By Sammie Ann Wicks
The statistics are staggering: Fatalities nationwide due to opioid overdoses numbered 42,000 in 2016 and 71,568 in 2017, according to a 2018 Centers for Disease Control report. That’s between 115 and 196 a day, with estimates suggesting the death rate is likely to rise.
One local addiction specialist who deals with the opioid crisis on a daily basis—she is director of the emergency department at Dignity Health Chandler Regional Medical Center—says the issue has only become more complicated with the entry of international players into the supply side of the American drug market.
“Today we’re seeing newer, more dangerous synthetic forms of opioids on the illicit market,
such as Fentanyl,” says Dr. Sandra Indermuhle, a prominent expert in the field of addiction. The synthetic became even more hazardous domestically with the current involvement of criminal drug interests in countries outside the U.S.
“Now, these ever-more-dangerous drugs are being manufactured in China, and the Mexican
drug cartels are adding them to their products,” Indermuhle says, noting that an analog of Fentanyl, called Carfentanyl, poses extreme dangers to humans in any amount.
“Carfentanyl is intended for use with very large animals, strictly for veterinary purposes,” Indermuhle warns, “and as such is 100 times more potent than anything we’ve seen so far.”
With the federal government preparing to spend $4.6 billion this year to address the problem, the Chandler Regional ER head says the opioid epidemic has changed its approach to the treatment of pain.
“Even though most opioid overdose deaths have been due to their illicit use in combination with other drugs, the growing epidemic has changed the rules about how doctors routinely treat patients with chronic pain,” she says.
“The state has now put limits on the number and quantity of tablets doctors can prescribe. After that, they must refer the patient to pain management specialists for different treatment modalities.”
The National Institute of Drug Abuse reports the physician prescribing rate decreased annually by 4.9 percent from 2012 to 2016 for high-dose opioids and by 9.3 percent from 2009 to 2016 for lesser dosages.
Indermuhle notes aspects of the brain’s chemistry help to fuel the tendency toward addiction for those susceptible to it.
“We know there is a genetic aspect to addiction,” she says, “and for some, all it takes is a life stressor such as divorce, perhaps, or the loss of a job, to activate this genetic predisposition.”
She reports it is the enhanced production of dopamine (a neurohormone released by the hypothalamus) which makes addiction to opioids so possible with overuse. “Dopamine is involved with the pleasure and reward systems of the brain,” she says, “those ‘feel- good’ responses that the drug gives.”
Indermuhle’s other specialty, emergency medicine, she says came naturally to her as an emergency room technician while she was a pre-med and psychology major at the University of Colorado- Boulder.
“Some people are just better able to cope with the fast-paced and emergent situations in the ER,” she declares. “I think I was just hard-wired for it from the beginning. I like excitement, and I run on adrenaline often—it’s my energy.”
She says an ability to deal successfully in an emergency room scenario depends on repeated exposure to it through training.
“You’ve seen it before, so when faced with an emergency, you don’t put your emotions aside and just forget them—you kind of suspend them and focus intensely on the present circumstance and deal with it—your brain and your training take over.”
A leader in a field heretofore dominated by male physicians, Indermuhle says women working in emergency rooms have a unique contribution to make to the scene.
“I believe women’s natural empathy will help us to connect with patients at a deeply human level. It’s an exciting time to work in this arena.”
Indermuhle earned a bachelor of science degree in psychology at Boulder, graduated from the University of Arizona College of Medicine in 2004, and completed a residency in emergency medicine at the University of Indiana School of Medicine in Indianapolis in 2007.
“My husband and I met in the ER,” she says, “while he was starting to suffer from burnout there,” adding jokingly, “Now, we do great with him taking care of me and our two dogs, while I handle the ER.”