Yale School of Medicine holds symposium in New Haven on Connecticut opioid crisis

This story was originally published in the New Haven Register and was written by Esteban L. Hernandez. 

NEW HAVEN >> The country’s two previous opioid epidemics led to changes in federal laws and policy, but had other unintended effects that likely are helping to fuel the current drug crisis, according to a Yale professor.

Yale University School of Public Health epidemiology and pharmacology professor Robert Heimer, one of eight speakers during a symposium held by the Yale School of Medicine Tuesday, detailed how the two other major opioid epidemics in the country affected the present-day crisis.

The first epidemic occurred in the late 1800s when morphine became popular and led to federal legislation to limit its spread, while another arose in the 1960s with the use of heroin spurred by the rise of the Golden Triangle, a reference to an area of southeast Asia known for its opium production, he said. Heimer said opioids have been around since the time of Ancient Greece.

“The consequence of that second epidemic are still with us today,” Heimer said.

Heimer said among those factors included expansion of prison populations, policies such as stop and frisk that “disfranchised minority communities,” and the HIV and Hepatitis C epidemic exacerbated by laws restricting access to clean syringes,

The current crisis likely started in the late 1990s and it’s heavily rooted in a sharp increase in prescription painkillers provided to patients, Heimer said, which itself was fueled by a heightened focus on treating chronic pain.

“It was a partial consequence of good intentions in the late 1980s … (with) pain increasingly being seen as a fifth vital sign in addition to temperature, blood pressure, pulse and respiration, but it doesn’t have a quantifiable measure,” Heimer said.

Eight speakers discussed several facets of the crisis. Yale’s School of Medicine sponsored the event with the Connecticut Opioid REsponse Initiative, Yale New Haven Hospital and the Connecticut Health I-Team. CORE’s creation was announced in October at the medical school.

Dr. Dan Tobin spoke about opioids’ effectiveness in treating chronic pain, which largely led to over-prescribing. It’s translated to the United States being, by a wide margin, the biggest consumer of opioids.

Somewhat ironically, it’s not clear whether opioids are the best treatment option for treating chronic pain, he said.

“There’s not a lot of good data,” Tobin said. “They need to be studied more.”

Yale School of Medicine Department of Emergency Medicine Chairwoman Dr. Gail D’Onofrio said the main intent of Tuesday’s symposium was to provide press with clearer language and tools for covering the opioid crisis. D’Onofrio said doctors want the press to focus more on treatment options and avoiding language that further stigmatizes people with addiction.

Defining behaviors exhibited by opioid use is one way people can become more informed about its impact. Opioid addiction alters the brain’s function, which is part of the reason it can be difficult to treat.

“There are things that are involved in, things like taking larger amounts over longer periods of time,” D’Onofrio said. “Wanting to cut down (on use) but craving and not able to cut down. To repeatedly using, no matter what happens, no matter if it influences your work, your family or any other type of obligations that you have.”

D’Onofrio also serves in the emergency medicine department at Yale New Haven Hospital and said the hospital continues seeing more and more people overdosing on the synthetic opioid fentanyl, but have yet to see a patient identified as having overdosed on the far deadlier carfentanil. State and local officials confirmed last week that the drug, which is 100 times stronger than fentanyl, has reached Connecticut.

Reach Esteban L. Hernandez at 203-680-9901.

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