TYLER NGUYEN
Student Intern at Northside Hospital
1st Trimester: 3Tower (Ortho)
2nd Trimester: Radiology
3rd Trimester: Rehab
My Essential Question:
With opiate addiction creating a nationwide crisis, how can we integrate alternative pain management practices to reinforce narcotic medications in order to progress patient discharge and facilitate their recovery after rehabilitation?
ABOUT ME!
Aspiring Do-Gooder and Go-Getter
Hey y'all! My name is Tyler, and I'm a senior at West Forsyth. I'm headed to Athens next year and cannot wait to be a DAWG! If you need me, you can probably find me at the lake or pulled over by FoCo police.
Presentation
A video breakdown of my capstone.
Why is this important?
Since 2014, opiate abuse has plagued the metro-Atlanta area to the point that it has been responsible for more deaths than car accidents and murders in the area combined. Think about that for a second. In an area that features I-75, I-85, I-20, the Perimeter, Georgia 400, and all of the connectors associated with them, think about how many fatal accidents there are. Being in a city that features neighborhoods with high crime rates and slow dispatch response times like The Bluff and nearby Pittsburgh, to the SWATs going down to Cascade and East Point, or even out East in Zone 6 with notorious streets like Edgewood, Bouldercrest, and Glenwood, think about how many murders occur. When people think of drug overdoses, they think of junkies under a bridge shooting up more than their bodies can handle. In reality, heroin and fentanyl are serial killers that are silently making their way into Atlanta suburbs claiming the lives of the rich and poor, not discriminating as it chooses its victims.
What did I know beforehand?
Heroin is an opioid. Opiates are frequently used in medical practices as painkillers, some common ones being Percocet, Dilaudid, Vicodin, and OxyContin. In pain management situations, patients may be prescribed an opioid orally or intravenously. These drugs block pain receptors and produce calming effects but are proved to be extremely addictive if used frequently or abused. Opiates, with their euphoric elements, have leaked into pop culture, making their usage “cool” amongst young adults. These prescription opiates are referred to as “designer drugs”. Atlanta-based artists like Young Thug and Future are poster boys for this movement with their songs featuring the promotion of these dangerous drugs, especially lean, which is slang for a liquid opiate syrup often sold as Promethazine with Codeine. People commonly mix lean with soft drinks to create a nightmarish cocktail known as “dirty Sprite” or “purple drank”. Future, who is known for his drug-use filled lyrics, popularized lean and has built a cult following behind it. As a result of these icons glorifying the use of opiates, the metro-Atlanta area has been plagued with people who suffer from the addictive effects of these drugs. The problem with opiates is that unlike other harmful, illicit drugs like stimulants and hallucinogens, their usage is commercialized and promoted to the public. With the exception of heroin, which is demonized in our culture, a lot of people probably do not understand the effects that these drugs have on their bodies. The popular pill forms, Percocet and Vicodin, are often inaccurately deemed as party drugs by the upper classes who tend abuse less harmful pills like MDMA (“molly”) and Adderall. It’s safe to assume that one of the main reasons opiates are killing at such a high rate is because abuse awareness is extremely low.
What did I find out?
As of late, opiates have made headlines on every major Atlanta-area news network. It’s an unfortunate reality, but local stations only started paying attention to the epidemic when people from suburban neighborhoods were overdosing. When lower-income people were dying from heroin abuse, society believed it was the crack cocaine epidemic all over again, confined to the projects and government housing. One of the biggest misconceptions about opiates is that people believe that addicts begin using and continually abuse it for same reasons as other drugs. Dr. Sharon Levy explained how that was not particularly the case. She notes in her article in the AJPH that the recent outbreak of opiate abuse is different from any other drug we have seen in the past. Instead of purchasing through street contacts, addicts were now lining up at doctors’ offices to get prescriptions for them. Average people were now victims of addiction due to the availability and willingness of medical professionals to administer their use. That’s where my research took place. Tackling the opiate epidemic as a whole is no easy task, but addiction stemming from rehabilitation pain management drugs is definitely preventable. A study by Dr. Ewan Cameron suggests that the solution is as simple as replacing narcotic painkillers with vitamin C. In large doses, vitamin C can alleviate the pain that patients feel before or after their operations. The ascorbic acid reduces inflammation and acts as an antibiotic and antihistamine. Since it is naturally occurring and non-addictive, vitamin C is a plausible alternative for opiates down the road. I also did an interview with a friend and former co-worker that is a recovering heroin addict.
Interview with JP
For anonymity purposes, only his initials will be revealed. The transcript of the interview only features the relevant questions and has been paraphrased for quality purposes.
TN: When did you begin using heroin?
JP: About three years ago. When I started serving at restaurants, I made a lot of extra money, so I started experimenting with different drugs. Before I knew it, I was hooked.
TN: How easy was it to buy?
JP: Easy, for me at least. I had a lot of friends that sold.
TN: When did you realize that heroin was a real problem for you?
JP: I was young, so I never thought I would become dependent. I considered myself a functioning user, but when my family and friends noticed, I realized I needed to quit.
TN: Was it hard to break the habit?
JP: Very. I knew I had to stop, but the withdrawal symptoms were awful.
TN: What makes heroin different from other drugs?
JP: The feeling you get when you use it. I just kept going back to the needle because it would always put me in a warm and relaxing state of mind.
TN: How are you doing now?
JP: I’m still recovering but I’ve been clean for five months now, so that’s something to be proud of.
What now?
Opiate addiction is something like we have never seen before. With its calming effects and harsh withdrawal symptoms, addicts tend to continue using until a fatal dose comes around. Many who abuse opiates are average people that are fully functioning, contributing to the low awareness of the detrimental effects of the drugs. This is not an issue that law enforcement can contain through possession arrests. Without awareness being brought to the opiate crisis, there is no way for it to be contained. Being at Northside for a while, I have noticed how pain management and rehabilitation evolved since opiates have been introduced in large quantities. After major orthopedic surgeries, I have seen patients leave the next day after being dosed with healthy amounts of Dilaudid and Percocet. Instead of long, grueling physical therapy, patients can return to their normal lives within a week of a major accident. There is no doubt that opiates are miracle drugs with great medical benefits, but hospitals need to adjust their practices to prevent addiction on their end.
Sources
Boone, Christian. “Fulton D.A.: Heroin Use Now at 'Crisis Stage' and Growing.” AJC, 15 Jan. 2016.
Tucker, Katheryn. “A&E Stages Heroin \'Intervention\' in Atlanta\'s Northern Suburbs.” Daily Report, 3 Jan. 2018.
Levy, Sharon, et al. “Facing Addiction: A Laudable, but Incomplete Effort.” American Journal of Public Health, vol. 108, no. 2, Feb. 2018, pp. 153-155.
Houston, Reagan. “Vitamin C for Pain Control.” Townsend Letter, no. 400, Nov. 2016, pp. 55-57.
Winston, Paul. “Addressing Narcotics Use and the Chronic Pain Epidemic.” British Columbia Medical Journal, vol. 59, no. 7, Sept. 2017, pp. 352-355.
Annotated Bibliographies
Sources pertaining to addiction and prevention.
Annotated Bibliography #1
Winston, Paul. “Addressing Narcotics Use and the Chronic Pain Epidemic.” British Columbia Medical Journal, vol. 59, no. 7, Sept. 2017, pp. 352-355.
The increase in narcotics use that has led to the current opioid crisis reveals the need to re-examine the concept of medical pain management. Pain is one of the most common reasons to visit a family physician and can be challenging to manage for all physicians, especially when it becomes chronic. We need to understand how misuse of narcotics occurs and identify the factors contributing to the patient’s pain rather than prescribing additional painkillers. We also need to provide patients with pain management tools other than narcotics and recognize that easy solutions are not the answer.
Potential quotes that can be used include:
“In my experience and that of my physical medicine and rehabilitation peers, rehabilitation patients rarely leave hospital using narcotics and are rarely prescribed narcotics once they are safely home.”
“People with chronic pain typically do not receive validation from friends and family, but instead face frustration, a lack of support, or dismissal. Narcotics use begins for many of these patients with visits to the emergency room or walk-in clinics, and continues with endless prescription renewals.”
“Unfortunately, physicians have been told they can safely increase doses of narcotics. The truth is that when a patient is not receiving good pain relief from a low-dose opioid it is absolutely wrong to escalate. If the pain is not reduced, the pain is not responding to the drug.”
“We must be honest with our patients when we feel their symptoms outweigh their premise signs and work with them to mitigate disability, not promote it.”
The British Columbia Medical Journal is a peer-reviewed journal where physicians share scientific research and insight. The BCMJ is overseen and peer-reviewed by an eight-physician Editorial Board that operates at arms-length from Doctors of BC so that it can be an open forum for debate on any topic.
My paper is going to be primarily about rehabilitation, and pain management plays a large part in that. There are many other forms of treatment that are mentioned in the article, physiological and psychological. Looking at it from a physician’s perspective provides insight that I wouldn’t have otherwise.Annotated Bibliography #2
Houston, Reagan. “Vitamin C for Pain Control.” Townsend Letter, no. 400, Nov. 2016, pp. 55-57.
The article offers information on the use of vitamin C for pain management. Topics discussed include tests performed by doctor Ewan Cameron who had various types of advanced cancer and needs regular therapy; use of vitamin C for decreasing childbirth pain and duration; and preventing infections and pain management with vitamin C.
Potential quotes that can be used include:
“Patients often worry about addiction and do not take enough painkiller. Fortunately, vitamin C has demonstrated the ability to quickly neutralize addiction and leave no side effects. This allows a higher dose of narcotic and better pain control.”
“Pains are symptoms, not usually the basic problems. But as the body fights pain, it generally consumes vitamin C. With low vitamin C (ascorbate) in the blood, white blood cells cannot kill germs and do other functions. Replenishing the blood ascorbate strengthens the body.”
“Vitamin C is extremely safe. Many people have taken over 15 grams per day for years. Based on small animal tests, the vitamin C lethal dose (LD50) is around 350.12 This means that a 150-pound person might ingest 350 grams of ascorbic acid with a 50% chance of living. But 350 grams is over half of a pound, an amount almost impossible for a person to take quickly.”
“Pain, simplified, includes an electric signal going through nerves to the opiate receptors in the brain. High-dose vitamin C may neutralize the narcotics in the receptors.”
These are direct quotes that explain how vitamin C works to relieve pain and shows how it is a safe alternative to the common narcotics that are used in medical practices.
The credibility of the source can be attributed to its inclusion in the Galileo database. The article was also published in the Townsend Letter, an alternative medicine magazine that is written by researchers and health practitioners. Bias can be found in Houston’s positive experience to vitamin C pain treatment, but quantitative data and other patients’ experiences with the treatment prove its effectiveness. The article is also fairly recent, as it was published within the last two years.
My topic is two-sided. Not only do I want to show the devastating effects of narcotic abuse, but I want to discover alternatives and solutions that are safer and less addictive. This vitamin C article shows how pain management can be performed in many other ways, in this case, a nutritional supplement.Annotated Bibliography #3
Levy, Sharon, et al. "Facing Addiction: A Laudable, but Incomplete Effort." American Journal of Public Health, vol. 108, no. 2, Feb. 2018, pp. 153-155.
This article talks about how addiction has evolved over the years, with victims becoming hooked on more serious vices like opiates. Levy notes how addiction is now associated with death rather than just bad judgment. She calls for the reconceptualization of the war on addiction by rethinking the problem and looking at preventive actions and effective treatment.
Potential quotes that can be used include:
“In light of this history and the current opioid use public health crisis, we commend the 2016 publication of Facing Addiction. The report clearly states that addiction is a medical problem associated with significant morbidity and mortality—not bad behavior or moral failings—and it calls for responses from health care systems and society that reflect this medical frame.”
“Reconceptualization of the problem coupled with thoughtful policy, prevention, and clinical practice efforts may improve the health of millions of Americans, including children affected by a family member’s substance use disorder and adolescents at risk from their own.”
“Facing Addiction explains that the increase in prescribing opioid pain relievers has driven the opioid crisis. Solutions to the crisis include changing prescribing practices, delivering evidence-based treatment, and using harm reduction strategies.”
“As opioid use disorders are chronic, are challenging to treat, and cause great mortality, a thorough examination of these issues is necessary, and prevention must be a central component of a long-term solution.”
Sharon Levy is a renowned doctor well known for her work in adolescent medicine research. This article was published in the American Journal of Public Health which is backed by the American Public Health Association, a government program based in Washington D.C. It is also worth noting that the article is very recent, with its publishing date in February of 2018.
This article will contribute to my project by showing my audience how current this issue really is. Doctors are just now beginning to acknowledge how addiction is now an epidemic that needs to be controlled. Preventative measures are still in the works while the opioid crisis is still as strong and potent as ever.
Tyler Nguyen © 2018