A highlight from COVID, Benzos, and Opioids

Automatic TRANSCRIPT

Life expectancy took a hit in two thousand twenty in the us. It dropped a year from seventy nine to seventy eight but this decline started long before covid it was in two thousand fifteen that the model number started to decline for the first time in one hundred years. The reason was drug. Overdoses particularly from opioids. And those overdoses have risen in lockstep with the cova crisis this year. Richard weidler and ashwin pat tar have been following these trends since the two thousands but the practicing psychiatrists donna wieslaw runs a general adult outpatient practice and not to pack tar works with a high risk population in addiction. Psychiatry both of changed their practices in response to the crisis. And today they're gonna share what we can do to reduce the risk of death. In the patients we serve. It's often called the opioid crisis. But that obscures the fact that most of the deaths involved multiple substances usually sedatives and benzodiazepines but even stimulants like atarot on ritalin can increase the risk of overdose with opioids so the drugs that we prescribe are part of the problem. Benz are the riskiest. Because the way that opioids calls death is through respiratory suppression and benzodiazepine opioids both suppress respiration in. Different ways. denso's do this. Through the gavitt. A inhibition and opioid suppress breathing in the dula. The effect is much like a stereo system unplugged one speaker and you can still hear the music. Unplug both and breathing stops. It's very rare for ben's does to cause overdose deaths on their own. But when combined with opioids they a much more lethal hall is another one to watch for it. Turns down breathing through a mechanism similar to the windows and a patient who is drinking a little too much and taking. Our poets is at high risk for an unintended is. Most of these deaths are unintended as patients may just take a little extra when their pain is high or they're having a rough day without any idea that it could kill them so any respiratory suppressant can be a problem with opioids as can any medication that alters memories self control consciousness and this is another reason that benzes are implicated in the problem then zoro's enhanced the rewarding effects of opioids in the cns and that leads to a somewhat counterintuitive. Clinical pearl. enso's are much more dangerous in the hands of someone in recovery from an opioid use disorder. And they are in someone who's recovered from alcohol use disorder. We know that from studies that followed up on these patients long term and measured both mortality relapse risk and other problems when patients with a history of abuse of either opioids alcohol take benzodiazepines. We're not here to scare you out of prescribing controlled substances. There are unintended consequences to that as well that we'll get into today in fact you could say. This whole crisis was an unintended consequence when that started in the nineteen nineties when doctors got the idea. That pain was under-treated and many emergency room. Physicians war no pain buttons on their white coats in the early nineties. There was an emphasis. Rela tension relied extent of managing pain and considering ban equal under the fish. Though sign. so you're also paying and then address it if it was an issue in nineteen ninety six those uh Hippo published looking. Better not be a seeing any differences in opioid overdoses as being managed and i wind did not show that there was a trend of over two thousand when the compared opioid overdoses was nine hundred. Ninety six you already see change. According to the cdc threat it really do nine hundred ninety nine and that was the fullest wheel of the opioid addiction and overdose epidemic. And that was the prescription

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