Commusings: How We Can End Overdoses by Dr. Mary Pardee & Theo Krzywicki

Dear Commune Community,

Opioids are a class of drugs derived from the opium poppy plant — from prescription drugs such as OxyContin and Vicodin to heroin and fentanyl (a cheap, synthetic opioid you will learn more about in this Commusings).

Opioids attach to opioid receptors on nerve cells in the brain, spinal cord, gut, and other parts of the body. When this happens, the opioids block pain messages sent from the body through the spinal cord to the brain.

In short, opioids stop us from feeling painful sensation. Administration of these drugs can provide needed relief after surgery or severe injury or for health conditions such as cancer. In the last two decades, however, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis. Regular use of these prescribed medications increases tolerance and dependence, requiring higher and more frequent doses.

The marketing of Oxycontin to doctors as “non-addictive” by Purdue Pharma in the late '90s and early 2000s has been well documented. This Machiavellian effort led to the over-prescription of opioids by doctors, which fueled an ensuing epidemic of opioid abuse. Opioid overdoses accounted for more than 100,000 deaths in the United States in 2021.

There are so many avenues to navigate through this labyrinth, from the regulatory to the physiological to the spiritual. How do we hold Big Pharma and doctors to account? As a society, why are we in so much pain? As a culture, why do we continually seek out external agents to assuage our internal sense of disconnection?

The scale of this scourge impacts so many people, including today’s author, Dr. Mary Pardee. She has, in turn, committed herself to being part of the solution. If you or a loved one is suffering from addiction and could benefit from Commune’s course on Recovery with Russell Brand, please drop us a line at [email protected].

Always here at [email protected] and on IG @jeffkrasno.

In love, include me,
Jeff

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How We Can End Overdoses

By Dr. Mary Pardee of MODRN Med and Theo Krzywicki of End Overdose

On November 4, 2018, my life changed forever…

I got a call from a friend that they couldn't get in touch with my ex-boyfriend, Ian. He wanted to know if I had the password to his phone.

I spent the next 24 hours trying to hack his phone, calling Apple to see if they would let me locate it, grasping for anything that would give me a glimmer of hope that he was OK.

But deep down, I already knew.

The next morning, I called his mom for an update and a stranger answered the phone, because she could not. He told me the worst news I had ever received.

Ian was gone. He had overdosed. 

Two days earlier he told me he loved me, and now he was gone.

The months and years that followed was the most challenging time I have ever been through. The grief was deeply humanizing, which I am grateful for. It was also more painful than I could have ever imagined.

I made a promise to myself, and to Ian when he died, that I would do something to help change the narrative and the stigma around mental health and addiction.

My story is not unique, though.

More than 136 people die each day from opioid overdoses. Last year more than 100,000 people died, a 30% increase from the year before. Overdose is the leading cause of death for individuals 18-45 years old.

In my journey to help increase awareness about overdoses, I came across Theo, co-founder of End Overdose. He has helped me to better understand both the scope of the problem and potential tools and interventions that can help. 

Our goal with this piece is not to just inform you about what the problem is, but also about the solution, since that is what matters. When we say “solution” we must understand that there are several levels to the opioid crisis. There are downstream effects, including overdoses and there are upstream issues like mental health, isolation, and problems with the ways we are living in society that are the antecedents to mental health issues and eventually drug abuse and overdose. 

It is widely accepted that mental health is at the root of drug addiction. However, drug addiction is not the only reason people use drugs. 

Humans have experimented with drugs for thousands of years. Cannabis use dates back to 8,000 BC, and opium use to 3,400 BC. Humans are fascinated by how we can alter our minds and change our perceptions of the world. While this is a taboo concept, we may want to start normalizing recreational drug use. We know very well that the abstinence approach to sex education does not work, and using the same approach to drugs has the same results.

Instead, we want to focus on true education and harm reduction — including teaching teens and adults about drugs, how they can be laced, how to test for laced drugs, and how to respond if they see someone overdose. 

Just like it’s a good idea to hand out condoms to teens, it’s also a good idea to educate them on drug use and how to minimize harm, because chances are they are going to experiment with drugs at some point in their lives. 

With the normalization of drug use in mind, one part of the opioid epidemic that we feel is not getting enough attention is reducing accidental overdoses and deaths from overdoses. Currently accidental overdoses are at an all time high because of the rise in synthetic opioids like fentanyl, with deaths involving synthetic opioids up 580% annually over five years (2012-2017).

Fentanyl is an opioid medication that was developed in the 1960s to manage pain for cancer patients as a transdermal patch, and it was successful for this purpose. The issue is that the lethal dose of fentanyl is the size of one sesame seed.

Drug dealers began to lace drugs with fentanyl because it can increase a drug’s euphoric effect. In some instances, it is also used in place of the actual drug being marketed. For example, many drug dealers are making counterfeit pressed pills of xanax and oxycodone. Xanax is a benzodiazepine, which is an entirely different class than opioids. If a dealer does not have access to xanax pills they may use fentanyl instead, as fentanyl is easily synthesized in a lab and still gets the user high. These pressed pills are essentially knock offs: They cost very little to make and offer huge profit margins. 

But what happens when someone who expects a benzodiazepine (xanax) is now taking something 100 times more powerful than morphine? With no previous exposure to opioids and no existing tolerance, it is easy to overdose. Even in individuals who have a tolerance to opioids, small amounts of fentanyl can still be lethal due to its potency.

Drugs commonly found to be laced with fentanyl include heroin, fake prescription pills (oxycodone, xanax), club drugs like molly, ecstasy, ketamine, and stimulants like meth and cocaine.

This knock-off phenomenon is not limited to fentanyl. Drugmakers also may add stimulants like cocaine to make drugs more addicting. Remember, the illegal drug industry is a business.

So what do we do? The non-profit, End Overdose, has two main solutions they are passionately educating around: 1) testing for fentanyl and 2) increasing access to the antidote of opioid overdoses, naloxone, which they offer for free here.

Testing for Fentanyl

One solution to the issue of fentanyl lacing would be the legalization and regulation of many major drugs to ensure that people know what they are taking. This is a complex discussion, however, and may or may not be the right answer for every substance. 

Regardless, legalization is not going to happen overnight, and people are dying and will continue to die. So what do we do, now? 

End Overdose sells fentanyl test strips so people can test their drugs at home to reduce the risk of taking something laced with fentanyl. These strips can be purchased here.

Fentanyl test strips need to be widely available in schools, discussed in drug education classes, and available at retail stores. If your child’s high school has not discussed these in their drug education class then say something. Let’s get it into their curriculum. 

Naloxone’s Role in Reducing Deaths

To begin, what does it look like when someone overdoses from opioids? 

The “opioid overdose triad” are the most common three signs. These include:

1. Respiratory depression (breathing rate slows down)
2. Pinpoint pupils (the pupils of the eyes become very small/constricted)
3. Unconsciousness (the individual may be unresponsive to sound or touch, including pain) 

Other symptoms can include a bluish tinge to the mucous membranes of the lips or nail beds. Sweating or clammy skin is also common.

Naloxone is classified as a competitive narcotic antagonist/antidote.This means that it works against opioids, fighting for control of the opioid receptor sites in a brain clogged with opioid molecules causing overdose. It is literally a precision-guided missile that tears opioid molecules off receptors then sits in their place, preventing the opioid from binding to the receptor and causing death. It can actually reverse the overdose. 

Naloxone is essential in this epidemic because it is the first response. We need to keep people from dying, and naloxone can save lives.

When administering naloxone, you still must call 911 and get the person to the hospital, as naloxone does not work forever. It temporarily reverses the overdose, and you want the person in the ER when it eventually wears off. 

Changing the Narrative

We are not going to stop people from using drugs, and education is not enough. We need to get products like naloxone visible and available not only where people use but also where people who use hangout. That includes nightlife industries, schools, cannabis stores, drug stores, colleges, clinics, and even places like coffee shops and bookstores. 

Theo and I want to empower individuals and small businesses to do their part. It says a lot when a nightclub or concert venue gives out test strips and trains their entire staff to respond to overdoses. It highlights that overdosing is a problem we can’t just ignore and we are each doing our part. 

Here are a few steps you can take now: 

• Get certified to respond to an overdose! It’s free and could save a life. 

• Share this article with friends and family so we can educate more people on how to prevent deaths from opioid overdoses
• Be kind: You never know what someone is going through internally. A smile, hug or kind word can go further than you could ever imagine. 

About End Overdose:

End Overdose is a non-profit working to end overdose nationwide through medication, direct intervention, and raising awareness. They certify more than 1,000 people per month to identify and respond to overdose in person and online as well as provide free naloxone and fentanyl test strips to anyone who needs it, in all 50 states. They also conduct in person training, supply nightlife (clubs, bars festivals) with naloxone, and have chapters on college campuses like UCLA. They are growing each month and need your support to make these services available and easy to access for everyone. Click here to donate to End Overdose.