American Pain

By: Ania WojasGraphic By: Katie Herchenroeder You’re sitting in a chair now, probably, whoever you are. You’ve got socks on and pants and maybe you’re holding a pencil. You feel these things. But not all the time. They don't bring you pain. The mind is great at selective attention. But now that I've brought your attention to the omnipresence of dampened feeling, you can't stop feeling your socks, can you? Don’t think about the pink elephant. But what happens when the pink elephant eats you, chews you up and spits you back out? There is pain everywhere, always.The flush of an opioid withdrawal is not only a psychological, but also a physiological, craving that leads its victim to suffer intense pain in both spheres.Prescription painkillers, fentanyl, and heroin are all examples of opiates. The compound they release binds to receptors in the brain that are known to control pain and pleasure centers in the body. Habitual and compulsive usage can make permanent changes to normal brain chemistry. The flood of synthetic “feel-good” chemicals allows the brain to loosen its control over natural opioid production; when drug-use is curtailed, the physical pain is in part caused by the brain’s inability to spring back into its normal pain prevention patterns. According to the American Addiction Centers​, this “imbalance” causes many unpleasant withdrawal symptoms, such as depression, insomnia, and severe irritability.The American Society of Addiction Medicine characterizes addiction as “​a primary, chronic disease of brain reward, motivation, memory and related circuitry.” The emphasis is placed on chemical changes, but behavioral patterns are also affected: “inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.”The opioid epidemic is characterized both by breadth and depth, geographically and symptom-wise. ​The problem of this health crisis is threefold: first, the increase in opioid circulation; second, prescription painkillers opening the door to heroin addiction; and third, batches of drugs being laced with deadly fentanyl.In the 1990s, pharmaceutical companies developed extended release pain relief medication in response to increased levels of undertreated pain. According to the US Department of Health and Human Services, they did so while assuring consumers that these drugs were not addictive.By the time it became apparent that this was not the case, prescribing rates for opioids had almost doubled from 1994 to 2007.The rise in addiction, however, became even steeper, with the ASAM estimating death rates from drug abuse to have quadrupled from 1999 to 2008. Increased production lead to increased availability and eventually, the rampant misuse or abuse of drugs that now characterizes the opioid epidemic. But how can people with genuine pain be denied relief by virtue of an addiction they never intended to develop? Even today, with much more news circulating about the prevailing problem, people underestimate the power of both recreational and therapeutic opioid use. Many still share unused painkillers, with most adolescent users report receiving these drugs for free from friends or family, says the ASAM.The opioid epidemic is not just about painkiller misuse, it is also about heroin. 80% of heroin users admit to having starting with pain-relievers, a trend that makes sense considering heroin is a more readily available, much diluted form of morphine. As neurochemist Dr. Theodore Cicero, the creator of the first FDA post-marketing drug abuse surveillance program, clarifies, many opt for this route because prescription opioids are “far more expensive andharder to obtain.” VICE journalist Manisha Krishpan reports that with recent fentanyl outbreaks, opiates account for 66% of all overdose fatalities.Fentanyl, unlike heroin, is a very concentrated form of morphine, so potent in fact that a pinch of it can kill almost instantly.This drug was originally made by pharmaceutical companies to target patients in late stages of cancer, experiencing immense pain. But now that drug cartels have figured out ways to manufacture fentanyl cheaper and quicker than heroin, many products, unknowingly bought by customers, are lethal. China has become a major trafficking country for fentanyl and has also recently began pushing a new concoction: Carfentanil. It is said to be over ten thousand times stronger than pure morphine and has allegedly made its way into the drug trade already.Its original, therapeutic purpose is as an elephant sedative.The Center for Disease Control has summarized the effects of the sheer potency of the drug saying, “...even limited circulation of carfentanil could markedly increase the number of fatal overdoses." Synthesizing cheap variations of morphine has become a lucrative, but murderous, arena. The resulting social impact has been severe, with more than half of all opioid induced deaths being attributed to fentanyl overdose.This is a problem seen in the very neighborhoods surrounding The City College of New York.Harlem is one of the epicenters of the opioid epidemic, with one of the highest overdose fatalities in New York City.To supplement a role as good Samaritans and responsible citizens, the Department of Health has made Emergency Response to Opioid Overdose courses available for free to the public. To supplement this initiative, the city also provides Narcan kits, the opiate-antidote that works to reverse the effects of overdose. On the government level, it has become clear that other measures have to be taken to combat the epidemic, and harm reduction has become the main philosophy guiding substance abuse treatment.Syringe exchange programs, needle exchange programs, and needle-syringe programs are community-based programs that provide access to sterile needles and syringes free of cost and facilitate safe disposal of used needles and syringes, according to the CDC. Officials and medical professionals alike are aware that after a heroin addict obtains clean needles from a needle exchange, they typically do not wait to put the tools in use in a nearby bathroom.Washington Heights’ Corner Project was one of the first harm reduction centers of its kind in the city.Liz Evans, director of the the program, says, in an interview with CNN, "People are dying in those bathrooms, and so there's an acknowledgment that as a syringe exchange provider, we have a moral obligation to make sure that people don't die in our building." She emphasizes, “Public bathrooms are the frontline of the opioid epidemic.”In NYC, over half of drug users frequent public bathrooms and abandoned infrastructure to feed their habit. A recent study reported that “undisclosed safe injection site in the United States found that if they hadn't used the site's facilities, over 90% of the users would be using in public bathrooms or out on the street.” Thus, the public bathroom near the Corner Project is monitored via a timed intercom that allows the staff to be immediately aware of, and responding to, heroin overdoses.Also, staff are equipped with Naloxone, ready to save the lives of people who would otherwise go unaccounted for.They play an additional role in community health by reducing the chances of potentially dangerous drug paraphernalia ending up on the streets. According to Dr. Sanjay Gupta “the Corner Project pushed the limits of harm reduction in the United States,” and it truly has. While safe injection sites are still illegal in the US, needle exchanges can be vigilant of unofficial injection sites, thus saving countless lives.In humanity’s unique, but finite, human experience, pain is a universal language. Yet the opioid epidemic is not a global one. In addition to recreational drug use accidents, opioids are responsible for killing scores of people who are trying to deal with legitimate pain.In the Land of the Free, comfort and ease seem to be a basic human right, but what is their appropriate threshold of magnitude and endurance? How does this nation avoid, control, or own up to pain when it is everywhere, always? For more information:On upcoming overdose prevention training:https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/training_calendar.htm#nycOn Quick Facts on Responding to Opioid Overdoses:https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/overdose_facts.htmOn the Department of Health initiative HealingNYC:https://www1.nyc.gov/assets/home/downloads/pdf/reports/2017/HealingNYC-Report.pdfOn Registered Opioid Overdose Programs: https://www.health.ny.gov/diseases/aids/general/resources/oop_directory/docs/nyc.pdf