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The Shamrocks' Lance Coffey, right, notched 12 points in two games to earn Athlete of the Week honors.

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Understanding Overdose: The physiology of drug use and overdose

A lot has been discussed about heroin and prescription opiates as overdoses continue to rise.

But what happens inside a person’s body when they use these drugs? Why are these drugs so dangerous, and what happens during an overdose?

Drugs like heroin, Oxycodone and morphine trace their lineage back to the opium poppy, a flower plant. Opium has been used for centuries because of its pain-fighting properties.

Fentanyl, carfentinil and the like are synthetic opioids, meaning they are not naturally occurring substances but have similar effects to natural opioids, according to the Drug Policy Alliance.

Opioid use and the brain

When a person uses heroin, the opioids attach to opioid receptors throughout the body, including in the brain, gastrointestinal tract, spinal cord and other organs, according to neuroscientist Jordan Gaines-Lewis, a policy research fellow at the Pennsylvania Department of Drug and Alcohol Programs.

Opioids block pain signals from the peripheral nerves to the spinal cord or from the spinal cord to the brain, she said.

“Drugs like heroin and fentanyl have a slightly different chemical structure that gives them a higher affinity for opioid receptors than prescription opioids, which partially explains why they are much ‘stronger,’” Gaines-Lewis said.

Along with inhibiting pain, opioids can trigger a euphoric feeling through a release of dopamine.

“Opioids activate a part of the brain called the ventral tegmental area,” she said.

This causes dopamine to be released into the nucleus accumbens - major component in the brain’s reward circuit, according to the National Institute of Drug Abuse.

This rewarding signal can motivate some people to continue seeking out the drug, Gaines-Lewis said.

“Dopamine release in the nucleus accumbens is also involved in strengthening associations between drug-taking and external stimuli,” Gaines-Lewis said. “For instance, if you only use heroin in your bedroom, being in your bedroom may become a stimulus that causes you to crave the drug.”

As people continue to use opioids, the receptors become less responsive to the drug, requiring the person to use more of the drug to release the same amount of dopamine and get the same effect, she said.

This can lead to people using not to get “high,” but rather to avoid the bottoming and “lows” associated with withdrawal.

“(T)hey need it just to function every day,” Gaines-Lewis said.


One area of the brain where opioid receptors are activated is on the brainstem.

The brainstem controls many of the body’s automatic functions like breathing and causing the heart to beat. When opioid receptors are activated in the brainstem, breathing becomes slow and irregular, and blood pressure decreases, Gaines-Lewis said.

The effects to breathing can lead to hypoxia, which is oxygen depletion to the body tissue, she said. All of this together can lead to a person losing consciousness and, in some cases, to death.

Gaines-Lewis said the opioid reversing drug naloxone works by causing the opioids in a person’s system to compete with naloxone for space on the opioid receptors. She said naloxone has a high affinity for opioid receptors, making it difficult for opioids to attach, which counteracts the overdose.

“I think one of the biggest misconceptions is that having naloxone on hand gives people with substance-use disorder a ‘safety net,’ or peace of mind that they can keep using opioids because a friend, family member or EMS will always be around to save them,” Gaines-Lewis said. “The research simply doesn’t corroborate this.”

Gaines-Lewis said that recovery from long-term opioid use is possible, but the process is different for every person.

She said people typically need to go through a process of detoxification, which treats the physical symptoms of withdrawal, followed by inpatient or outpatient treatment, which includes medical care, counseling and aftercare planning.

Gaines-Lewis said many people can also benefit from programs like pain or stress management, recovery houses, 12-step programs or occupational, social, educational or vocational services.

Medication-assisted treatment, with drugs like methadone, Vivitrol or buprenorphine, can also help a person abstain from illicit drug use by blocking the symptoms of withdrawal or eliminating the euphoric “high” feeling, she said.

Michael Bupp, The Sentinel  

Tim Lohr of North Middleton Volunteer Fire Company assists Ayden Caston with a shopping cart Monday at Ollie’s Bargain Outlet in Hampden Township.

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North Middleton family gets shopping spree after house fire

The Caston family lost a lot when their home in the 800 block of Pheasant Drive in North Middleton Township was destroyed in a fire on Nov. 20.

“I got my family out and they are all that matters,” Natasha Caston said. “My children, I was lucky enough to get my dog and everything else is just stuff.”

On Monday, Natasha, her husband Will and their three children came one step closer to replacing some of that stuff, as well as have a bit of holiday cheer, thanks to a local nonprofit organization.

The Mark L. Butler Foundation, an organization created in 2012 to strengthening community relations primarily through youth-based programs, sponsored a shopping spree at Ollie’s in Hampden Township for the family.

The Caston’s were given five minutes to go through the store and fill shopping carts full of toys, clothes and other goods.

“Our foundation focuses on families and kids in need, and when we heard that the Caston family lost their home to a fire, it was just a huge indicator for us that we needed to step in and help our community,” Mark L. Butler Foundation Executive Director Brooke Butler Romito said. “We just wanted to reach out and help our community.”

Natsha and Will’s son Gage said he filled two carts and was excited to pick out toys like Nerf guns and Legos.

The family was assisted by members of the North Middleton Fire Company and North Middleton Township Police during the shopping spree.

Will Caston said the three children are dealing well with the experience and largely understand what happened.

He said the family went back to the home since the fire to get some closure.

“They’ve been really level-headed since the beginning,” Will Caston said. “They were a little scared on the night of, obviously, but once firefighters showed up and everybody showed up and put the fire out, they’ve been doing really good.”

The family said the outpouring of support from the community has been overwhelming. They received more clothing than they are able to use, Will Caston said.

He said any excess clothing they are unable to use or clothes that do not fit the children are being donated to organizations like local homeless shelters and women’s shelters.

“There are times where you feel like your faith in humanity and your faith in God may be wavering,” Natasha Caston said. “I’ve found a whole new faith in humanity and God through all of this.”

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5 Questions
5 Questions: Boiling Springs man plunges into fight against slavery

Recent CNN video of a slave auction in Libya focused world attention on the issue of modern-day slavery that traps some 40 million people globally in forced labor or prostitution, according to International Justice Mission, an organization that fights human trafficking.

For the fourth year, modern-day slavery and the work of International Justice Mission is the focus of an unusual fundraiser undertaken by Mat Hench of Boiling Springs.

Each day between Thanksgiving and Christmas, Hench submerges himself in frigid water while seeking donations for the work of International Justice Mission.

Hench is a physical therapist assistant at Select Physical Therapy in Carlisle.

Q. What drew you to the cause of fighting modern-day slavery?

A. Everybody would agree that slavery is a bad thing, but many people see it as a historic happening rather than a current problem. I was looking for a nonprofit to support, and when I found out that slavery continues to be prevalent and there were organizations doing something about it, I knew that was something I wanted to be a part of.

Q. What are you doing with the Freezing for Freedom fundraiser?

A. I am completely submerging myself into cold water every day from Thanksgiving til Christmas to bring awareness to the cause and raise money for the International Justice Mission. This year, it will be 33 days in a row.

I have jumped in a variety of different natural bodies of water, including the Boiling Springs lake and Bubble, Yellow Beeches Creek, Lake Wildwood and Lititz Spring. I try to get in and out as fast as possible. The only stipulation is I have to get 100 percent wet.

Q. Tell us about International Justice Mission, the organization for which you are raising money.

A. The International Justice Mission is an organization that helps to rescue victims of violence. Once the victim is rescued, IJM works to restore them to life and represent the victim in the justice system. IJM also works to put the criminals in prison.

Q. What has been the craziest experience you’ve had while doing this?

A. We always do a midnight jump at the Boiling Springs Bubble on Christmas to celebrate. The first year we did this, the state police noticed that something was going on and they decided to pull over to investigate. We were still in the water at this point and when we saw the lights, we crawled out and stood there freezing for several minutes while being questioned. They wanted to make sure we were in our right state of mind. I can’t imagine why they would think otherwise.

Q. How can people become involved in the fundraiser?

A. I want to encourage people to donate to For those not in a position to help financially, it would help a lot to spread the word and to bring modern-day slavery into the light for the people that don’t understand the severity of it today. I would love for people to connect with me on social media by liking the “Freezing for Freedom” page on Facebook and helping to share it with their friends. Prayer is always appreciated.

Supreme Court allows full enforcement of Trump travel ban

WASHINGTON — The Supreme Court on Monday allowed the Trump administration to fully enforce a ban on travel to the United States by residents of six mostly Muslim countries.

This is not a final ruling on the travel ban: Challenges to the policy are winding through the federal courts, and the justices are expected to rule on its legality.

But the action indicates that the high court might eventually approve the latest version of the ban, announced by President Donald Trump in September. Lower courts have continued to find problems with the policy.

Opponents of this and previous versions of the ban say they show a bias against Muslims. They say that was reinforced most recently by Trump’s retweets of anti-Muslim videos.

“President Trump’s anti-Muslim prejudice is no secret. He has repeatedly confirmed it, including just last week on Twitter. It’s unfortunate that the full ban can move forward for now, but this order does not address the merits of our claims,” said Omar Jadwat, director of the American Civil Liberties Union’s Immigrants’ Rights Project. The ACLU is representing some opponents of the ban.

Two justices, Ruth Bader Ginsburg and Sonia Sotomayor, noted their disagreement with court orders allowing the latest policy to take full effect.

The new policy is not expected to cause the chaos that ensued at airports when Trump rolled out his first ban without warning in January.

The ban applies to travelers from Chad, Iran, Libya, Somalia, Syria and Yemen. Lower courts had said people from those nations with a claim of a “bona fide” relationship with someone in the United States could not be kept out of the country. Grandparents, cousins and other relatives were among those courts said could not be excluded.

The courts were borrowing language the Supreme Court itself came up with last summer to allow partial enforcement of an earlier version of the ban.

Now, those relationships will no longer provide a blanket exemption from the ban, although visa officials can make exceptions on a case-by-case basis.

The justices offered no explanation for their order, but the administration had said that blocking the full ban was causing “irreparable harm” because the policy is based on legitimate national security and foreign policy concerns.

In lawsuits filed in Hawaii and Maryland, federal courts said the updated travel ban violated federal immigration law. The travel policy also applies to travelers from North Korea and to some Venezuelan government officials and their families, but the lawsuits did not challenge those restrictions. Also unaffected are refugees. A temporary ban on refugees expired in October.

All the rulings so far have been on a preliminary basis. The San Francisco-based 9th U.S. Circuit Court of Appeals and the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, will be holding arguments on the legality of the ban this week.

Both courts are dealing with the issue on an accelerated basis, and the Supreme Court said it expects those courts to reach decisions “with appropriate dispatch.”

Quick resolution by appellate courts would allow the Supreme Court to hear and decide the issue this term, by the end of June.