The U.S Opioid Epidemic
Opioids — A double-edged sword
Opioids are a class of drugs that includes the illegal drug heroin as well as chemicals that relax the body and can relieve pain. They are commonly used to treat moderate to severe pain and can be available by prescription (NIH). However, it is a double-edged sword. While opioids save many patients from suffering, they also take numerous lives.
The origins of the Opioid Epidemic
“The opioid epidemic is a plague of opioid addiction and overdose that has swept the United States over the past 20 years.” (Georgetown Behavioral, 2018)
The opioid crisis has been regarded as one of the most devastating public health disasters in the United State. According to statistics, from 1999 to 2021, over 1,028,000 people have died from drug overdose and about 650,000 deaths involving opioids, including both prescription drugs and illicit opioids (Lim et al., 2022). An average of 136 Americans are killed by opioid drugs daily, and the number of deaths has increased by 519.38% since 1999(NCDAS, 2022).
The origins of the Opioid Epidemic started in late 1990. The pharmaceutical companies publicized the drugs as more effective pain relievers and presented a fraudulent description of the drug as less addictive than other opioids. With the approval from Food and Drugs Administration (FDA), healthcare providers began to prescribe them at greater rates, leading to the widespread misuse of opioids. Simultaneously, the number of overdoses and deaths from prescription opioids has begun to increase considerably (NIH, 2022).
The main drivers of this public health catastrophe — who should be blamed?
The opioid crisis can represent the multi-system failure of regulation and the profit motive of the pharmaceutical industry and the medical community (Harvey V. Fineberg, 2022).
The root causes of this catastrophe are also attributed to the high rate, and availability of prescription opioids, which can be traced back to the over-prescribing of opioids to treat pain by doctors, rather than other alternatives. Most people who are addicted to opioids and overdose on them started from prescription opioid drugs. Moreover, up to 80% of heroin users are reported to abuse this illegal drug beginning by using prescription painkillers. However, many physicians seem to prescribe them in a thoughtless manner. Between 2006 to 2020, an average of 2.18 billion opioid prescriptions were dispensed with a 70% dispensing rate per 100 persons(CDC, n.d).
“ Some doctors routinely give a month’s supply of opioids for short-term discomfort when only a few days’ worths or even none at all is needed. Research suggests that patients given postoperative opioids don’t end up needing to use most of their prescribed dose.”( Bicket, M.C et al., 2017).
With easy access to opioid drugs, everyone can get opioids with prescriptions for either legal or non-legal purposes. Once people become opioid-addicted and can not obtain enough volume of drugs through prescription, they usually get opioid drugs from friends or relatives who have prescriptions or start to acquire them illegally. According to SAMHSA, over half of those who misused prescription pain medicines in 2013 and 2014 obtained those pain relievers from a friend or relative, while 22% got the drugs from their physicians. The rest either stole or purchased drugs from a friend, acquired from a dealer, or “doctor-shopped” with multiple prescriptions.
Additionally, the study suggests that 16.3 million people misuse prescriptions annually, and up to 95% of opioid abusers use prescription opioids at least once in a year. The high availability of prescription opioid drugs consequently causes the compound effect. Demand for opioid pills somewhat drove demand for heroin while demand for heroin unsuspectingly fed demand for synthetics-as-substitutes (Ciccarone, 2019), and this blend of factors contributed to the opioid epidemic which seriously impacted the whole United States.
It is urgent to combat the opioid crisis before it becomes irreversible.
“ Without urgent intervention, more than 1.2 million Americans will die from opioid overdose by the end of the decade.” (Dr. Howard K. Koh ).
To prevent the condition from getting worse and address this public health crisis, combined interventions are absolutely crucial. Two ways of intervening are with the PMP program and surveillance of the drug supply.
Prescription monitoring programs (PMP) with expanded healthcare services for individuals are crucial to managing the Opioid Crisis.
PMP allows physicians to avoid the over-prescribing as well as dangerous drug combinations by learning if a patient has multiple prescriptions from other prescribers, and raising the chances of discovering “doctor shopping”. The studies show that mandatory PMP and county coalitions led to 35% and 21 % decreases in prescription opioid overdose deaths respectively between 2015 to 2018. Aside from the current supply interventions, the expanding distribution of substance use treatment and harm reduction must be implemented combinedly.
A number of medical therapy options for opioid use disorder have been found to be both medically effective and cost-efficient, especially naloxone treatment. According to a national study, overdose deaths dropped by 14% in states that enacted laws to make naloxone more accessible over the last decades (McClellan et al., 2018). Thus, the increasing distribution of naloxone within communities is the primary action to prevent opioid overdose. Moreover, research from Rao et al. (2021) found that expanded health services for people with opioid use disorder combined with PMP would moderately reduce the severity of the opioid epidemic over the next decade. (Rao et al., 2021).
Surveillance of the Drug Supply
In addition to regulating the legal supply of prescription opioid drugs, it is also essential to monitor the illicit drug supply by increasing local drug surveillance. Public healthcare collaboration can mitigate this crisis by sharing data from the local criminal justice system to analyze drug samples and dissemination, so as to enhance the understanding of the drug in circulation and how opioid mixtures are changing. By collecting higher quality, more comprehensive, and timelier data on the dynamic nature of illicit drug markets, there will be more flexibility with innovative surveillance and prevention strategies so that specific needs can be met at the local level (CDC, 2019).
Conclusion
This opioid epidemic has seriously impacted the U.S over the past decades. Several factors led to this disaster and put millions of people in danger. Additionally, the public should not put labels on those who are addicted to opioid drugs. Instead, society should help reduce the stigma and encourage affected people to obtain treatment, since they are also the victims of this public health crisis. With the combined interventions and everyone’s effort, society and those who suffer from opioid addiction can combat this crisis effectively. “We can save lives and give people an opportunity to join the 23 million others living in recovery. Remember, dead people do not recover.” (Chin Hwa Dahlem, PhD, FNP-C, FAANP)
References
NIDA. 2021, June 1. Prescription Opioids DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/prescription-opioids on 2022, June 21
The Origin and Causes of the Opioid Epidemic. (2018, August 14). Georgetown Behavioral. Retrieved June 19, 2020, from https://www.georgetownbehavioral.com/blog/origin-and-causes-of-opioid-epidemic
Lim, T. Y., Stringfellow, E. J., Stafford, C. A., DiGennaro, C., Homer, J. B., Wakeland, W., Eggers, S. L., Kazemi, R., Glos, L., Ewing, E. G., Bannister, C. B., Humphreys, K., Throckmorton, D. C., & Jalali, M. S. (2022). Modeling the evolution of the US opioid crisis for national policy development. Proceedings of the National Academy of Sciences, 119(23). https://doi.org/10.1073/pnas.2115714119
NCDAS. (2022, April 6). Drug overdose death statistics [2022]: Opioids, fentanyl & more. NCDAS. Retrieved June 19, 2022, from https://drugabusestatistics.org/drug-overdose-deaths/
NIH. (2022, June 3). Opioid Overdose Crisis. National Institute on Drug Abuse. Retrieved June 19, 2022, from https://nida.nih.gov/research-topics/opioids/opioid-overdose-crisis
Harvey V. Fineberg. (2022, February 24). What led to the opioid crisis — and how to fix it. Harvard T.H. Chan School of Public Health. Retrieved June 19, 2022, from https://www.hsph.harvard.edu/news/features/what-led-to-the-opioid-crisis-and-how-to-fix-it/
Centers for Disease Control and Prevention. (n.d.). U.S. Opioid Dispensing Rate Maps | Drug Overdose | CDC Injury Center. https://www.cdc.gov/drugoverdose/rxrate-maps/index.html
Bicket, M. C., Long, J. J., Pronovost, P. J., Alexander, G. C., & Wu, C. L. (2017). Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review. JAMA surgery, 152(11), 1066–1071. https://doi.org/10.1001/jamasurg.2017.0831
McClellan, C., Lambdin, B. H., Ali, M. M., Mutter, R., Davis, C. S., Wheeler, E., Pemberton, M., & Kral, A. H. (2018). Opioid-overdose laws association with opioid use and overdose mortality. Addictive Behaviors, 86, 90–95. https://doi.org/10.1016/j.addbeh.2018.03.014
Rao, I. J., Humphreys, K., & Brandeau, M. L. (2021). Effectiveness of Policies for Addressing the US Opioid Epidemic: A Model-Based Analysis from the Stanford-Lancet Commission on the North American Opioid Crisis. The Lancet Regional Health — Americas, 3, 100031. https://doi.org/10.1016/j.lana.2021.100031
Centers for Disease Control and Prevention. 2019 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States Surveillance Special Report. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published November 1, 2019. Accessed June 19, 2022, from https://www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf.
