Putting a Stop to the Opioid Epidemic: Early to Current Trends and Treatment

The opioid epidemic started long before its initial appearance in nearly every local U.S. newspaper. This epidemic began in the early 1990s; from 1979–1990, overdose fatalities increased approximately 5.3% each year and jumped to 18.1% each year from 1990–2002 (Paulozzi & Budnitz, 2006). Its tendrils reach into cribs as in American babies addicted to opioids are born every 25 minutes (Patrick, 2017); in Kentucky, the epicenter of the opioid epidemic, nearly 15 of every 1,000 newborns are dependent on opioids from birth (Saint Louise, 2017).

Though some question the judgment of people addicted to opioids, the current epidemic is no simple case of immorality or social deviance. In fact, Science magazine notes that the origins of the current U.S. epidemic are in doctors over-prescribing opioids to avoid untreated chronic pain and the “aggressive marketing” of heavily concentrated opioid drugs (Burke, 2016). In the 1980s-1990s, morality drove the new availability of opioids for chronic pain management, as it was perceived to be unethical to leave pain undertreated (Ballantyne & Sullivan, 2015). However, in 2002, death certificates reporting the cause as prescription opioid overdose occurred 91.2% more often than in 1999, while heroin and cocaine related deaths jumped from 12.4% to 22.8%, respectively, in that same time period (Paulozzi & Budnitz, 2006). Addiction has increased because of misguided, legal methods of prescribing opioids. Just as best intentions sometimes do, this endeavor for empathetic treatment of pain inadvertently went south.

Jumping on the new potential market, drug cartels sold heroin to these newly addicted patients as a less expensive substitute (Burke, 2016). The recently increased drug overdoses have their roots in drug dealers lacing their heroin with fentanyl, which is not only cheaper than heroin but also 25–50 times more potent than heroin alone (Saul, 2016). Heroin’s surging potency accounts for much of the rising opioid mortalities.

Calling for better prescription methods and control, the Centers for Disease Control and Prevention (CDC) created a guideline in March 2016 and an app for prescribers about appropriate CDC opioid guidelines. However, it is the opioid overdose maps from 1999 to 2014 derived from the CDC and National Institute of Health (NIH) data that are the most harrowing.

*The Guardian adapted the CDC and NIH information to create the above maps of Opioid Overdose Deaths in Nadja Popovich’s article.

Disturbing as these maps may be, they detail the spread of the opioid epidemic and how imperative it is that effective actions be taken. As for what the U.S. can do right now about the epidemic, the CDC recommends that the public be informed about opioids to help prevent opioid addiction and overdoses; for states, the CDC recommends the Prescription Drug Monitoring Programs, electronic database tracking prescriptions of controlled substances to patients, as these programs have shown some successes in Florida, New York, Oregon, and Tennessee.

As this epidemic did not start from one avenue alone, the solution cannot be found on a simple, individualistic scale of treatment. Public health and appropriate policies and funding must be called upon to halt and correct this devastating trend. The National Governors Association (NGA) Center for Best Practices proffers one framework of devising and creating state policies to address the opioid epidemic. This plan hits on several key factors that public health emphasizes: disease surveillance, prevention, treatment, and evaluation. These core aspects should be driven by data and reflected in health policy, as time and time again, preventative measures for health not only serve to build healthier communities, but also save money, lives, and quality of life (Richardson, 2012; Woolf, 2009). After all, public health can be seen as what is or is not acceptable for our community’s and nation’s health. Certainly, this opioid epidemic jeopardizing our community’s health and wellbeing warrants the government prioritizing and funding countermeasures to assure that this does not become acceptable.

For more information: The CDC and NIH offers information, infographics, individual state data, and their own efforts in this epidemic.

References:

Ballantyne, J. C., & Sullivan, M. D. (2015). Intensity of Chronic Pain — The Wrong Metric? New England Journal of Medicine,373(22), 2098–2099. doi:10.1056/nejmp1507136

Burke, D. S. (2016). Forecasting the opioid epidemic. Science, 354(6312), 529–529. doi:10.1126/science.aal2943

Paulozzi, L. J., Budnitz, D. S., & Xi, Y. (2006). Increasing deaths from opioid analgesics in the united states. Pharmacoepidemiology and Drug Safety, 15(9), 618–627. doi:10.1002/pds.1276

Popovich, N. (n.d.). A deadly crisis: mapping the spread of America’s drug overdose epidemic. Retrieved July 20, 2017, from https://www.theguardian.com/society/ng-interactive/2016/may/25/opioid-epidemic-overdose-deaths-map

Richardson, A. K. (2012). Investing in public health: Barriers and possible solutions. Journal of Public Health (Oxford, England), 34(3), 322–327. doi:10.1093/pubmed/fds039

Saint Louis, C. (2017, July 14). Mom is part of the cure for tiny opioid victims. The New York Times, pp. A1, A2, All.

Saul, J. (2016). China white lie. Newsweek Global, 167(15), 24–25.

Woolf, S. H. (2009). A closer look at the economic argument for disease prevention. JAMA, 301(5), 536–538. doi:10.1001/jama.2009.51