Dr. Joseph D’Orazio, a medical toxicologist at Temple University’s Lewis Katz School of Medicine, came to speak to our class on Feb. 26 about the relationship between the medical field and the opioid epidemic in Philadelphia. The first part of D’Orazio’s presentation emphasized the importance of language. The topic of correct language-use when speaking on the epidemic and the individuals that it affects has been an important theme from all of the guest speakers we’ve heard from, and D’Orazio was able to inform us that, while this topic is important to many medical professionals, the medical field is far behind in implementation. He notes that the use of stigmatizing language towards individuals with a substance use disorder is still prevalent, and has a large impact on how patients perceive both individuals in the field, and themselves. D’Orazio stressed the importance of individuals understanding that a substance use disorder is categorized as a chronic illness, and should be treated the same way, without stigma. He also tackled the argument about substance use being a choice, by presenting the science behind addiction, including how different parts of the brain operate and override one another, and how dopamine plays part in the process. This concept, he linked with mental health disorders, such as anxiety, depression, and post-traumatic stress disorder. From here, D’Orazio gave us a little history on the opioid epidemic, the three waves of it, and some statistics about usage in the United States and Philadelphia. He also gave us background on where opioids come from, the most commonly used types, and how they get laced with other substances such as fentanyl. And on the topic of fentanyl, D’Orazio dispelled common myths about the substance- like the idea that you can overdose by touching it- and informed us about the problem with unequal distribution when mixing fentanyl into heroin, and how that links to a higher risk of overdose. D’Orazio then went into the medical issues addressed after an overdose, like brain, kidney, or lung injury. He also explained the idea of tolerance, and how many individuals with a substance use disorder are no longer using to get high, but using to get well. He finished his presentation on the topic of withdrawal, focusing on recovery options other than detox, like medication-assisted therapy.
D’Orazio’s presentation was extremely informative, and gave me a better perspective on the science behind substance use disorders. He blended the typical conversation around the opioid epidemic with the history and science of it, making sense of it all as one grand narrative. It was really shocking to me to find that the medical world is behind on the correct language-use around the topic, especially since D’Orazio appears educated on it and adamant about using correct terminology himself. I also found the science side extremely fascinating, especially about how the functions of the brain link with both addiction and mental illness. Another really interesting aspect of his presentation was the conversation we had about where opioids come from, how they get laced with other substances like fentanyl, and how it can be unevenly distributed between doses. I always wondered about the process, and so I definitely feel as though I have a better understanding of it. Overall, D’Orazio’s presentation was interesting to me, and helped me to better understand the processes going on within the medical end of the opioid epidemic, something that I feel is often overlooked.