Brooklyn Holmes

Dr. Cassel

English 101-13

2 November 2018

Annotated Bibliography

My topic is concerned with why drug overdoses are so common in our society today, how

to decrease the number of drug overdoses, and what factors play a role in drug overdoses. The

number of drug overdoses increases per year and there has not been anything done to decrease

the number of overdoses. I wanted to evaluate this topic because I feel that overdoses are

overlooked and shown not to be a problem in society.

Bakker, A. and Fazey, C. (2018). “Methadone tolerance testing in drug misusers.” NCBI

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1647386/ Accessed 7 Nov. 2018.

A treatment was conducted to see if the number of drug overdoses could decrease if drug

abusers were given methadone for rehabilitation. It started with the researchers asking the drug

misusers also known as their patients how much drug patience they need because it is beneficial

for treatment. The idea of this methadone treatment was introduced in the 1960’s and received

criticism and was told it was controversial. It was less criticized when evidence was shown that it

reduced mortality rate, criminal activity, and it improved the wellbeing.

In the first two weeks of the treatment, the patient’s tolerance is tested. Once the test is

completed it determines the amount of methadone the patient can withhold. They compare this to

the usual number of opioids the patient takes. If they are given too low of a treatment it will not
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do anything to the withdrawal symptoms. It is also said that if given too low of methadone that

the patient will just replace the missing methadone with heroin or other street drugs. The deaths

from this show that in fact, other substances played a factor in their overdose. An undertreatment

can also occur testing it could result in toxicity, so if a high dosage (over 100mg) then this

predicts better outcomes.

In the UK the recommended dosage is 60-120mg and in this study, it has been proven

most effective if the max dosage is not given. In the study, fifty percent dropped out in the first

week because of having to low of a dosage. Thirty-three percent was kicked out of the study

because of the inability to pass a urine test for other drugs. This concluded that the patients that

needed the most help would be the less likely to receive it.

The reason the researches want to take a tolerance test to drugs. They use this information

to test which drugs have been taken before because this affects the withdrawal process. The dose

of methadone a patient receives is based off if they have taken methadone prior. If not, the

patient is required to receive less than forty milligrams. The first step of this treatment is to

ensure a safe dosage from the tolerance test. Then the researcher is required to explain the risks

and that this treatment relies on the trust of the patient. The researchers then inform the

possibilities of toxicity and to watch for withdrawal signs. The patient can only receive their dose

from a pharmacist and must report back to researchers to see if they have any signs of

intoxication. There are multiple follow-ups with researchers and it is suggested that the patient

always communicates with them. It is believed that this procedure will improve the lives of

addicts who are at high risk to eventually overdose.

To test the theory of the treatment a study was conducted on one hundred and twenty-one

patients. Thirty of those patients had more than one tolerance test and doses of twenty to one
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hundred and fifty were given. None of these patients showed intoxication and lasted thirty

months. Seventy-six of those patients are still registered and a total of five died from other

causes.

When starting the treatment with patients who have never used methadone have to be

more cautious. Studies show a higher dosage decreases deaths. It is hard to determine if

methadone was a cause of death. It is assumed that it was only caused if a patient could not

tolerate. Therefore, the test is conducted so it is known what the patient can handle. To test to see

if methadone caused deaths a survey was conducted on fifty drug related tests. Forty-six of them

was from a multi-drug use and four was from wrong methadone dosage. It was concluded that

deaths could have been prevented by the patients were briefed of the risks. A doctor

recommended that daily review should occur, but this studies impression is review before the

patient starts treatment.

This test showed doses up to one hundred and fifty milligrams didn’t encounter toxicity

or death. There are potential hazards and it is not possible to predict patient safety. It is assumed

the .2% of deaths will occur at most but a larger trial is required. It is said from the results of this

study that patients can only undergo if methadone has been taken before. In case of a situation,

Naloxone is available, and patients will be observed. Patients judge own dosage size and still

will not show a result of intoxication. If the General Medical Council finds this treatment

irresponsible will be proven false because the only drug-related deaths in our series occurred

after methadone was discontinued.

The writer’s purpose for this article is to show that this study is a way to decrease the

number of drug overdoses. The audience is to the General Medical Council because for this

study to continue they need more funding, research, and for the study to be proven as
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responsible. It was written in 2006, even though it is not up to date it still shows that medical

professionals who conducted this study didn’t make any progress with their theory because most

drug professionals today are sent to rehab.

The writers are Adam Bakker and Cindy Fazey. They are both experienced for writing

this article because Bakker is a general practitioner and Fazey is a professor in international drug

policy. They are reliable because both of their profession show they have knowledge of this

study and to conduct it in the correct manner. The source is reliable because it came from a

government-issued website that is focused on the National Institutes of Health.

This information is vital to my topic because this study is a big controversy on how to

handle the drug epidemic. Most professionals disagree that giving drug abusers more drugs to

make them clean doesn’t have a point. This study states that giving drug abusers methadone will

make them clean and only have a low outcome of deaths. Most professionals think drug abusers

are usually taken to rehab where they take drugs away from them all together. Since this article is

older and shows a different perspective to decrease the number of overdoses it will be important

to show the reader a solution that is frowned upon.

“Drug Overdose.” Drug Policy Alliance, DPA, www.drugpolicy.org/issues/drug-overdose.

Accessed 4 November 2018.

Drug overdose is the leading cause of death in the United States for ages under fifty.

Overdose deaths now exceed other causes such as firearms, car accidents, and homicides. The

“tough on crime” and the stigma associated with drugs use block prevention and treatment

policies. People ages twenty-five to forty-four who are addicted to heroin have quadrupled since
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2010. Nearly 64,000 people have died of drug overdose since 2016 and have increased by

twenty-two percent from the previous year.

The causes of an underlying overdose crisis are complicated because of the

pharmaceutical companies and doctor play a significant role. The focus is on the demand for

drugs which is the main reason people use drugs. Most opioids don’t come from medical

professionals, they are oversupplied and entered on the street or stolen. There are many factors

that play a role in drug overdoses that include poverty, lack of economic opportunity, and lack of

a safety net. People who use opioids are likely to use other drugs like cocaine or heroin. Once

people become addicted to drugs, treatment becomes more difficult.

There is a solution to decrease the number of overdoses, but it is a long-term approach.

Most drugs on the street have been reported to include fentanyl which causes more death. Many

states have reported fentanyl overdoses that lead to death. Fentanyl caused deaths can occur

quickly and most people are unaware their drugs are lined with fentanyl. Fentanyl is produced

illegally and doesn’t come from companies. In the United States fentanyl comes through the dark

web and it is added to the drug supply before it enters. There are multiple signs of an overdose

such as body limpness, slow breathing, pale skin, and loss of consciousness. Most overdoses are

not discovered because people don’t know what to do in a situation. DPA told a story of a

mother who opened an organization called GRASP because she lost her son to an overdose. She

discusses how seeing the signs of an overdose and how it affects the family is important.

DPA is working to pass legislation to remove barriers to monitor overdose trends, support

research, and find solutions. DPA believes that the drug epidemic is so serious that it needs to be

taken to the state and federal level. The solutions they are trying to pass includes Methadone and

Buprenorphine, Naloxone, Good Samaritan Laws, and Support Consumption Services. The
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Methadone and Buprenorphine is a treatment for opioid use to relieve withdrawal symptoms and

cravings it is also known as OAT. Naloxone returns breathing to unconscious overdose victims

and it is used in emergency departments. It has saved over 27,000 people and could potentially

save more if used at the scene. The Good Samaritan Laws offer immunity to people who have

committed a drug offense if they went out if their way to save someone’s life by calling

emergency services. Support Consumption Services are given people a place to use drugs

responsibly and are under supervision. There is also the option of Drug Checking which is a

urine test to see if a person is clean, so they can make better decisions.

The purpose of this article is a national effort to reduce drug overdose deaths by

providing sensible evidence-based solutions. The organization writes their articles for state and

federal legislation. This was written in New York in 2018 to show the legislation that there is a

serious issue in cities and still has not improved over time.

The DPA is a reliable source because they are a non-profit organization to find solutions

for drug overdoses. The director of this organization is Mena McFarland who has worked for 13

years aside international and domestic drug policies. This organization believes that drug

offenders should not be arrested or incardinated because this affects the war on drugs.

This source is vital to my research because it shows solutions to end overdoses but through a

different perspective. Since this organization believes that drug issues can only be solved at a

federal and state legislative level. The organization also believes that drug offenders should be

handled differently for breaking the law since it is an addiction. This gives “the other side” to the

story that instead of the normal belief that drug offenders should be put away.
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Finkelstein, Yaron, et al. “Repetition of Intentional Drug Overdose: A Population-Based Study.”

Clinical Toxicology (15563650), vol. 54, no. 7, Aug. 2016, pp. 585–589. EBSCOhost,

doi:10.1080/15563650.2016.1177187.

Intentional overdose is the leading method of self-harm, suicide, and repeated attempts. A

population-based cohort study was done in Ontario, Canada from 2002 to 2013. The study was

conducted on all Ontario residents presenting to an emergency department after an overdose

occurred. Results from this study concluded that most people return to the hospital after a second

overdose. Researched concluded that secondary prevention initiative should be given to

individuals who survive an overdose.

Suicide is a global health concern claiming roughly one million lives per year. North

America has had very little success in suicide prevention. The hardest part of this situation is

identifying who is most vulnerable. Recurrent overdose is the strongest reason that is associated

with intended suicide especially in teenagers. Researches wanted to focus on the post-attempt

period to find predictors of overdose repetition.

This study on the population lasted eleven years and it was found that repeat overdose is

very common. After the first incident occurs, repetition could be prolonged for many years. One

out of five patients presented in the emergency department with recurring overdose. It was

shown that depression, psychiatric care, alcohol dependence, and ingestion of psychiatric drugs

can be associated with repetition. It is very difficult to predict who will repeat self-poisoning and

what causes it because each patient is different. Researchers discovered that their original idea

was to monitor the after this period because it was shown that the second occurrence could be up

to two years after. Between one and two percent of individuals discharged with self-poisoning or
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self-harm die within a decade of the first attempt. It was shown that a follow-up visit with a

medical professional can decrease the suicide attempt risk.

Overdoses that are repeated and intentional are very common in our society. The

reoccurrence is possible but usually after a longer period. There can be many factors that

associate with the potential overdose, but these don’t necessarily affect the decision. Since

overdoses can’t be predicted and can happen at any time after the first incident it is said that

there should be efforts made to prevent all intentional overdoses.

The purpose of this source is to prevent future intentional overdoses. This study was

conducted for emergency medicine personals who are the first to deal with the patient after the

overdose occurs. This study was conducted in Toronto, Canada in August of 2016. This affects

the information because it shows that overdoses are common everywhere and numbers need to

be decreased worldwide.

The writers of this article are; Yaron Finkelstien, Erin Macdonald, Simon Holland, Marco

Sivilotti, Janie Huston Muhammad Mamdani, Gideon Koren, and David Juurlink. All these

sources are reliable because their careers include professionals in toxicology, pharmaceuticals,

and medical engineering. This proves that all these authors have enough experience to complete

the study with vital information.

This information will be used for my research to show that intentional suicide is one of

the many reason drug overdoses are so common today and that intentional suicide is a factor in

the role of overdoses. The information from the study shows the number of intentional suicides

that happen per year and how the study found a way to decrease them.
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Figure 1 The severity of the drug epidemic.

National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 6 Mar. 2018,

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis. Accessed 7

November 2018.

More than one hundred and fifteen people die in the United States after an overdose on

opioids. The addiction to opioids consists of prescription pain relievers and heroin. The

economic burden of prescription opioid overdose is 78.5 billion dollars per year. The reason
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prescription overdoses happen because pharmaceutical companies reassured the medical

community that the pain relievers were not addictive. More than two million people in the United

States suffer from substance disorders. About 21 to 29 percent of patients prescribed opioids

misuse them. About 8 to 12 percent of those develop an opioid disorder and then 4 to 6 percent

of those end up using heroin.

The opioid overdose has increased by 30 percent in 2017. Overdoses have become a

public health crisis. It has been discovered that pregnant mothers are likely to abuse opioids, and

this causes Neonatal absence syndrome. NIH (National Institutes of Health) and HHS (Health

and Human Services) have put in efforts to improve access to treatment, reoccurring of a drug

overdose, promoting use, the understanding of the epidemic, providing support and advancing

practices for pain management. This led to NIH to meet with companies to discuss non-addictive

strategies for pain, new medications, and technology to treat opioid disorders and improve

recover services. The director of NIH launched HEAL (helping to end addiction long-term) to

find solutions for opioid use.

The writer’s purpose is to try and put an end to opioid use and prevent overdoses. Their

audience is for the public to have knowledge on the topic and to realize how big an issue this is.

This article was written in March of 2018 in Maryland since this article was recently updated this

shows that this is still an issue in our society and was written by an experienced non-profit

organization.

The writer of this article is the NIDA, which is an organization that wants to advance

science on causes consequences on drug use and addiction to apply it to society. This

information is adequate because all members of the organization have experience and knowledge

on this topic. The director of the organization Nora Volkow has been there since 2003. She has
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published more than 680 articles and has made many advances on the study of drugs in the brain.

They are reliable because they have multiple national committees to support them and they are a

non-profit organization.

This information is vital for my research since it shows a way to decrease the number of

overdoses and gives statistics on how common overdoses are. It also will be helpful to my

research that there are organizations working on finding ways to decrease the national number of

overdoses.

“Prescription Drug Abuse.” Mayo Clinic, Mayo Foundation for Medical Education and

Research, 19 Oct. 2018, www.mayoclinic.org/diseases-conditions/prescription-drug-

abuse/symptoms-causes/syc-20376813. Accessed 9 November 2018

Prescription drug abuse is taking medications that were not prescribed by a doctor.

Prescription abuse is an increasing problem that can affect any age group but is common mostly

in teens. These drugs include anti-anxiety medications, opioids painkillers, stimulants, and

sedatives. Early identification of these can prevent the possibility of addiction.

The three most common medications that are prescribed and that are known to lead to

abuse are opioids, anti-anxiety medications, and stimulants. Opioids are used to treat pain and

contain hydrocodone. These are generally prescribed after an injury or a surgery. Symptoms of

abusing opioids include nausea, drowsiness, confusion, and poor judgment. Anti-anxiety

medications are used to treat anxiety or sleep disorders. Symptoms of abuse include slow

breathing, slurred speech, and dizziness. Stimulants are used to treat ADHD and sleep disorders.

Symptoms of abuse include feeling high, insomnia, paranoia, reduced appetite, and high body

temperature. Other signs to watch for are stealing and selling prescriptions, excessive mood
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swings, poor-decision making and “losing” prescriptions. When you are taking this medication is

it suggested by a doctor if you think that you have become addicted to the medication to

immediately come in because the sooner, they tackle the problem it is less likely to lead to

addiction.

Reasons people abuse prescriptions are to feel good or to get high, to relax, increase

alertness, wanting to experiment, to maintain withdrawal symptoms, to be accepted by your

peers and to improve concentration. There are also many risk factors in prescription drug abuse

such as addiction to other substances, family history of abuse, present psychiatric condition,

exposer to peer-pressure and the lack of knowledge of the drug. While prescription abuse is more

common in teens, in older people prescription drug abuse is usually caused by taking multiple

drugs for the multiple conditions they have. It can become a serious problem when combined.

Abusing drugs can cause many issues and can lead to death. It occurs commonly when combined

with other substances such as alcohol or illegal drugs.

All prescription drugs can have serious or harmful outcomes. Opioids can cause a slow

breathing rate, the stopping of breathing, a coma or death. Anti-Anxiety can lead to memory

problems, slow breathing rate, withdrawals, or death. Supplements can cause heart problems,

seizures, and paranoia. These prescriptions can also cause two things physical dependence and

addiction. Physical dependence to these prescriptions is also known as tolerance in the body.

When drugs are long-term used it can cause the body to be dependent. This leads to higher doses

and withdrawal symptoms. Addiction is like physical dependence, but it can cause a compulsive

need to constantly use even with the problems they can cause. Other common consequences

include the use of illegal drugs, lack of judgment, involved in crime, car accidents, and decreased

academic performance.
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To prevent prescription abuse you need to make sure that you’re getting the right

medication, check in regularly with a doctor, follow the directions, know the symptoms of the

medication, never use another person prescription, and don’t buy prescriptions online. To

prevent this risk in teens you can discuss the dangers of abusing the medication, set up rules, talk

about alcohol use, lock up the medication, and properly give them the correct amount.

The writer’s purpose for writing this article is to educate people who take these kinds of

prescriptions to be aware of the risks and consequences of taking too much of the medication.

This article was written in 2018 which means it is up to date and that prescription drug abuse is

most common today.

The writer of the article is Mayo Clinic and is credible because it is a trusted medical

institution. Mayo Clinic has many faculties that have Ph.D. and are experienced in the field of

substances abuse. Dr. Hall-Flavin is a psychiatrist who specialized in alcohol and drug abuse for

over twenty years. He has received many awards and certifications in his work.

This information will be vital to my topic because drug overdoses are most common in

teens. It is said that most teens are led to harder drugs after abusing prescription drugs. This

information will show how and why people take drugs which can lead to overdoses.

“The Effects of Fentanyl Use.” DrugAbuse.com, American Drug Association, 29 Jan. 2016,

drugabuse.com/library/the-effects-of-fentanyl-use/. Accessed 13 November 2018.

Fentanyl is a synthetic opioid analgesic and is potent. It is usually meant for controlling

pain, but it can be easily be abused. It can be harmful and fatal meaning it can cause death by

respiratory failure. Fentanyl is used by patients who have already grown tolerant to opioids. If a

person taking the drug isn’t tolerant it can be fatal and lead to an overdose.
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DEA classifies fentanyl as a Schedule 2 controlled substance. This means that is a higher

risk for abuse. Addiction can happen rapidly and should be monitored by a physician. A deadly

combination is fentanyl and heroin, it is also known as “China White.” It is added to the heroin

for a greater high and makes a greater risk for an overdose.

Short-term effects of fentanyl abuse include relaxation, euphoria, and reduced feeling of

pain. Side effects include nausea, vomiting, altered heart rate, hallucinations, constricted pupils,

and seizures. Overdose symptoms include difficulty swallowing, extreme fatigue, cardiac arrest,

severe confusion, and altered levels of consciousness. Long-term effects usually show signs of

poor judgment in personal life. It can cause organ damage, death, harm to personal life, and

mental health issues.

A dependency can be avoided if you follow directions of medication and avoid

recreational use of fentanyl. Treatment has two components which are detox and rehab.

Withdrawal symptoms can include tremors, agitation, anxiety, sweating, and intense drug

cravings. After detox rehab will begin and find a rooting cause of addiction. Rehab includes

family therapy and wellness components. Aftercare is important because the need for the drug

still occurs after and one must fight through the urge. Options to help aftercare are sober living

facilities and certain programs.

The writer’s purpose for writing this article is to explain the dangers of using fentanyl

and if one becomes addicted there are resources that help addiction. The audience is for patients

or addicts taking fentanyl. Since the article was written in 2016 this shows that rehabilitation is

still available to help addicts.

It was written by the corporation drugabuse.com and this company is personally affiliated

with American Addiction Centers. This author is credible because the entire organization is

experts in the uses of drug and the rehabilitation process. All members have enough experience

in their fields to successfully write about this topic.

This answers my fat question by showing how fentanyl is a big factor on the opioid drug

epidemic. I will use it in my paper to show the side effects and long-term effects this certain type

of addiction can have on the body. I will also use this source to help describe the steps of rehab

and how it can be helpful to the aftercare of an addict.