Taking a Deeper Look At The Opioid Epidemic In the US and How It Has Grown
Millions of people in the United States turn to opioids for pain management. In some cases, opioids prescribed by doctors are appropriate, however, they only help to hide the pain. This leads to the fact that reliance on opioids has resulted in one of the biggest drug epidemics in US history. Both illegal and prescription opioids are abused so frequently as they are highly addictive.
Commonly Used Opioids
Opioids that are usually prescribed include morphine, codeine, hydrocodone, oxymorphone, methadone, buprenorphine, fentanyl, and oxycodone. Illegal opioids that are commonly abused include heroin. Opioids like codeine and morphine are obtained naturally from opium poppy plants, which are typically grown in South America, Central America, and Asia. Morphine is used to synthesize heroin.
Oxycodone and hydrocodone are categorized as semi-artificial opioids as they are made in laboratories using both synthetic and natural ingredients. Vicodin or hydrocodone was the most commonly prescribed opioid drug between 2016 and 2017 and in 2016, there was a nationwide distribution of up to 6.2 billion of these hydrocodone pills. Percocet or oxycodone is the second most used opioid with up to 5 billion tablets being distributed within the US. In 2015, the International Narcotics Control Board stated that Americans made up approximately 99.7% of global consumption of hydrocodone.
Another notable opioid is Fentanyl, which is entirely synthetic and initially developed to act as a powerful anaesthetic used during surgery. The drug can also be administered to ease serious pain caused by terminal illnesses such as cancer. Fentanyl is stronger than morphine by up to 100 fold and even the smallest dose can be lethal. Over recent years, illegally produced Fentanyl has played a significant role in the number of deaths caused by drug overdose.
Another synthetic opioid is methadone, which is typically given to heroin addicts in recovery programs in order to relieve their withdrawal symptoms.
Opioid addiction is a chronic illness and it can lead to significant economic, social, and health problems. Opioids drugs act on the nervous system to induce feelings of pain relief and pleasure. Certain opioids are prescribed legally by doctors or health care providers to help patients manage severe and chronic pain. Opioids typically bind to the receptors within the spinal cord and the brain to disrupt pain signals. These drugs also activate the areas of the brain responsible for the feeling of reward through the release of dopamine hormone, which creates the feeling of euphoria.
Opioid addiction can be distinguished by the compulsive and strong need to abuse opioid drugs even when there is no medical need for one to use them. Opioids have a very high capacity to induce addiction in certain people even in cases where the medications are properly prescribed and taken according to the physician’s directions. Most prescription opioid drugs are usually converted to others if not misused and people who develop opioid addiction might prioritize obtaining these drugs and using them. Opioid use may take first priority over other things in the person’s life and it may have a negative impact on personal and professional relationships.
Opioids can alter the brain chemistry resulting in a higher tolerance of the drug. This means that one will need to increase the dosage taken each time in order to get the same euphoric effect. If one has been taking opioids for a very long time, he or she will become dependent on the drug such that when they do not take the drug, they experience psychological and physical withdrawal symptoms including anxiety, diarrhoea, and muscle cramping. It should be noted that addiction and dependence are not the same because even though anyone taking opioids for a long time becomes dependent on the drug, only a small number of people additionally experience the constant compulsive urge to take the drug hence addiction. Opioid addiction can lead to life-threatening health issues such as the risk of overdosing, which occurs when one takes high opioid dosages resulting in reduced breathing or cessation of breathing. This, in turn, causes unconsciousness and possibly death if the person is not treated immediately following an overdose. Illegal and legal opioid drugs both have an overdose risk factor if someone takes too high of a dosage of the drug or combines it with other drugs, specifically tranquillizers known as benzodiazepines.
The HHS reported that in 2016 and 2017, approximately 11.4 million people in the US abused prescription pain medication with up to 886000 using heroin. People who develop a dependency on pain medication have a tendency to switch to heroin as it is cheaper than obtaining prescription medication. An estimation made by the National Institute on Drug Abuse states that half of the young people injecting heroin switch to the street version of the drug following abuse of prescription pain medication. The Institute also found that 3 out of four new users of heroin started out with prescription medication. Between the years of 2002 and 2016, the number of heroin-related overdose deaths rose by 533% with the estimated number in 2002 standing at 2089 and in 2016 at 13, 219.
Naloxone is a drug that can be found as a nasal spray or an injection and is used to treat overdoses. This drug can reverse or block opioid effects in the body and it is typically carried and used by first responders.
The US Opioid Crisis
According to experts, America is experiencing a severe opioid epidemic because a little over two million Americans have developed a dependency on abused street drugs or prescription pain medication. According to a provisional count by the CDC, in 2017 the United States had more than 72,000 deaths caused by drug overdose and out of this number, 49, 068 deaths were caused by opioids. The United States Department of Health and Human Services reported that in 2016 and 2017, there were more than 130 daily deaths caused by opioid drug overdose. IMS Health, which is a market research firm also reported that in 2012, there was an increase of up to 282 million prescriptions from 112 million in 1992 in the number of doctor-dispensed opioid prescriptions. This number has reduced since to 236 million prescriptions dispensed in 2016. According to IQVIA which was formerly IMS Health, this number also reduced by 10% between 2016 and 2017.
The CDC has estimated that the overall economic burden resulting from prescription opioid abuse in the US equates to roughly 78.5 billion dollars annually. This figure involves the costs of criminal justice involvement, addiction treatment, productivity lost, and healthcare.
The emergence of the US Opioid Epidemic
Pharmaceutical companies in the late 1990s guaranteed the medical community that patients would not develop an addiction to prescription pain relievers, specifical opioids. This prompted healthcare providers to start prescribing these drugs at a higher rate. The pharmaceutical companies at the time used misleading marketing to push doctors with regards to the efficacy and safety of these drugs. The doctors then started prescribing opioids to patients for the treatment of all kind of pain. Most doctors had grown tired of dealing with patients suffering from pain that was difficult to treat and in some states, they complied thus writing prescriptions for each resident to get a full bottle of pills. Eventually, this resulted in the overall pervasive misuse and diversion of these drugs prior to the knowledge that they have the potential to become highly addictive. This led to an increase in opioid overdose rates. More than 33,000 people in the US died in 2015 from opioid overdose, which included the use of fentanyl, heroin, and prescription opioids.
Factors Contributing to the US Opioid Epidemic
The drugs began to proliferate in the US making the country the leader in opioid medication prescriptions on a global scale. There are some important factors that played a role in this change.
The pharmaceutical companies come first on this list. These companies wanted to make as much money as they could and so they began marketing their opioid drugs as not only effective for pain treatment but also safe. This is regardless of the evidence, which clearly indicates that the proven risks were more than the benefits when it comes to opioid use for specifically for chronic pain. However, this evidence was only true for most cases and not all of them. A good number of patients and doctors fell prey to this campaign. However, the manufacturer of OxyContin, Purdue Pharma and some of the company’s higher-ups eventually ended up paying fines adding up to more than 600 million dollars for their deceptive marketing assertions. Currently, opioid distributors are facing more lawsuits on the same grounds.
The doctors were also to blame for the opioid epidemic. They were facing significant pressure from government agencies, medical associations, some pharma-backed and non-pharma backed advocacy groups to take a more serious approach towards pain treatment. The doctors were also facing additional pressure to treat and see patients more efficiently and quickly. This was due to what can be described as the “Toyatazation of Medicine”, which was the immense pressure that was placed on doctors within sizeable integrated healthcare institutions to practice medicine in a specific manner. The aim of this move was to ensure patients can get out of healthcare centres faster so insurers could bill them as much as they could and to ensure patients got the highest customer satisfaction. Opioids served to kill these two birds with one stone. Since doctors did not know how they could handle some of the complicated pain problems brought to them by their patients, the easiest option was to prescribe some pain pills. This was because most of the time the answers to some of the patients’ ailments required too much time and resources to answer, not to mention the answers were complicated in some cases.
In other cases, the doctors would simply overprescribe this opioid pain medication. Patients who would come in with complaints of acute pain would be given enough medication to last weeks or even months by the doctors when a few days’ worth of dosage would suffice. For example, it was common for doctors to prescribe weeks’ worth of opioids to patients who had gotten wisdom teeth removals. This is regardless of the fact that the pain from the procedure typically causes pain that does not last for more than a week. Additionally, the pain from wisdom teeth removal can often be treated using other painkillers such as ibuprofen. These prescriptions meant patients would be left with a significant surplus of pain pills simply because doctors wanted to avoid complaints from patients and play it safe. In other situations, the doctors involved would practice outright malice by generating pill mills whereby they would often give away opioids for hard cash without any question.
The Role of Patients In the Opioid Epidemic
For patients, some serious health problems require addressing in terms of the opioid epidemic. Firstly, according to the CDC, the number of US adults suffering from chronic pain in 2016 was at 50 million. Seeing as there is proven evidence indicating that opioid usage has more risk than reward in most of these cases, patients are better off looking for other treatments to alleviate chronic pain. These alternatives include:
- Techniques to help with the mitigation and self-management of pain
- Approaches involving alternative medicine like meditation and acupuncture
- Specialized Physical exercises
- Non-opioid medication
Unfortunately, these alternatives are often difficult for pain patients to access. Some of these patients might not have sufficient insurance to provide for treatment and even for those who do, their respective health plans may not cater for comprehensive pain treatment or care. For those who have health plans covering pain treatment and sufficient treatment, they may not have a nearby doctor or clinic to offer the specific care they are looking for. This means that more often than not, the only appropriate answer for these patients would be opioids.
For some patients with chronic pain, opioids may still be a viable option as they can work for some when carefully prescribed on a schedule that can reduce excessive tolerance buildup. However, it is not advisable to run to opioids as a first-line treatment because of the dangerous risks it poses before one has tried out alternative methods.
According to information from the CDC, the broad proliferation of this opioid medication meant the pills were so many that in 2015 alone, enough of them could be prescribed to medicate every single American for 3 weeks around the clock. These pills were so many that usually they were diverted to the black market, friends of the patients, family members, and even teenagers looking for them in their parents’ medicine stash. This resulted in an explosion of opioid drug addiction and misuse of the drugs.
Opioid-Related Deaths In America
The opioid epidemic in the US seems to be growing bigger and if relevant action is not taken against it, then many people may be expected to die. According to a forecast conducted by STAT, the conclusion was made that up to 650,000 people are going to die from opioid overdose over the next decade. Approximately 64,000 deaths occurred as a result of opioid overdoses in 2016 within the US-based on data put out by the CDC. This death toll is even higher compared to those of HIV/AIDS, car crashes, and guns annually in the US and even higher than all the Iraq and Vietnam War US military casualties combined.
The same opioid epidemic also played a major role in the drop in life expectancy in the US for two years consistently, 2015 and 2016. This was the first time ever that there had been a two-year decline in life expectancy in the US since early in the 1960s.
Take New York city for example, in its battle against tobacco, the city reduced accessibility to tobacco by raising taxes making cigarettes costlier and also banning public smoking. Alternatively, New York city made it easier to access alternatives to tobacco by developing a phone line through which people could get free nicotine gum, free nicotine patches, or access to a clinic. This gave rise to a steady drop in the smoking rate between 2002 and 2015 from 21.5% to 14.3%.
On the other hand, the opposite occurred with opioids whereby opioid painkillers flooded the US markets thanks to the healthcare system and in conjunction with pharmaceutical companies. Illegal drug traffickers then jumped on the opioid bandwagon and overwhelmed the country with illegally manufactured opioids Fentanyl and heroin. The aim was to provide people with drugs to use if they wanted something more potent or if their painkillers ran out. This all made it quite easy for people to get these opioid drugs and abuse them. At the same time, little attention has been directed towards ensuring opioid users get the help and treatment they need. The 2016 surgeon general’s addiction report stated that only about 10% of individuals with a drug use disorder often get access to specialty treatment. The same report associated this low rate to healthcare supply shortages and lack of affordable treatment options is specific regions of the country. This can result in some people waiting for weeks or even as long as months simply to get treatment or help.
The combination of these two problems has bred a disaster which has only been exacerbated further by the mental and socioeconomic health problems that have been bothering the US for a long time now.
Fentanyl and heroin as mentioned before, are even more dangerous than painkillers. Generally, heroin is more potent, more addictive and as such, more likely to induce overdose in users. Fentanyl, which is even stronger than heroin, is usually laced into heroin sold illegally without the user knowing or sold to the user as heroin deceitfully. This means there is a higher chance of the person taking a larger dose than the body can handle. Part of this shift meant that the crisis started affecting various people. While overdose deaths from prescription opioids have mostly affected older Americans and middle-aged ones, there is also proven evidence that fentanyl and heroin are both more likely to affect younger adults ranging from ages 20 to their early 30s. This means there is a divide created within the opioid epidemic by people’s age.
The death toll from opioid overdose merely understates how deep the opioid crisis really is because the addiction and misuse of these drugs can result in more problems aside from death. These problems include financial strain as these substances can be quite expensive not to mention restricting one’s social functioning. Approximately 2.1 people in the US are believed to have an opioid use disorder and this is simply an underestimation.
There are multiple reasons attributed to the rapid rise of addiction in the country ranging from an increasing feeling of social isolation, jobs leaving some areas of the country, to bad access to mental healthcare. It should be noted that in America, there has been an increase in alcohol-related deaths, suicide, and other deaths of despair which is an indication that there is a deeper-rooted issue in American life.
There are more complex problems in the US now more than ever. If all these mental health, emotional, and physical problems are not addressed, then simply concentrating on the opioid supply is a senseless move because people will continue to experience these problems.
Response to the Opioid Crisis
Since the epidemic started with the use of painkillers, medical groups, doctors, regulators, and government agencies have drastically reduced prescriptions for the same. Several states have restricted the amount or number of opioids that doctors are allowed to prescribe. There has also been the development of a stricter regulatory schedule for some opioids implemented by the federal government. Doctors have been threatened by law enforcement with the loss of medical licenses and incarceration if they unscrupulously prescribe opioids. Additionally, the CDC has come up with guidelines and other proposals requesting doctors to cease the prescription of opioids to patients with chronic pain aside from special cases.