A Brief History
On August 10, 2017, President Trump agreed with his commission’s report released a few weeks earlier and declared the country’s opioid crisis a “national emergency”. The opioid epidemic has been dominating news headlines in recent years due to the increase of fatal opioid overdoses taking the lives of over 130 Americans each day. Unfortunately, opioid addiction has affected all walks of life – from young adults full of potential, rich or poor, and even innocent unborn children. Between 1999 and 2017, more than 400,000 people have died from a drug overdose that involved opioids; however, the opioid epidemic began over 20 years ago. In the late 1990s, pharmaceutical companies began to pump out prescription painkillers at alarming rates without informing the public about the abuse and addiction potential of the drugs. The alarming rate of overprescribing opioid medications denotes the first wave of the opioid crisis.
Digging Deeper
Progression of the Opioid Crisis
With claims that these drugs would be effective in alleviating pain without the risk of addiction, physicians across the nation began to prescribe opioids more frequently and opioid medication sales quickly skyrocketed. This led to widespread abuse and diversion of opioid medications, causing many to become addicted. The number of opioid prescriptions written quadrupled between 1999 and 2010, and doctors and hospitals began to discover just how addictive these medications could be; however, it was too late – opioid abuse and overdoses were already beginning to destroy lives across the nation.
By the time physicians began to understand just how addictive prescription opioids were, many people who were misusing opioids began turning to stronger, illicit forms of the drug. Between 2002 and 2013, heroin-related overdoses increased by 286%. In addition, 80% of heroin users reported becoming addicted to their prescription opioid medications before turning to heroin. By 2010, the second wave of the opioid crisis was indicated by the devastating increase in heroin overdose deaths.
When physically addicted to a substance, the body begins to build up a tolerance, causing their body to require larger amounts of a substance to produce the desired effects. When addicted to prescription painkillers, many find that, over time, they don’t work as well. As a result, many turn to stronger, more illicit opioids like heroin and fentanyl. In 2013, at the peak of the third wave of the opioid crisis, the United States saw its first rise in overdose deaths caused by synthetic opioids like fentanyl – a drug that can be 50 times more potent than heroin and 100 times more potent than morphine. Fentanyl is the most potent opioid that is used in the medical community but has been increasingly popular among illicit drug users as the epidemic continues to progress.
The Opioid Epidemic Today
Despite the knowledge of how addictive prescription opioids can be, overprescribing of opioid medications is still common practice. In 2017 the CDC found that there were nearly 58 opioid prescriptions written for every 100 people and the average number of days per prescription has continued to increase. Some states, such as Tennessee, have seen even more astonishing rates of opioid prescriptions. In Tennessee, approximately 94 prescriptions were written for every 100 people in the state.
In an effort to increase regulations on opioid pain medications, the CDC released guidelines for prescribing opioids and prescription drug monitoring programs (PDMPs) have been implemented. Although PDMPs have the intention of tracking prescribing habits of patients and prescribers, there are still problems with their effectiveness. Without a federal mandate over them, PDMP regulations vary by state. As a result, data taken in by PDMPs are not shared with other states. Data that shows only in-state activity can still allow for doctor shopping across state borders. While PDMPs have served a purpose in reducing prescribing dates, they failed to have an impact on overdose mortality rates.
While minimal actions are being taken to reduce opioid prescriptions, illicit opioids continue to place their deadly grip on Americans each and every day. To keep up with the demand of those suffering from opioid use disorder, it has become commonplace to see heroin mixed with synthetic opioids like fentanyl and carfentanyl, making these substances even more deadly. Between 2015 and 2016, overdose rates due to synthetic opioids more than doubled. Fentanyl is now the most common drug involved in overdoses. It is so deadly, that overdose deaths have become a major concern across the nation. In addition, a recent study found that in one county in Florida in 2018, 86% of opioid deaths involved fentanyl. Often times, users are not seeking fentanyl, but it ends up in their drug supply anyway due to the cheap cost of the substance and widespread availability.
Desperately Searching for a Solution
With more than 130 people dying each day from an opioid-related overdose, the need for a solution has become crucial to the American people. While addiction is a disease that will likely never be exonerated from the earth, the best prevention strategy is through education and awareness initiatives. This includes not only educating youth about substance abuse but educating those who suffer from chronic pain about medication misuse and alternative forms of pain management. Whether this means bringing in people who have experienced opioid addiction first hand into schools to inform students about substance abuse or by providing physical therapy and less addictive pain medications to those with chronic pain, something has to be done.
In addition to prevention and education about opioid abuse, it is imperative to expand substance abuse services to those who need it. Not only do these programs need to be accessible, but they need to be affordable as well. Fortunately, in 2014 the Affordable Care Act began expanding insurance coverage to those seeking addiction treatment. However, those who are suffering that don’t have insurance are often left behind. In order to help heal those who have been touched by opioid addiction, treatment services should be expanded to even those who don’t have health insurance coverage.
Another step that healthcare providers have taken to help aid those who are suffering from opioid addiction is by implementing more accessible medication-assisted treatment programs. Medication-assisted treatment (MAT) involves the use of medications with integrated addiction treatment. While drugs like Suboxone and Methadone are weak opioids themselves, they are less addictive than illicit opioids and can help those suffering to get sober by eliminating cravings and alleviating painful withdrawal symptoms. In addition, safer, non-addictive treatments, such as Vivitrol and Naltrexone, are also effective in eliminating opioid cravings in those who are trying to get sober.
When taking a look at how the opioid epidemic began and how prescribing practices are done, it is easy to see how the nation reached such a desperate place regarding the opioid crisis. Although certain steps have been taken to try to alleviate some of the impacts, individuals across the nation must take a personal approach in preventing opioid abuse and addiction by taking steps to raise awareness and prevent opioid abuse.
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Historical Evidence
For more information, please see…
Campbell, J.N. and Steven M. Rooney. A Time-Release History of the Opioid Epidemic (SpringerBriefs in Molecular Science). Springer, 2018.
McGreal, Chris. American Overdose: The Opioid Tragedy in Three Acts. PublicAffairs, 2018.
The featured image in this article, Official White House Photograph by Andrea Hanks of First Lady Melania Trump participating in a discussion with panel moderator Eric Bolling during an Opioid Town Hall Tuesday, March 5, 2019, at the Westgate Las Vegas Resort & Casino in Las Vegas, is a work of an employee of the Executive Office of the President of the United States, taken or made as part of that person’s official duties. As a work of the U.S. federal government, it is in the public domain. This image was originally posted to Flickr by The White House at https://flickr.com/photos/148748355@N05/33434037858. It was reviewed on by FlickreviewR 2 and was confirmed to be licensed under the terms of the Public Domain Mark.
