“Jackson County was one of the highest prescribing counties in the state and we had one of the highest overdose rates in the state … at this point, we’re doing pretty well,” said Dr. Jim Shames, Jackson County medical director, at a Rotary Club of Ashland meeting Thursday. “The state as a whole has made a lot of improvement.”
Shames said Oregon is now the state with the greatest success in reducing opioid-induced overdose deaths.
“We are prescribing less opioids. We are headed in the right direction,” Shames said. “Basically, I was aware of the problem early on and because I was in a public health role, it felt to me that it was a major public health problem, and at the point nobody else was really aware that we were in the middle of an opioid crisis.”
Starting about eight years ago, he helped fund Oregon Pain Guidance, an organization of specialists educated on the risks and solutions related to the issue and dedicated to treating chronic pain in a more appropriate manner. A number of those specialists, along with Shames, contracts with the Oregon Health Authority to travel around the state, assess clinics and aid in the process of finding healthy ways for the clinics to cope with the crisis.
He said another way Jackson County is leading in the reduction of opioid-related deaths is its advocacy for Naloxone training for anyone who wants it. Naloxone is essentially an antidote to opioid overdose. Anyone can administer it after proper training to revive someone who is overdosing.
Shames said that Jackson County has the lowest number of opioid-related deaths out of the state, but it’s still a huge problem.
“Around the world, middle-aged folks are living longer, except for U.S. whites,” Shames said. “U.S. whites are dying in America with greater frequency than they were 25 years ago, in counter distinction to all the rest of the subgroups, including Hispanics and African-Americans.”
The highest risk for these people is relapsing.
“Ten percent of people that show up in an emergency room with an overdose will be dead within a year,” Shames said.
Every day, more than 115 people in the U.S. die after overdosing on opioids, according to the Centers for Disease Control and Prevention.
Shames is a family practice physician, was the medical director for the Addiction Recovery Center in Jackson County and has worked in opioid use-disorder providing medical assisted treatment for 25 years, among an even longer list of opioid treatment and prevention specialties and programs.
He said people who have adverse childhood experiences, or ACES, such as trauma caused by some form of abuse, are much more susceptible to addiction.
“If people have four or more of these adverse childhood events, they’re 10 times more likely to be involved in drug abuse, and in fact, are more likely to be obese, have diabetes and be depressed, and when you add it all up, they really have a much shorter lifespan.”
He also said some people are naturally more inclined to become addicted to opioids.
“Some people don’t metabolize alcohol the same way. Some people don’t metabolize opioids the same way,” Shames said. “We’re not the same.”
Paired with the number of free-flowing narcotics in the U.S., it’s a breeding ground of disaster.
Shames said when he began practicing medicine, it was considered inappropriate to provide people with opioids for non-cancerous chronic pain.
But then, that ideology took a turn. Shames said direct consumer advertising from pharmaceutical companies highly influenced the way doctors treated patients.
“We were told that we weren’t being compassionate enough …. Health care providers, we want to relieve peoples’ suffering and we have this tool in our toolkit called opioids and we were led to believe that when we weren’t using that tool and people had pain, we were really allowing them to suffer.”
Shames said there were many other factors influencing this new influx of opioids into the medical field ,such as the introduction of Oxycontin, the persuasion on the medical board from its representatives, and the effort to quantify the pain scale.
But he said that opioids don’t relieve chronic pain very well. They only work in about 30 percent of long-term cases because the body quickly builds up a tolerance to the drug. If a patient builds a tolerance and their physician continues to increase their dosage, addiction is more likely to occur.
“What happens is, over time, people spend an awful lot of mental energy thinking about opioids, wanting to get opioids, and they have this uncontrollable craving for the drugs,” Shames said. “The primitive part of the brain, the pleasure-seeking part of the brain, it just kind of hijacks the prefrontal cortex, the executive functioning of the brain, such that you’re responding now to a very primitive, reptilian kind of response and you might find yourself doing things you might not normally do.”
Shames said once addiction sets in, the consequence is physical dependence, because once the body doesn’t have the drug anymore, withdrawal takes over and is very painful.
“As they come down from this pleasurable experience, they start having a lot of dysphoria … and pretty soon they just end up being preoccupied with getting the drug and that’s all they can think about until they get the drug again,” Shames said. “And when you are in that cycle, there are changes in the brain, neurotransmitters that go away, there are fibers, neural connectors that disappear.”
Shames said he thinks medicated assisted treatment is key. The three main medications are methadone and buprenorphine (also known as suboxone), which help with pain and addiction to narcotics; and vivitrol, which can help prevent relapse.
He said if these drugs could be more affordable and used more widely, it could highly impact the opioid crisis in America.