Addiction Medicine: A Talk With Dr. Jarid Pachter

Family medicine specialist Jarid Pachter led a lecture on Addiction Medicine at the Cutchogue New Suffolk Free Library on June 20, sponsored by Eastern Long Island Hospital. Attendees were given a NARCAN kit with instructions on its use. Dr. Pachter has been practicing in Southold for more than a dozen years.

What is NARCAN?

NARCAN is not a treatment for drug-use disorder. NARCAN is a treatment that brings someone back from the brink of death from an opioid overdose. The way this medication works is that you put it in a person’s nose and it removes the opiate from the parts of the brain that are controlling their breathing so they’re not in respiratory arrest anymore.

It’s my feeling that everyone should be given a NARCAN kit.

Is it effective for all opioid-related overdoses?

The problem with NARCAN is that most heroin nowadays has fentanyl in it, so it takes more than one dose of NARCAN to revive that person because the fentanyl is so powerful.

Why is fentanyl put into heroin?

Drug dealers from multiple countries are competing with each other for business and fentanyl is not just a more potent drug, it’s also a hell of a lot cheaper, which means people can produce more of it and make more money off of it.

Where do substance-abuse disorders stem from?

Substances have been around for thousands of years. When something has been around for that long, it actually has the ability to change your genetic make-up. There’s always a family history. The story is always the same with patients who I see in detox. There’s always a family history of that person — and not necessarily using substances. It could be gambling; it could be a sex addiction; it could be a body-building obsession or body dysmorphia, but there is mostly always a family history of addiction.

What is a common road toward heroin use?

Let’s pretend you got Vicodin because you got your wisdom tooth removed and that first time you took the Vicodin you loved it. It was amazing. The dentist was so nice he gave you 60 of them, which happens all the time. I don’t mean to pick on dentists, but they’re notorious for this. I can’t attest that much has changed with that since the prevalence of opiate use.

So he gives you the 60 pills and says you should take them in three or four weeks, but you went through them in three or four days, so you start going toward the doctor to get more pills, which aren’t going to make you feel the same way as the first one, but you start buying, crushing, and sniffing pills, which are expensive, and eventually you’ll run out of money and turn to heroin.

Everyone says, ‘Oh, I’ll never do heroin.’ Yeah, you will. It’s inevitable, so you start sniffing heroin and injecting heroin, but you’ll never again feel the same way as you did that first time. What happens is, over time, dopamine isn’t getting released anymore and all the morphine or heroin or oxycodone is doing is keeping you from having withdrawal or not being sick, then you have to keep using in order to not be sick.

gianna@indyeastend.com