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What is Addiction, What actually happens during an Overdose and Who is your Emergency Contact?

What actually is Addiction? I mean, we talk about it all the time. We say all the time I'm addicted to soda or sweets or my terrible relationship or this or that. But what is it? What does it really mean to be Addicted (5)?

According to (1) :

Addiction is the repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.”

“There are four key parts to this definition of addiction:

1. Addiction includes both substances and activities (such as sex and gambling).

2. Addiction leads to substantial harm.

3. Addiction is repeated involvement despite substantial harm.

4. Addiction continues because it was, or is, pleasurable and/or valuable.”

According to the American Psychiatric Association Substance Abuse Disorder varies a bit (2):

“Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems. “

Opioid Use Disorder has a similar but different definition (3):

“While opioid use disorder is similar to other substance use disorders in many respects, it has several unique features. Opioids can lead to physical dependence within a short time, as little as 4-8 weeks.2 In chronic users, abruptly stopping use of opioids leads to severe symptoms, including generalized pain, chills, cramps, diarrhea, dilated pupils, restlessness, anxiety, nausea, vomiting, insomnia, and very intense cravings. Because these symptoms are severe it creates significant motivation to continue using opioids to prevent withdrawal.

As with other addictions, both genetic factors and environmental factors, such as ease of access, contribute to the risk of opioid use disorder. Access to prescription opioids and heroin have contributed to the current opioid epidemic.”

Addiction is so complicated. We only know a piece of what our brains are capable of. We are so complex but also simple at the same time. We respond to our feelings... happiness, sadness, anger, love, hate etc. We do what feels good... even if it starts to feel bad eventually, we sometimes keep doing it. This happens across the board. We see it over and over again. Substances, friendships, relationships, jobs... I believe these things are intertwined. Yes, we make a choice to do a drug (even alcohol) for the first time, most of us do anyway. Some people find in that first taste something they can no longer live without. Some people will never touch it again. Some people can do it socially and it will never effect their lives. It is something that is in you and not me that could make you the addict to a certain substance or vice versa. When I had my children I was on Oxycotin after the extremely painful c-sections I had. I took them as prescribed, did not abuse them but, I was on them for three weeks, every four hours if needed for pain. I never got addicted to them... I healed and was fine after my prescription ran out. I never thought about them again, never craved it, never needed it. Joey, on the other hand, did a few over a few weeks and was hooked. My point is, addiction is tricky... and what your body and brain have an affinity to be addicted to is even more so.

I think there are parts of ourselves we are trying to fill, trying to repair, trying to fix or numb or just make better. We turn to drugs, people, situations that have at one time or another did just that for us. They “fixed” something, somehow, even if it was for a second. Something we were never able to do for ourselves. How can we "fix" these pieces of ourselves without substances that hurt us? That solution is part of what this project hopes to contribute too.

The following was written by a member of our board Megan Enriquez. She is a nurse, a mother, a good person. She's a friend, an advocate, a caring member of society. She does not judge, she does not scold, she helps. She is a helper, one of those people that Mr. Rogers talked about. One of the good ones. I asked her to write this piece because I think we need to see every part of this journey, this battle, no matter how raw, how emotional or how sad. The road needs to be seen as a whole. All the people involved. Again, addiction touches every single person in some way. We all play a part and when we lose someone, or love someone who has known this struggle, that part never ends. Megan takes home with her everything that happens at work, it's impossible not to. Yet she still does not judge people who suffer from addiction. If she can do that, so can others. *This scenario is fictional and a combination of events that has been witnessed over the last 10 years in an emergency department setting*

"Sunday morning in the Emergency Department. Night shift has just walked out the door and day shift is checking in with all their patients as they take their first sip of a large Dunkin’ black coffee with a turbo shot. EMS radio blasts and as you jog over to answer it you think to yourself- here we go. This is Elmhurst Medic 2 on the line, 36-year-old female, overdose, two doses of Narcan given intranasally minimal response, patient being bagged currently, heart rate 120, blood pressure 95/50, unknown past medical history in route ETA: 5 min.

Charge nurse called alerted the troops- intubation cart, glide scope, crash cart opened drugs open and ready, suction set up, IV bag primed, intra osseous access drill ready, respiratory called for a ventilator. We know the drill- we all do here.

The ambulance pulls up, and it begins. As if it’s a well-orchestrated choreographed dance we’ve all done many times before. Blood pumping through all our own veins as we prepare for the victim’s arrival ready to treat this patient. Take the last sip of your hot coffee because with any luck at all, it’s going to be a long few hours.

On the count of three- 1, 2, 3. The lifeless appearing cool, pale, body is moved off the EMS cart and on to ours. She is now here and we are ready for her. Trauma sheers are busy exposing her limbs- as the physician intubates her sliding the tube gracefully into her trachea. Drill into the tibia done in seconds IV already primed and pressure bag on the fluids as we push the Narcan.

“Do we have a name?” someone asks above the noise... “I think I saw an ID in her coat pocket.” Alarms blaring, people hustling, bright lights shining looking down at the ID- the picture, the person, the life before this minute. Cell phone present, I click open the screen and there she is with two beautiful kids beside a lake.

The team continues to attempt to stabilize this stunning mother of two as my role shifts... I am now attempting to find the ICE (In Case of Emergency) number in the phone.

This series of events is seen nation-wide every day in Emergency Departments. In every social economic class and race. Addiction is a powerful disease and one that deserves our attention and resources."

So what is an overdose, really? What actually happens to your body when it occurs? What is happening to the woman's body in the story above? This article was written by Maggie May Ethridge for United States of Addcition- Tonic (4) and of all the articles I found explaining this, I thought this was the best. It explains it in a way that everyone can understand and is not to technical.

  • "First, the drug spreads throughout your body. When you take an opioid, whether a pill or an injectable, the drug enters the body and travels through your synapses, through the heart and into your lungs, where the blood gets flushed with oxygen before getting drawn back into the heart once again. With the next pump of your heart, your now opioid-rich blood is pushed out to the rest of the body, where it plugs into the system of opioid receptors all over your body.

  • When it hits the brain, you get happy. Once the opioid molecules are ferried across the blood-brain barrier, they enter a section of the brain at the center of your reward circuitry called the nucleus accumbens, where the happiness hormone dopamine is produced. There, the drug latches onto GABAergic neurons. Imagine GABA as a dam: They make sure our dopamine doesn't overflow, which can cause agitation and paranoia. Opioid molecules blow that dam open, and let dopamine spill over into the bloodstream, creating a feeling of bliss, way beyond what our GABA cells would normally allow us to experience. Soon the high evens out, and even before the rush is over, you might start to nod off, head dipping and jerking as you drift between waking and sleeping.

  • Your breath starts to slow. The opioid works on the systems that control both sleep and breathing: At the base of your brain lies a respiratory control center that drives your breathing, reacting to the level of carbon dioxide and oxygen in your blood to spur you to breathe. During an overdose, the slowed breathing that occurs with opioid ingestion of any kind becomes dangerously slow, leading to a complete stop.

  • Then your heart. Your heart rate slows as the opioid suppresses neurological signals. The oxygen level falls low enough that the heart starts having abnormal rhythms; the heart is not beating properly. At this point some overdose patients have sudden cardiac arrest.

  • Things begin to shut down. Because there is an overwhelming amount of opioid in your brain, your body stops receiving the correct signals at all to breathe. Your lungs and heart are barely working. With lungs and heart barely working, your brain begins to be damaged by lack of oxygen. The brain is highly sensitive to lack of oxygen; permanent brain damage sets in after four minutes of oxygen deprivation in most situations. Variables such as the temperature of the body can affect the damage to the brain—the colder the body, the more reduced the brain damage. If you're receiving CPR during this period, brain damage can be prevented or reduced.

  • You foam at the mouth, or choke. Sometimes opioid overdose can include pulmonary edema (fluid leak into the airspaces of the lung). This is a noncardiogenic pulmonary edema, meaning it is not caused by fluid backup from a failing heart; doctors are still unsure of the exact mechanism behind this event. This manifests as foam coming out of your mouth. It is not uncommon for opioid overdose patients to experience aspiration. This is when your body's natural gag response is suppressed or eliminated by the opioid's effects on the respiratory control center of the brain. As you become increasingly less conscious, the natural secretions in the back of the throat are not ejected or swallowed. Opioid patients who vomit can also aspirate their vomit and die.

  • Your brain gets permanently damaged. Opioid overdose can cause seizures from lack of oxygen to the brain. These seizures can further damage the brain. Brain damage–from mild to severe–is not often discussed with opioid overdose but is a real possibility. Overdose patients can end up paralyzed and unable to speak.

  • Narcan can reverse the effects. Narcan, an anti-overdoes medication that is widely available, can usually reverse these effects. Sometimes overdose patients have to be given multiple treatments of Narcan, depending on the amount of opioids in their system. Narcan can always be attempted for revival if the patient is still alive. Given through an IV, Narcan works in seconds, given through a shot or with nasal spray, within minutes. Narcan moves into the receptors of the brain where the opioid is stuck, knocks the opioid molecules off the receptor, and replaces them. The opioid is then metabolized in the body. Narcan generally has no side effects. If a patient overdosed on Oxycontin, which has a slow release in the gut, they can be revived from overdose only to overdose again. They may need an IV infusion of Narcan in slow-release, until the opioids are cleared from the body. People who have overdosed on heroin can go into full, immediate withdrawal after a Narcan dosing, so doctors will typically attempt to give small, repeated doses of Narcan to avoid a patient waking and immediately leaving the hospital in search of more opioids."

This is what happened to Joey as he overdosed on Oxycondone. He could not be saved from Narcan because the damage to his brain was too severe. His body couldn't repair it, nor could the doctors working to save him. He aspirated and was given antibiotics to help the pneumonia while he was in the hospital. He experienced all of the things above.

What this article doesn't talk about is if there is pain. I wonder about that often. If he was in pain in those last hours of his life. I wonder... Do you know you're overdosing? Do you think someone will find you in time? Do you know when it takes the turn from an overdose to dying? Do you know you're dying? Do you have the capacity while your body is shutting down to relive moments that brought you happiness and reminisce about your loved ones before the final breath and final heart beat?

"The ringing of the phone is something you never listen to before... it’s a noise that just happens while you're waiting for the other person to pick up. But when you’re making “the call” knowing that it’s the last moments that the person on the other end is about to have their lives collapse and they will never be the same because of it. You almost hope they don’t answer so they might have a few more minutes of normalcy.

They answer, “Hello?” and their nightmare is now a reality.

As I prepare for the family’s arrival, I take a sip of my now cold coffee and say a prayer for them and their beautiful mother and do my best as a nurse, a person, a mother, a friend in preparing to support them in this chaos. I've done it more times than I thought I would and I'm sure in the midst of this epidemic, I will continue too."

Sources and Information/Resources for Education:







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