Overdose deaths by opioid abuse: A crisis with no end in sight. The United States is experiencing a devastating epidemic of drug usage and overdose deaths. From teens to older adults, the dramatic increase in overdose deaths is driven largely by the explosion in addiction to opioids — heroin and prescription painkillers such as oxycodone. Some experts say the crisis is about the get worse before it gets any better.
Addiction to prescription opioids by the numbers Since 1999, the number of overdose deaths involving prescription opioids has nearly quadrupled according to the Centers for Disease Control and Prevention (CDC).
“Prescription opioids play an important role in reducing pain and suffering,” says neurologist and addiction medicine specialist Dr. Russell Surasky with the Surasky Neurological Center for Addiction, “but opioids as a class of drugs have great potential for misuse, and as the number of prescriptions has skyrocketed in the last 25 years, we have seen soaring increases in the negative consequences related to their abuse.”
The Centers for Disease Control (CDC) report that the number of drug overdose fatalities reached a new high of 47,055 in 2014, or about 125 Americans every single day. And so far, 2016 is not looking any better.
States like New York, New Mexico, and West Virginia have been making headlines with spikes in heroin and opioid overuse over the last months.
So how did we get here? The reasons and answers to this question are pretty clear.
“Twenty-five years ago opioids were only being used for extreme cases, like after a big surgery or trauma. But then big pharmaceuticals companies began to market oxycodone, the single most profitable prescription painkiller to this day,” explains Dr. Surasky.
“These companies decided that if they could get physicians to write up prescriptions of oxycodone for chronic pain, or conditions like arthritis, then they would make a heck of a lot more money. They deliberately reached out to doctors and lied to them about possible addiction to these drugs.”
And it worked. Purdue Pharma has generated an estimated 34 billion dollars since releasing their brand name and controversial version of oxycodone, OxyContin.
“That’s really how we went from 76 million to more than 240 million prescriptions a year today, and now more drug overdose deaths than car accidents in the United States,” adds Dr. Surasky.
Although these are prescription drugs, people often share their unused pain relievers, unaware of the dangers of nonmedical opioid use. According to the American Society of Addiction Medicine, most adolescents who misuse prescription opioids are given them for free by a friend or relative.
The CDC reports that in 2012, health care providers wrote 259 million prescriptions for opioid painkillers, “enough for every adult in the United States to have a bottle of pills.”
Earlier this year, the CDC also released the Opioid Prescription Guidelines – a document that provides recommendations on appropriate prescribing, including determining if and when to start prescription opioids for chronic pain treatment; guidance on medication selection, dose, and duration, and when to discontinue medication.
But these are just guidelines. Doctors are not obligated to follow them. And some are openly against the guidelines, arguing it is their job to asses the situation according to the patient’s needs.
Opioids: Dangerous and highly addictive medications.
Opioids act by attaching to receptors in the brain that are stimulated to reduce the perception of pain and produce a feeling of well-being. When the drug wears off it detaches from the receptors and strong cravings compel taking another dose.
After repeated use, opioids induce tolerance, meaning users need higher and higher doses to achieve the same level of pain relief.
Over time, opioids cause long-term changes in the brain that persist even when the drugs are stopped and can cause cravings and relapses years later.
What is the federal government doing to combat the opioid abuse epidemic?
There have been ongoing efforts by the local and federal governments to encourage safer prescribing of opioid painkillers. Earlier in 2016, New York signed legislation that lowers the limit for opioid prescriptions for acute pain from 30 days to no more than a 7 day supply, with exceptions for chronic pain and other conditions.
Overdose deaths from heroin and opioids are on track to increase by 50% this year on Staten Island alone. According to the New York Department of Health, heroin overdose rates among Hispanic residents of New York have more than doubled since 2010.
Massachusetts, Connecticut, and Rhode Island have also taken steps to limit first-time painkiller prescriptions. But whether these measures will help combat an overdose crisis remains to be seen.
Officials in Huntington, West Virginia, a state that has long-battled drug overuse problems, recently responded to 26 heroin overdoses, including one death, within a four-hour time period.
The growing trend of using highly powerful opioids such asfentanyl, a painkiller 50 times stronger than morphine that is being made illicitly and sold on the streets, is one reason for the huge rise in overdose cases. This crisis is being felt all over the United States.
The opioid abuse epidemic has also put extra pressure in schools and universities.
The National Institute on Drug Abuse says 1 in 12 high school seniors reported having tried Vicodin, a combination of narcotic pain reliever (hydrocodone) and a non-narcotic pain reliever (acetaminophen), for recreational use.
Furthermore, 1 in 20 adolescents reported abusing OxyContin. And for college-aged students, 1 in 10 reported having a prescription for OxyContin or Vicodin, but 20.2% said they took more than they were supposed to.
Treating opioids addiction and preventing overdose deaths “For an addicted person to simply decide to permanently stop using opioids is next to impossible,” says Dr. Surasky. “After as little as a few weeks of use, opiates ‘hijack’ the brain, and the need for the drug becomes overwhelming.
“Unless the neurological damage can be healed, those cravings will persist for the rest of a person’s life. Fortunately, we have learned a great deal about how these drugs affect the brain and we now have treatments that undo the damage, prevent relapse and help people achieve permanent recovery.”
While doctors, pharmaceutical companies, and lawmakers try to find suitable ways to fight this devastating epidemic, emergency rooms are stocking up on doses of opioid overdose reversal drug, naloxone.
Naltrexone (brand name Vivitrol®) has become widely available for treating overdosed patients.
“Vivitrol is a medication that immediately stops cravings and withdrawal symptoms,” says Dr. Surasky. “With the patient’s firm commitment to recovery, along with counseling and a strong support system, Vivitrol is a powerful tool in treating addiction to opioids and alcohol.” President Barack Obama’s efforts to combat deaths by opioid abuse includes an $11 million funding opportunity for states to purchase and distribute the opioid overdose reversal drug and to train first responders on how to administer it.
An “opioid antagonist,” works by binding to the receptors in the brain and prevents opioids from acting on the receptors. By blocking attachment, the treatment prevents the pleasurable opioid effect and reduces cravings for the drug.
The bottom line:
Opioid addiction has already destroyed thousands of lives. Health care costs for treating addiction to opioid painkiller medications accounted for $25.0 billion in 2011. It is clear that there is a pressing need for innovative pain treatments, and a better understanding of opioid addiction for both.
The National Institute of Health is currently supporting more than 30 studies designed to prevent chronic pain. Other national efforts include prescription drug monitoring programs (PDMPs), vaccines against opioid addiction, and thousands of overdose prevention programs across the country.
But unfortunately, until lawmakers, doctors, and patients determine what works and what policies are the most effective, our country will continue to suffer from an opioid overdose epidemic.