Workplace Health Benefits Support Moments of Care That Count. Like seeing clearly for the first time. Finding relief from chronic pain. Or getting the prescription you rely on.
And when multiplied across all Canadians with Health Benefits, these moments add up to millions of Canadians staying healthier for longer. Equaling a stronger healthcare system for all of us. Learn more at clhia.ca slash multiplying care. Well folks it seems like these days that there's an infinite amount of medicine that can help alleviate or even cure whatever that's possible.
But with any medicine you gotta be careful. You gotta follow the directions when taking it. And make sure that it doesn't fall into the wrong hands. Especially if you have been prescribed an opioid by your doctor.
Now more than ever you gotta take the necessary steps to make sure that you or someone you love does not become addicted. And becomes another statistic in this opioid epidemic. Enjoying us here to talk more about it. As Sean Douglas if this is your first time tuning in he's been on the show many times.
He is a pharmacist at a Kroger in Mounts Mill. Sean thanks for coming back on I appreciate it. Thanks Rob McCory for shaving your. So before we get into the ins and outs of prescription opioids let's let's kind of talk about what they are.
So how do opioids interact with our bodies? Opioids. Medications such as hydrocodone, oxycodone, methadone. Those are probably the most common ones.
They simply block our pain receptors. Somebody has pain. They have dental work. They have surgery.
A phantom pain in their back that's just nagging them. These medications won't do anything at the root cause to get rid of the pain. They simply block their receptors so our brain doesn't feel the pain. As part of blocking the pain they also slow down a lot of body systems.
They'll cause constipation because they slow our colons. They'll make us drowsy. They can make our speech slurred. Then probably the worst side effect, most dangerous side effect is they also slow down our respiratory rate.
They slow our lung functions down. Gotcha. And one other commonly prescribed opioid. I know codeine.
It sounds like that as well. So that's just another one that we can add to the list right there. And there are other options. We just want to make it clear.
There are other options available to manage your pain. There's exercise, physical therapy, compresses whether they be hot or cold, even over the counter medications. But there are some instances where opioids are required to manage the pain. Yes.
Primarily with the cascade of events that we've seen over the last 20 to 25 years, the CDC came out with a set of guidelines. I believe it was two years ago, it might have been three. Among their suggestions was limiting the time frame that you've got the medication. The idea being you have a surgery, it's a good chance you're going to need something to block that pain as your body starts the healing process.
You have significant dental work. You're probably going to need something, depending on how invasive it is. I've talked to some of the CEs I've gone to. They talk about the alternate methods such as just your Tylenol, your ibuprofen, dentists, and oral surgeons have looked at surgeons and dentists that have gone both ways doing the opioids and some that have gone to not using opioids.
Ironically, the ones who switched to non-opioid, so they didn't really have any patient complaints about it. But depending upon how invasive it is, if you break a bone, really tear your ankle up, spraining your ankle, tearing ligaments. A good chance, at least for a short term, you're going to need something to block that pain until you get the inflammation out of there until things start to heal up. But if you can try shorter term, it's much more preferred.
They want acute therapy, acute injuries using just short term acute treatment. Exactly. Again, Sean Douglas of Pharmacists at the Kroger and Moundsville joining me here on Weekend Focus. We're talking about prescription safety, particularly with opioid prescriptions.
More so than ever, you've got to make sure that you follow the directions, like I said at the beginning, because misuse of opioid medicines can make things go very wrong, very quickly. Just a couple of stats here for you from drugabuse.gov. Roughly 21 to 29% of patients prescribed opioids for pain end up misusing them. And there are some pretty stiff consequences when that happens.
In 2017, around 1.7 million people in the US suffered from substance use disorders related to prescription opioid pain relievers. And in that same year, more than 47,000 Americans died as a result of an opioid overdose. So very critical that you follow the directions if you are prescribed an opioid. Yeah, definitely.
And a lot of times when we don't use them as prescribed, it's people that have the opioid prescriptions come to the pharmacy. If they get questioned by the pharmacist, a lot of them get defensive. And in all honesty, we're not trying to make people defensive. A lot of the issues are accidental.
You're really hurting instead of taking one every six hours, you take one and then four hours. And then you still hurt and you take another one at four hours. So you're getting a little too much of it. You've got a brother, a mother, a best friend who may have just had some dental work.
They say they're hurting. Oh, I've got a couple left from my appointment. Let me give you one. Not knowing necessarily what other medications they're on, you can run into issues.
They might be a larger tablet. You think, well, I really can't swallow this habit. Let me break it or crush it. If it's an extended release form, it's meant to disperse over 12 hours.
Now, all of a sudden, you're getting 12 hours worth of medication basically within an hour. Yeah. So a lot of times it's not that people are intending to do something wrong due to situations that they think they're trying to do the right thing, trying to make themselves comfortable. They accidentally do something and that's where the issues become.
Absolutely. So let's kind of go over the process of the prescribed opioids. It's kind of starting with the steps that you need to take before starting any prescribed opioids. And you mentioned it just a couple minutes ago telling your health care provider about any medicines that you may be taking.
And this includes other substances, vitamins. Definitely. In pharmacy, we're doing more and more what we call medication therapy management. And we'll do comprehensive medication reviews.
The basis is we're just trying to get as much information as we can on all of the medications you take over the counter, dietary supplements, prescriptions, hold it at other pharmacies. Because the more we have record of our systems, the safer your therapy will be. Really, every prescriber, every pharmacist should be trying to build that kind of a database. Let's say your brother passed away.
One doctor prescribes you some Xanax for the panic attack you're having from the grief. You go to Adenis or you go to a surgeon, they prescribe some hydrocodone for you. You don't tell them you're on the Xanax. The Xanax is already slowing your respiratory rate.
It's slowing your body function, just making your drowsy. The hydrocodone is going to do the same thing. If you've got two different prescribers involved and you haven't told both of them, maybe you got one filled at Walmart pharmacy because it's right next to the doctor's office and the next one you get filled at Kroger because it's right next to that doctor's office. We don't know your on-boat of them.
We haven't done our due diligence with the tools that are out there. All of a sudden you may end up with a significant problem. Exactly. Telling everybody, all of your prescribers, all of your pharmacies, everything you're taking is only going to be in your best interest.
It also helps if you read any material about the medicine that's given to you. It could be any of the resources that I see right here, right in front of me. As we speak right here, just any and all information that's given to you about the drug, go ahead and read it. If there's something that you're uncertain about, you've got to ask questions.
Absolutely. You can never ask too many questions. Whether it be you asking or your prescriber or me as a pharmacist, we should be letting you know what to expect from the medication. Common medications that may interact with this medication.
How long you should be on the medication? A lot of people will get, and I keep going back to your Xanax and that class of medication because that's where the vast majority of death certificates that are presented to the Board of Pharmacy with questions. Hey, why did this happen? It tends to be a Xanax type medication and a hydrocodone type medication.
People, again, not necessarily seeking things, trying to abuse them. It could be you or I who had two different issues going on, taking medication, didn't know there was going to be a problem where we had a change in dose and the increased dose caused a problem. A lot of times we think we don't realize all we should only be on this for a week or a month, and we keep trying to refill the medication thinking we're supposed to continue on it. So asking the questions, how long do I need to be on it?
What should I expect from it? What is the medication going to do to me? Letting them know what other medications you're on. Letting them know about any family history.
If anyone in your immediate family, brother, sister, parents, grandparents, have had any kind of substance disorder, unfortunately that means you're going to be more likely to develop dependence on it. Being upfront and letting someone know about that means we should most likely get you one of those alternate therapies. The Minneapolis VA did a double what they call a double blind study, so they had two groups of people. And both groups knew they were going to be traded for pain, but they did not know what they were receiving.
One group started with immediate release opioids. If that did not work, they escalated to extended release opioids. If that didn't work, they escalated to fentanyl. The other group started on Tylenol and NSAIDs, such as Aleve, Advil, Motrin.
When that didn't work, they escalated to Gabba-Patton medication, such as Amatrypoline and Nordtrypoline, which we call in the health care fields at adjuvant medications, so just kind of boost the end set of the Tylenol. If that didn't work, we went to add it on something like a duloxetine or cymbalta or lyrica. The group that got the non-opioids actually, when they asked about pain relief, they actually scored better on pain relief. So getting something that is not, it's getting something that is different from an opioid doesn't mean you're not going to get pain relief.
So if you've got health issues, if you've got a family history of dependence disorders, if you yourself have had addiction disorders or dependence disorders, if you take medication for mental health problems, they really suggest that you look that side. If you're upfront, we can go that non-opioid route and most likely give you a significant pain relief still. John Douglas, a pharmacist at the Kroger in Moundsville, joining me here on Weekend Focus, talking about prescription safety, particularly with prescription opioids. So we kind of touched up a little bit on this while people are on opioid prescriptions, if that is the case, taking the medicine exactly as it's prescribed, take one every six hours, whatever directions there may be.
If the medicine isn't treating your pain, make sure you consult your health care provider. And a little bit later on in the medication, it can be a good idea to taper off of that medicine. So kind of explain why that's so crucial. So one of the, when the CDC came out with their guidelines, a lot of us who have been in school were familiar with the bell curve.
You know, they, small groups on each end and most of the people in the middle. And dosing on medication, part of their guidelines is a suggestion to have more or less a bell curve look to things. You start low and slow with your dose. The slower you start, the lower dose you start on an increase as needed is less likely to cause any addiction issues, less likely to cause any health-related problems.
Likewise, you build up, you get to the dose that satisfies your current issue. Once you're able to resolve that issue or once you find an, I'll decide this is going to be long term. I should probably go with an alternative therapy where there'd be physical therapy, acupuncture, chiropractic, using the non-opioid method. You'll want to wean back off.
If you build your dose up, if you started on a high dose, you're much more likely to end up with an overdose situation. So that's why you want to start low and go slow. Your body will develop an ability to tolerate that higher dose if you start low and build up. It'll likewise, if you just stop from that high dose, your body's going to start shouting at you, where is that medication?
Your body's going to think, I need that medication. You may start breaking out in cold sweats, nausea, shakes, potentially seizures. You may develop behavior saying, I need, I can't stand this. I need to get ahold of that medication, in which case, who knows what you might do?
As far as trying to forge a prescription, steal a prescription from someone else. If you slow, take it off, get off of it more slowly. Your body's going to, same way, it tolerated going up. It's going to tolerate coming down off the medication.
So starting low dose, building up slowly, and then slowly taping yourself down off is going to be the easiest thing for your body physically to allow that opioid to do the right thing for you, to be able to block the pain in a sufficient manner. So just make sure everyone to just keep that bell curve in mind right there, if by chance you are prescribed an opioid for your pain. And this is something that we touched upon a few minutes ago as well. Swallowing your medication whole, if you're able to, don't cut it, don't crush it, or anything like that, because you mentioned the example, if you crush the pill, and then swallow it, you're pretty much getting the opioid within an hour, and it could end up being pretty bad.
Definitely. If you're trying to taper off your medication and you're thinking, boy, I really don't want this dose that I'm on. I want to cut it in half. Make sure you touch base with the pharmacist that filled your medication.
I would say talk to a pharmacist, but if you can talk to the pharmacist that filled your medication, they're going to know exactly what you had. They will know if that dosage form is able to be broken without any adverse effects. So if you want, you know, talk to your doctor about prescribing a lower dose, or talk to your pharmacist to see if you can break the dosage form. Many of them can be, but there are also a ton out there that you really don't want to break, crush, grind up, trying to put them in apple sauce, what have you.
So be very careful that you're consulting the right person, make sure if you can or cannot do that. And the other biggie that we touched up on just as a reminder, don't share your medication with anyone else because it's in another way that the increased risk of dependency, addiction, or even an overdose can present itself. Exactly. And a lot of the accidental overdoses, a lot of the overdoses are accidental by, well, I gave my friend the Xanax, did not know that they were maybe on Percocet or Vicodin, or vice versa, giving them a pain medication and opioid, not knowing they're on some other things, then can slow the system.
And there are so many, the family we call benzodiazepines or benzos that have your adavans, your Xanax, your clonopin. Those tend to be the primary ones, but we also see with muscle relaxers such as flex, rheal and robax and ensoma. We see it with anihystamine, the older anihystamine, like your hydroxyls, your benedrilles, they slow the system down, create a similar effect essentially doubling up on the constipation, the drowsiness, the cognitive effects, and the low respiratory rate, which can lead to people stop breathing. There's also the sleeping pills.
You know, your Xanax, sorry, not your Xanax, your Ambien, your Tamazepam, they also have that same type of interaction. So there's a whole series of medications that can interact with the opioids, can have dire effects for somebody. So definitely don't want to share the medications. And one thing people don't think of, you know, you can buy lockboxes.
I really suggest, especially if. And that was the next thing that I was going to touch up on, walking up your medicine. Yes. And a lot of times it can be somebody's at your house, working on, you know, cleaning your carpet, working on your refrigerator, fixing the roof.
They need to go to the bathroom. They have access that way to your bathroom or your bedroom. They open the bottle, take a few pills out. If you don't have a good count, you don't even realize they're gone.
A neighbor, a friend of a neighbor, a friend of your kids, somebody gets into the house, they take a few pills, or they take the whole bottle of pills. You know, we at Kroger, we sell these lockboxes. And I felt a lot of people comment, well, gee, that's not going to stop anybody. Well, if they really want to steal your medicine, it's not.
But for the person that's just trying to tap you for a couple tablets, or visiting the house and might be able to slip the bottle in their pocket, those are the people that will keep your medication with you and keep them for potentially ever-dosing themselves. Exactly. And the other biggie that we want to bring up here, because you mentioned avoiding certain medications when you're on these opioids, you mentioned Xanax, Ambien, and a few others. But the other thing to mention, if you're on an opioid prescription, don't operate heavy machinery at the very least until you know how that's going to affect you.
Exactly. If you have an an easy example is the dental work. You know, if you have a root canal, you have a wisdom tooth hold, doctor gives you some Percocet or some Norco, you think, I'm going to take this and go right to work. Probably should see how the first couple doses are going to treat you before you get behind the wheel of a car, before you go work at a construction site, anything of that sort, before you go out and operate your tractor or even your lawnmower.
You know, you might be a little less stable on your feet, slip, slice your foot with a lawnmower, something of that sort. So some of the things sound kind of corny, but yeah, definitely get a few doses in you before you try to operate anything that's potentially dangerous to you or people around you. Absolutely. Again, Sean Douglas of Pharmacists at the Kroger and Moundsville, joining me here on Weekend of Focus.
We've been talking about prescription safety, especially when it comes to opioid prescriptions. Now, we hope and pray that an overdose does not occur wherever you may be listening. But if you do come across somebody who's experiencing an opioid overdose, there are steps that you can and need to take. So the very first thing, recognize the signs and symptoms of an opioid overdose.
So Sean kind of go over the signs and symptoms and what to look for. So there are a handful of things that someone would present with. Their skin would tend to be pale. You know, much like you see somebody that's sick.
You know, you think, oh boy, they've got a fever, they've got nausea, they might be ready to throw up, they might be ready to pass out. A paleness kind of like that. Their lips, their fingertips, their nail beds, may turn, would likely turn blue because as your respiratory rate slows, you get less oxygen. So lips, nail beds, fingertips turning blue.
The body seeming limp and lifeless. The respiratory rate slows, usually less than one breath per five seconds. So if you notice, a person falls asleep on the couch or a person sleeping next to your spouse or your significant other in bed. And for whatever reason, you notice, boy, it seems like the breathing slow.
Once every five seconds, once every 10 seconds, definitely want to try to wake them up because there may be something significant going on when the respiratory rate gets that low. There can also be what's described by people as either choking or gurgling sound. It may sound like a snoring sound, but more often it's kind of a gurgling, choking sound. That is essentially the person suffocating.
So definitely if you hear something like that, you want to take action. So again, first and foremost, recognize the signs and symptoms of an opioid overdose. Then the next step, the very important step, call 911, let someone know that they stop breathing and the first responders will be on their way. Now step three, this is kind of a if you have it kind of step here, but step three, you can give the LACSONE, AKA Narcan.
So let's talk a little bit about that, Sean. What is Narcan? And how does it work to combat the overdose? So when humans take an opioid, the opioid wants to attach to our, wants to attach to our receptors.
When it attaches to the receptors, we get the effect of the opioid. Narcan or Naloxone is what we call, well, the opioid is an agonist. The Naloxone is an antagonist, so it works the opposite. So the opioid binds to the cell, the Naloxone is going to knock the opioid off of the cell.
When the opioid is knocked off of the cell, respiratory rate goes back to normal, the drowsiness, the sedation starts to subside, the constipation, what subside, and so on and so forth. So Naloxone can be administered either through an injection or through an nasal spray, and within minutes starts to reverse the effect of whatever opioid is in our body. The last few years has become very easy to get Narcan. It's been about 20, 25 years that we've recognized the opioid prescriptions have gone through the roof.
The U.S. uses 99% of the world's hydrocodone. Deaths have shot through the roof. So they've begun and recognizing the issues that have developed due to that.
They've made Naloxone very easy to obtain. If your doctor is writing a prescription for an opioid for you, they should discuss Narcan or Naloxone with you. However, anyone can go to the pharmacy, talk to the pharmacist, we can prescribe, essentially, Narcan without a prescription. We have a questionnaire we go over, we have a form we fill out, we essentially process it as a prescription with us being the prescriber, you get your Narcan.
So if you're on an opioid, if your spouse is on an opioid, if somebody you're living with is on an opioid, if your best friend's on an opioid, if you're concerned that somebody in your apartment complex has a drug issue, you might want to have it on hand. It's very easy. Talk to your pharmacist, we can set you up with some Narcan, and everybody to get say an opioid prescription really should have a discussion either with the prescriber or their pharmacist about having some Narcan on hand. The company that makes Narcan provides, I come across a sheet they provided, has five steps to using the Narcan, and it's a very easy thing to use.
You remove it from the package. It's kind of a T-shaped device. You would insert the tip, kind of the nasal spray tip into the nose, you would just simply administer the dose into the nose. So really anybody can do it?
Absolutely. So just a recap of the steps. If you come across somebody with an opioid overdose, recognize the signs and symptoms first, call 911. If you have Narcan handy, go ahead and administer it and then start rescue breathing.
So Sean, let's go over the steps with rescue breathing. When somebody is under that, so you've administered that, you want to do the rescue breathing. You want to tilt their head back. So the easiest way, generally is to slide one hand under the neck and gently lift the neck up so the chin will be coming upward.
You may use your other hand on the forehead to help guide so you can get the chin up. That way you can open the mouth and the airways up. If a person's laying flat, the airway gets a little bit of a kink in it's just not as easy to get the breaths in. When you lift the neck, bring the hand underneath the back of the neck and lift up a little bit, opens the airway.
Then just simply providing, open the mouth, breathe in. Couple breaths, wait to see if they respond. A couple breaths, wait to see if they respond. If you're someone that's trained in first aid, you may have one of the mouthguards.
You might want to use that because in the case that they come to, if they're really sick, in the worst case scenario, you're trying to help them and they throw up all over you. If you've got one of the mouthguards, that helps. But hand under the back of the neck, lift up, gently open the airways, open the mouth, couple breaths in, wait roughly a minute, give a couple more breaths, wait roughly a minute, so that we are at least trying to circulate the air and keep oxygen moving through their bloodstream. Absolutely again, Sean Douglas, a pharmacist at the Kroger and Moundsville joining me here on Weekend Focus.
We've been talking about prescription safety, particularly with opioid medications. If you do get prescribed one, only got a couple more minutes left here. So really quick, let's go over the safe drug disposal methods because one way that you can cut down on somebody getting addicted to opioids is if you get rid of any part of the unused prescriptions. So drug drop-off boxes are one way to get rid of those drugs, but there are also drug take-back programs that people can utilize.
Yes, DEA sponsors and actually runs drug take-back days. And they're typically, I want to say the last Saturday in April and the last Saturday in October typically. I can speak from a Kroger perspective. I know there are Kroger's, the Wheeling, Mount Deschaunable Road Kroger and Wheeling typically participates locally, but they have a handful of stores that will take part.
You can bring anything to the drug take-back day. It doesn't have to be an opioid. It can be any medication, a parent passes away, a medication you've got in your cabinet you don't want to use. Take it, no questions asked.
They're not going to look at who you are, what you've got. They're simply going to take your box, the bottle you hand them, whatever it is. They'll take it, they'll dispose of it in a safe fashion. It's going to protect, keep your house safer, it's going to keep the rest of society safer by not being available for anybody to get their hands on.
Absolutely. And just to touch up on it, you mentioned the two drug take-back days. The first one was back in April 27th. The next one coming up is October 26th.
So if anybody wants to keep that in mind, mark that on your calendar, that's the next National Prescription Drug Take-Back Day. And also there's home disposal that people can do, mixing unused pills with undesirable substances like cat litter, just something that people wouldn't get into. And also removing the prescription labels and disposing of the empty bottles. Exactly.
Any kind of undesirable. And again, just speaking from my experience at Kroger, I don't know if the other changes that we have, dispose our X packets we dispensed with what appear to be the acute prescriptions and ones that are only a few days in duration. Simply a little packet, it looks like the flavoring stuff you put in water, crystal light and so forth. You open it up, you dump it in the bottle of pills, fill it up two thirds of water, shake it up, it creates a cement in there so you can't get the tablets out.
You can then throw that in the trash. So definitely ways you can dispose of them in the trash. And if I can give you a website real quick also, rxdrugdropbox, all is one word, rxdrugdropbox.org will help people locate drop boxes, police offices, sheriff's offices, pharmacies that might have drop boxes you can take your medication to as well. Good deal.
So if you have been prescribed an opioid prescription, please keep all this information that we just went through in mind that way. You can be responsible with your prescription and that way you or other people don't become addicted and become another statistic. So Sean, I thank you so much for joining me here on Weekend Focus. Again, thanks so much for your insight and your head is coming back here.
Hey, I appreciate you having me. It's information we could do three shows on it. If you have any questions, make sure you reach out to your pharmacist or so much out there we can help you with. Thanks for having me.
No problem. And just something really quick here before I go. If you're experiencing addiction or if someone you love is experiencing addiction, the Substance Abuse and Mental Health Services Administration's National Health Line is a good resource to use. The number to call for that is 1-800-662-4357.
Again, the number 1-800-662-4357. Again, I want to thank Sean Douglas for joining me this week. I always appreciate his insight whenever he's on the show and I thank you for tuning in. Don't forget that you can catch this episode, past episodes and past interviews on the Weekend Focus podcast on the free iHeartRadio app.
I'm Corey Glue. Thanks for tuning in to Weekend Focus and until next time, you have yourself a good week. You deserve that.