Her name is Katie. Katie is the beloved daughter of Bob and Laura and the older sister of Kia. Katie isn’t her real name, but she is a real person and this is a real story. 

Katie enjoyed an active childhood. She loved coloring, playing soccer and chasing butterflies. She shared a smile with everyone she met. She wanted to be a veterinarian when she grew up. Middle school was tough for Katie as she struggled with grades, finding friends and her relationship with her parents. She was challenging and defiant at times, but found joy in playing basketball, and her dad coached the basketball team. When Katie entered high school, she seemed to find her stride. Her grades improved, she found a great group of friends and she made the varsity basketball team. Her notebooks were covered with butterflies and Katie was often complimented on her artistic ability. At the end of her senior year, she was excited to attend Washington State University.  

Before we finish the story about Katie, I’d like to share some important information on opioids and opiates. According to the Alaska Department of Health and Social Services, between 2010 and 2017 there were 623 opioid overdose deaths and that death rate increased 77%. In 2018, the most recent data available, Alaska lost 110 lives due to drug overdose, the majority due to opioid overdose. 

International Overdose Awareness Day is a global event held on August 31 each year that aims to raise awareness of overdose and reduce the stigma of a drug-related death. 

What Are Opioids and Opiates?
Opioids and Opiates are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin^®), hydrocodone (Vicodin^®), codeine and morphine. Opioids are typically prescribed for pain relief. 

How Does Opioid Addiction Develop?  
Made from the opium poppy plant, or produced synthetically to have a similar effect, all opioids affect the brain’s regions that produce feelings of reward at the mu receptor. Opioids activate the brain’s opioid mu receptors, and once attached to these receptors they reduce the perception of pain. Over the course of use, a chemical tolerance develops and a person will need to take more of the drug to feel the same effects. This is called dependence.

To intensify the effects, a person may begin to use the drug more often than prescribed, or in ways other than prescribed. This misuse can lead to addiction. 

A person suffering from addiction can make decisions that seem reckless and have serious consequences, because addiction affects the parts of the brain responsible for decision-making and self-control.  

Addiction behaviors include actions that are illegal, or at a minimum outside what is acceptable as ‘normal’ in a person’s culture.  

People who become addicted to prescription opioids may eventually transition to heroin or supplement with heroin because it is easily obtained, costs less than illicit prescription pills, and is easier to prepare for injection. 

Opioids produced on the black market can be especially dangerous and have varying and unpredictable potency, often containing dangerous substances that cause compounded intoxication with higher risk of overdose.

Taking too much of an opioid, or taking it in ways other than prescribed, increases the risks of addiction and can lead to overdose and death.  

Signs And Symptoms of Addiction
Opioid addiction, also known as opioid use disorder, is a medical condition defined by not being able to abstain from using opioids, and behaviors centered around opioid use that interfere with daily life. Some common signs of opioid addiction include:  

1. Inability to control opioid use
2. Uncontrollable cravings
3. Drowsiness
4. Changes in sleep habits
5. Weight loss
6. Frequent flu-like symptoms
7. Decreased libido
8. Lack of hygiene
9. Changes in exercise habits
10. Isolation from family or friends
11. Stealing from family, friends or businesses
12. New financial difficulties

Signs And Symptoms of Overdose
Sometimes it can be difficult to tell if a person is just very high, or experiencing an overdose. If it appears someone is getting too high, it is important they are not left alone. If the person is still conscious, walk them around, keep them awake, and monitor their breathing. If unsure, it is best to treat the situation like an overdose.

The following are typical signs of an overdose: 

1. Loss of consciousness
2. Unresponsive to outside stimulus (e.g., does not respond to loud noise)
3. Awake, but unable to talk
4. Breathing is very slow and shallow, erratic, or has stopped
5. For lighter skinned people, the skin tone turns bluish purple, for darker skinned people, it turns grayish or ashen.
6. Choking sounds, or a snore-like gurgling noise 
7. Vomiting
8. Body is very limp
9. Face is very pale or clammy
10. Fingernails and lips turn blue or purplish black
11. Pulse (heartbeat) is slow, erratic, or not there at all

What To Do If An Overdose Is Suspected?  
Overdose is a life-threatening condition. When people survive, it’s because someone was there to respond. If an overdose is suspected, call 9-1-1, give accurate details about what happened, and make sure to provide first responders or emergency medical personnel with as much information as possible. 

• What drug(s) were taken?
• How long ago were they taken?
• How much was taken?
• Who else should be contacted immediately?

Be honest with the medical professionals. Withholding even one piece of information or lying could have life-threatening consequences. The medical staff must know as much as they can to treat the individual properly. 

Naloxone (Narcan, Evzio) is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications. 

Naloxone is typically administered by first responders. 

In Alaska, people at risk from opioid overdose can receive a Project HOPE Overdose Response Kit. 

Kits include:

1. Two doses of Narcan® (Naloxone)
2. Sanitary gloves
3. Brochure on how to give Narcan® to someone
4. Carrying case

The kits are available free of charge. In Fairbanks the kits are available at the Interior AIDS Association, Fairbanks Fire Department, Fairbanks Public Health Center and the Fairbanks Airport Police and Fire. 

The last time I saw Katie, she was surrounded by medical professionals in an emergency room at Fairbanks Memorial Hospital. She was unresponsive, her body was limp and her face was very pale. The medical team tried valiantly to save Katie’s life. Bob and Laura were at the window praying for a miracle that never came. The grief on their faces was indescribable. Katie died as a result of heroin overdose. 

On this International Overdose Awareness Day, I’ll be thinking about Katie and the other 100+ Alaskans that will die from drug overdose this year. Please don’t let this happen to someone you love. Understand the signs of addiction, have the tough conversations, ask the questions – someone you love may need your help. 

If you have questions about opioid addiction or the health of a loved one, please contact your Primary Care Provider or the Addiction Medicine Team at Tanana Valley Clinic.