Discussion Week 8

Final Film Critique

Martin Gutierrez

[Institutional Affiliation(s)]

Author Note

Opioid Epidemic Article Summary

The opioid epidemic is severely damaging the United States. Dr. Joel Smithers was sentenced in U.S. District Court in Abingdon. He prescribed more than 5000,000 doses of opioids. It was said that “This physician perpetuated, on a massive scale, the vicious cycle of addiction and despair ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HfIV66uF","properties":{"formattedCitation":"({\\i{}Virginia Doctor Who Prescribed More than 500,000 Doses of Opioids Sentenced to 40 Years in Prison})","plainCitation":"(Virginia Doctor Who Prescribed More than 500,000 Doses of Opioids Sentenced to 40 Years in Prison)","noteIndex":0},"citationItems":[{"id":55,"uris":["http://zotero.org/users/local/WcSf8WB9/items/ACCGGF3Q"],"uri":["http://zotero.org/users/local/WcSf8WB9/items/ACCGGF3Q"],"itemData":{"id":55,"type":"webpage","title":"Virginia doctor who prescribed more than 500,000 doses of opioids sentenced to 40 years in prison","abstract":"Prosecutors said Dr. Joel Smithers ran a medical practice in Virginia like an interstate drug distribution ring","URL":"https://www.cbsnews.com/news/dr-joel-smithers-martinsville-virginia-doctor-prescribed-500000-doses-opioids-sentenced-40-years-prison/","language":"en-US","accessed":{"date-parts":[["2019",10,9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Virginia Doctor Who Prescribed More than 500,000 Doses of Opioids Sentenced to 40 Years in Prison)." New findings to combat the opioid epidemic were announced by Trump administration in September. They are giving almost $1.8 billion to the Department of Health and Human Services so that they can help communities fight the crisis.

As the world is growing fast, the number of the opioid epidemic is also increasing. The article highlights the seriousness of the situation going on in the country. To take care of people and save them from dying is the duty of every doctor. It is sad to know that doctors are illegally prescribing such harmful drugs which caused a huge number of deaths in the country. The government is taking good steps to reduce the opioid epidemic. They are giving $1.8 billion to the Department of Health and Human Services which is a good step to fight the crisis for the betterment of the country.

Opioid Antagonists and Agonists

Opioid is an exogenous drug that binds to opiate receptor, produces analgesia, and is blocked by opiate antagonist. Opioid is naturally taken from poppy plant which is used to make drugs like, Morphine, Codeine etc. Opioid antagonists block one or more of the opioid receptors in the central or peripheral nervous system. They are naltrexone and naloxone. These are used to reduce the effect of opioid in the body. While opioid agonists like, heroin, morphine, opium and others are the drugs which stimulate receptors in the body.

Opioid antagonists are used to block the receptors of opioid but these treatments are poor for opioid dependence. Excessive use of opioid agonists is harmful but the excessive use of antagonists as its treatment is harmful too. Its intermittent use can cause destabilization of central and peripheral nervous system. “An accelerated detoxification process does not translate into easier withdrawal management, as prolonged clinical discomfort and worsening of the withdrawal symptoms are reported ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"T72I3wF8","properties":{"formattedCitation":"(Mannelli)","plainCitation":"(Mannelli)","noteIndex":0},"citationItems":[{"id":59,"uris":["http://zotero.org/users/local/WcSf8WB9/items/RSMEPN84"],"uri":["http://zotero.org/users/local/WcSf8WB9/items/RSMEPN84"],"itemData":{"id":59,"type":"article-journal","title":"Agonist-antagonist combinations in opioid dependence: a translational approach","container-title":"Dipendenze patologiche","page":"17-24","volume":"5","issue":"1","source":"PubMed Central","abstract":"The potential therapeutic benefits of co-administering opiate agonist and antagonist agents remain largely to be investigated. This paper focuses on the mechanisms of very low doses of naltrexone that help modulate the effects of methadone withdrawal and review pharmacological properties of the buprenorphine/naltrexone combination that support its clinical investigation. The bench-to-bedside development of the very low dose naltrexone treatment can serve as a translational paradigm to investigate and treat drug addiction. Further research on putative mechanisms elicited by the use of opioid agonist-antagonist combinations may lead to effective pharmacological alternatives to the gold standard methadone treatment, also useful for the management of the abuse of non opioid drugs and alcohol.","ISSN":"1970-1101","note":"PMID: 22448305\nPMCID: PMC3311161","title-short":"Agonist-antagonist combinations in opioid dependence","journalAbbreviation":"Dipend Patologiche","author":[{"family":"Mannelli","given":"P."}],"issued":{"date-parts":[["2010"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Mannelli).” Major pharmacological effects of opiates are sedation and anxiolysis, nausea and vomiting. Apart from antagonist and agonists, there are mixed agonist-antagonist opioids that have dangerous effects on human body. These include: “Pentazocine (Talwin), Butorphanol (Stadol), Nalbuphine (Nubain), Dezocine (Dalgan) ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Vnmyy5ha","properties":{"formattedCitation":"({\\i{}Yuzu: Julien\\uc0\\u8217{}s Primer of Drug Action})","plainCitation":"(Yuzu: Julien’s Primer of Drug Action)","noteIndex":0},"citationItems":[{"id":57,"uris":["http://zotero.org/users/local/WcSf8WB9/items/F75XVE94"],"uri":["http://zotero.org/users/local/WcSf8WB9/items/F75XVE94"],"itemData":{"id":57,"type":"webpage","title":"Yuzu: Julien's Primer of Drug Action","URL":"https://reader.yuzu.com/#/books/9781319200541/cfi/6/24!/4/2/10/10/10@0:63.4","accessed":{"date-parts":[["2019",10,9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Yuzu: Julien’s Primer of Drug Action).” Opiates decreases brain stem respiratory center’s sensitivity to higher levels of carbon dioxide in the blood. It is said that the antagonist approach has treated the addiction and limited the intake of some of the drugs but it did not work for most opioid addicts, especially because of poor medication adherence.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Mannelli, P. “Agonist-Antagonist Combinations in Opioid Dependence: A Translational Approach.” Dipendenze Patologiche, vol. 5, no. 1, 2010, pp. 17–24.

Virginia Doctor Who Prescribed More than 500,000 Doses of Opioids Sentenced to 40 Years in Prison. https://www.cbsnews.com/news/dr-joel-smithers-martinsville-virginia-doctor-prescribed-500000-doses-opioids-sentenced-40-years-prison/. Accessed 9 Oct. 2019.

Yuzu: Julien’s Primer of Drug Action. https://reader.yuzu.com/#/books/9781319200541/cfi/6/24!/4/2/10/10/10@0:63.4. Accessed 9 Oct. 2019.