to cope.”
Because a one-time use of a drug that includes fentanyl can cause death, Dr. Christo believes it is critical that schools talk to students about the risks. “We need to spend some money in targeting adolescents,” he says. “Grades six, seven, and eight, is a critical time. We need to educate ages 13 to 25, even age 12, to let them know what the risks are, what can happen. You can have one dose and die.”
Even if that one dose doesn’t cause death, it can lead to addiction and, once a person is addicted, it is difficult to quit. The term “dopesick” is slang for opiate withdrawn symptoms which may include nausea, vomiting, chills, body aches, diarrhea, night sweats, and insomnia. “We have good data that medically assisted treatments (MATs) are very helpful in helping to maintain sobriety with respect to opioid misuse disorder,” says Dr. Christo. “The craving and the withdrawal often lead people to relapse and these medicines like methadone and buprenorphine, for example, help significantly. And then patients can engage in psychological treatments as well.”
There are two obstacles, however, for patients to receive such treatments. “One, we have a dearth of substance abuse treatment centers across the country,” he says. “There just aren’t enough. That’s a problem that we need to focus our resources on. Two, not all of these facilities have been using these medications as treatments.” Disseminating information about MATs is critical.
In 2016, the CDC wrote a landmark paper on the opioid crisis. “The authors of that felt that opioids were being used too often and leading patients down the path of abuse, addiction, and death,” says Dr. Christo. As a result, there was a reduction in the use of opioids to treat chronic pain. “There’s a positive in that because initially opioids were used as the first line agent to treat pain, but really they should be used as more of an effort after other treatments fail,” Dr. Christo says. “That has really helped. However, there are a fair number of patients in chronic pain who were using opioids legitimately and safely who were then cut off. And I think that’s the tragedy.”
Is it possible for someone with chronic pain to use opioids for an extended period of time? “It definitely is,” he says. “I have those parents myself who have been on opioids for many years and use them safely and are able to do things to make life worth living for them. That’s the key here.” Safeguards, however, must be in place.
With any mind-altering substance – everything form tobacco to alcohol to opioids and methamphetamines – there’s a danger with respect to addiction. Why do some people become addicted and others don’t? “We don’t exactly know why I might be able to have one beer a week whereas my good friend has to have five beers every day and develops an addiction,” he says. “There is a genetic predisposition to addiction, but it’s also, more than genetic. There are environmental and socio-economic factors that come together to lead a person down the path to addiction. But there are things that we can do before starting opioid therapy to make sure, as best we can, that we’re not prescribing opioids to a patient in pain who is at high risk for opioid use disorder.”
One sign of progress is that the stigma surrounding addiction is slowly changing, with the word “addiction” supplanted with “substance use disorder.’” “The downside is that new description may imply that abuse is easily overcome, whereas when you use the word `addiction,’ people pay attention because it’s quite serious and it means that it’s going to be a difficult problem to get through and it really is.”
Dr. Christo would like to see the federal government provide increased support for law enforcement to crack down on those who are selling these substances. Despite the seriousness of this epidemic, however, there have been no hearings on Capitol Hill. “Several months ago, I thought that President Biden had assigned someone to try to develop a committee related to combating the opioid crisis and reducing the number of deaths,” Dr. Cristo says. “But I haven’t seen anything recently on that.”
Local governments need funding, not only for law enforcement, but also for supplies of naloxone, also known as Narcan, the opioid reverse agent that saves lives. “Most of the time you need a prescription (for Narcan), but in a fair number of states you don’t need a prescription. The pharmacist can just provide it. And law enforcement can dispense it.” Someone who overdoses and receives Narcan, stilll needs to go to the hospital because Narcan’s effect wears off in a few hours, Dr. Christo notes.
With the absence of an aggressive federal program to raise awareness about this epidemic, others need to step up. “Our job (in the medical community), and perhaps the jobs of the nonprofits, are to provide some education,” Dr. Christo says. That critical information, he believes, can save lives.
For more information on Dr. Paul Christo, go to his website.
Charlene Giannetti is a co-producer of the film “Life After You” about the heroin/opioid crisis.
Top illustration: Bigstock
