26 Jun More Information Monday: The Opioid Epidemic
This week we look at one of the biggest issues America is facing today: The Opioid Epidemic
Opioid Crisis sounds really bad. Can you break it down – what are opioids and how is it a crisis? Where would have have I heard about this before?
Opioids are used to treat pain and are commonly known by their brand names such as Vicodin, OxyContin, Dilaudid, and Demerol. There are also illicitly manufactured opioids such as heroin and synthetics, known as fentanyl, which also cause the similar type of reaction in the body.
Right now in the U.S., there are 2.5 million people who suffer from a use disorder or addiction to prescription opioids and/or heroin (that’s equal to almost the entire population of Chicago – the 3rd largest city in the U.S.)
In addition to this issue coming to light in the news by itself, the sudden deaths of Heath Ledger, Philip Seymour Hoffman and Prince due to their problems with prescription painkillers, synthetics, or heroin have also brought this issue to the headlines.
(Source: 1, 2 and 3)
So how bad is it – can you give me something to compare this to?
More adults use prescription painkillers than cigarettes, smokeless tobacco and cigars COMBINED.
In just 2014, more than 240 million opioid prescriptions filled in the U.S. In 2014, there were about 240 million people between the ages of 18 and 65 – that means enough prescriptions were filled to give EVERY ADULT in the U.S. one pill bottle of opioids.
In 2015, more than 32,000 people died from opioid overdoses which just about equalled the number of people who were killed in car accidents.
(Source: 1, 2, 3 and 4)
How are legitimate prescriptions linked so closely to heroin and other illegal drugs? That seems like two opposite ends of the spectrum.
People go to see a doctor for any number of pain related issues and are issued a prescription for a painkiller or they are commonly given to patients after surgery or medical procedures. This is often a person’s first interaction with opioids. However, the longer the body is exposed to painkillers (analgesics if you would like the medical term), a higher dose may be needed to reach the same effectiveness/relief needed. Over time, a person’s brain chemistry can be altered due to the nature of these drugs. A survey found that ⅓ of Americans who took prescription opioids for at least a 2 month time-period reported becoming addicted or physically dependent on the medication.
This is where a seemingly controlled situation starts to get out of hand. Because there are regulations on how often these medications can be be prescribed or filled, people would start to seek out other avenues to find pain relief. Many people who have become addicted to prescription painkillers turn to heroin because it’s lower in cost and, in many locations, easier to obtain.
(Source: 2 and 4)
How does something like this start? How does an epidemic begin?
It first started in 1980 when literature in the New England Journal of Medicine that misrepresented the addiction level of opioids – saying they weren’t as addictive as they actually are. Then in the 1990s is when it really went to the next level (but is not linked to the rise of the Macarena or Beanie Babies). Doctors were looking for ways to help patients manage their pain levels and medical authorities instructed doctors to look at pain levels as the “fifth vital sign” (the other 4 being temperature, blood pressure, pulse and respiration rate) in assessing a patient. This was encouraged by the pharmaceutical companies as well. This focus on pain lead to more prescriptions of painkillers written than ever before.
At the same time, there was a new drug coming onto the market – the now well-known OxyContin. Developers told doctors that the risk of addiction would be very small because it was time-released, meaning a limited amount of the drug would enter a person’s system at a time. In addition, OxyContin had an unprecedented promotion and marketing campaign; spending 6 to 12 times more promoting OxyContin than its competitors spent and offering highly lucrative bonuses for the sales representatives to push this drug. By 2002, the company was generating $1.6 billion in revenue from this one drug alone.
However, the patients were getting around the time-release of the drug by crushing it into a powder and then snorting it or injecting it (the company has now re-formulated the pill to stop that). Also, studies have found the company misrepresented the risk of addiction and was ultimately sued paying $634 million in fines as well as other lawsuits that were brought against the company for deceptive marketing.
Now, just in the past month one of the doctors that wrote the article back in 1980 was interviewed and said how he regretted it immensely given how he feels it unknowingly attributed to the opioid crisis we have today.
(Source: 1, 3, 5 and 7)
So the push of one drug company causes an entire epidemic? How did it get to the level we’re at today?
The longer people were being prescribed these medications, the more they needed to get the relief and the more addicted they became and there was limited awareness of the dangers these medications could have. With the rising supply of prescription painkillers, a black market was created. Patients would start selling unused pills or dealers would recruit people to pose as patients to get prescriptions from as many doctors as possible (aka doctor shopping – not exactly something Amazon Prime handles). States that had very relaxed laws were breeding grounds for “pill mills” where doctors would prescribe opioids to anyone who would pay. Over the course of the last 20 years, the abuse of prescription painkillers has spread to every state in the U.S. and from inner-city youth and jobless rural residents to wealthy suburbanites and young professionals.
(Source: 1 and 3)
How did heroin become a part of this epidemic?
Often addiction starts with prescription medications, but people tend to turn to heroin because it’s cheaper. For those who haven’t read the latest profit and loss statements of street drugs – heroin is about ¼ the cost of the same dose of a prescription painkiller. The more dangerous and potent synthetic form of heroin, Fentanyl, is even cheaper than that.
On top of that, when law enforcement would shut down a “pill mill”, heroin and fentanyl dealers would move in to reach new “customers”.
At the same time as the prescription opioid addiction was rising, heroin dealers out of Mexico were expanding an order-by-phone system (this is a real thing) in parts of the U.S. where users could order it by phone and have it delivered to their home or designated parking lots. They would also intentionally have operations in areas that were known for high levels of addiction to OxyContin. Basically, drug dealers knew that people who couldn’t get access to prescriptions or couldn’t afford them would be looking for the relief the pills provided and would turn to heroin or other synthetics.
(Source: 1 and 4)
I’m guessing like most things, there isn’t a SIMPLE solution is there?
Of course not – on any level. There are medications that can help treat addiction to opioids (such as methadone and buprenorphine) but many don’t have insurance coverage to afford it or access to someone able to prescribe it due to state limitations on those drugs. Also, just location of said clinics makes it hard for people to access these treatment drugs.
Also, there is concern regarding instituting overreaching policies regarding prescribing painkillers because there are many people who have to deal with severe pain on a daily basis due to medical conditions and need ways to help manage that pain.
There is extensive debate regarding funding for treatments and the best way to address this crisis (which will obviously be discussed on Two-Sided Tuesday) – there is no miracle cure and a lot of the solutions are expensive.
(Source: 3 and 4)
Is there anything being done about it?
There are definite steps being taken on many levels to try to curb this epidemic. In 2016, President Obama signed the Comprehensive Addiction and Recovery Act to expand treatment programs and funding to help in developing alternatives to opioid painkillers. There have also been changes in policies that expand who can administer Naloxone which is a nasal spray that, if done quickly, can reverse the effects of an overdose.
Authorities are attempting to stop the “doctor shopping” and over 30 states have instituted an electronic database system that doctors can check to see patterns of pill-seeking behavior before prescribing opioids.
In 2017, President Trump began the commission on Combating Drug Addiction and the Opioid Crisis to look at the federal response to the crisis regarding funding, programs, accessibility to treatment among other things. The proposed budget also included an increase to the Department of Justice’s budget to help “fight against opioids and other illicit drugs”.
However, there are many concerns regarding the debates about the health care bills going through Congress because many of the versions propose cuts that would leave many without health insurance and drastic reductions in funding to drug-treatment programs.
(Source: 1, 2, 3 and 6)
Join us tomorrow to see the many debates regarding this issue on Two-Sided Tuesday!
1: Katel, Peter. “Opioid Crisis.” CQ Researcher, 7 Oct. 2016, pp. 817-40, library.cqpress.com/cqresearcher/cqresrre2016100700.
2: “Prescription Medication Abuse.” Opposing Viewpoints Online Collection, Gale, 2016. Opposing Viewpoints in Context, link.galegroup.com/apps/doc/PC3010999232/OVIC?u=brookdalecc&xid=83702631. Accessed 25 June 2017.
3: Kleiman, Mark A. R. “High Stakes.” Foreign Affairs, vol. 96, no. 2, Mar/Apr2017, pp. 130-139. EBSCOhost.
4: “Untangling the web of opioid addictions in the USA.” The Lancet, vol. 398, 24 June 2017, p. 2443,doi:10.1016/S0140-6736(17)31713-0. Accessed 25 June 2017.
5: Van Zee, Art. “The Promotion and Marketing of Oxycontin: Commercial Triumph, Public Health Tragedy.” American Journal of Public Health, vol. 99, no. 2, Feb. 2009, pp. 221-227. EBSCOhost.
6: Reinl, James. “Trump Administration and the Opioid Epidemic in the USA.” Lancet, vol. 689, no. 10085, 03 June 2017, p. 2181. EBSCOhost.
7: Haney, Taylor, and Andrea Hsu. “Doctor Who Wrote 1980 Letter On Painkillers Regrets That It Fed The Opioid Crisis.” NPR.org, 16 June 2017, www.npr.org/sections/health-shots/2017/06/16/533060031/doctor-who-wrote-1980-letter-on-painkillers-regrets-that-it-fed-the-opioid-crisi. Accessed 25 June 2017.