Article By Jessica Irvine
A Brief History
The major struggle with opioid use began in 1991, when the prescribing rate increased drastically as a treatment for pain. This has been referred to as the first wave of three. Being that they were new, adequate knowledge about opioid side effects were not extensively known. So, doctors were encouraged to prescribe opioids because they were not thought to be highly addictive or harmful. Logically, the areas with the highest prescribing rates were the first places where opioid abuse and illegal distribution occurred.
Jumping to 2010, the ‘second wave’ of the opioid crisis is marked by increased deaths attributable to heroin overdose. Addiction and side effect data was extensively tested and accepted, thus the push to decrease opioid prescriptions took affect. However, addicts were then forced look elsewhere. Heroin is a cheap, potent, illegal, injectable opioid that was simple to obtain. Usage of heroin increased among most demographics, and there was a 286% increase in heroin related overdoses from 2002 to 2013.1 An estimated 80% of heroin users admitted to using opioids previously.1
The third wave of the opioid epidemic began in 2013 with a new drug hitting the market: fentanyl. Fentanyl and other synthetic opioids are created to be more potent than those previously used and, therefore, are more dangerous. According to the National Institute of Drug Abuse(NIH), in 2017 an estimated 47,000 American deaths were attributable to opioids, including fentanyl, heroin, and prescription opioids. Presently, about 130 Americans die daily from opioid overdoses, according to the Center for Disease Control(CDC).
The Issue at Hand
Opioid addiction and overdose is a devastating crisis in America. This issue causes over 78 billion dollars per year to be lost in terms of years of potential life lost, addiction treatment, and healthcare, according to the CDC. From 1999 to 2017, an estimated 400,000 people lost their lives from opioid overdoses.3
A major contributor to the crisis still lies in prescriptions. It is known that 21 to 29 percent of patients misuse their chronic pain opioid prescription.2 Four to six percent of these individuals will pursue heroin.2 A second major contributor is the illegal buying and selling of cheap opioids. Among these are heroin and synthetic drugs, such as Fentanyl, that may be used to lace other drugs without the buyer’s knowledge.
With this abuse has come an increase in neonatal abstinence syndrome, meaning that they are born with opioid withdrawal. The implications of this syndrome are visible in lower birth weights and increased respiratory complications. It is estimated that every fifteen minutes a baby is born with this syndrome in the United States.
Geographically, the eastern United States is most effected by the opioid crisis, however, the effects can be seen across the country. West Virginia, Ohio, Connecticut, Maryland, Massachusetts, Rhode Island, and Washington D.C. had the highest Life Expectancy Lost(LEL) in 2016 as a result of opioid related deaths.
Examining the distribution in terms of ethnicity, it is clear that this epidemic predominantly affects White, non-Hispanic individuals in terms of quantity. Data from the Henry J Kaiser Family Foundation(KFF), shows that across the United States in 2017, there were over 37,000 opioid overdose deaths among Caucasian individuals, around 5,000 for African Americans individuals, and about 3,000 deaths among hispanic individuals.5
However, socioeconomic status contributes to this issue and the degree of influence, as well. The NIH reports that opioids are often thought to be drugs of equal opportunity, affecting a diverse group of people. However, they also highlighted that opioids have affected the poorest regions of the country, such as Appalachia. Individuals in these areas have been identified as being at an increased risk for addiction as well as it’s devastating consequences such as HIV or overdose. A major determinant of this is quality and access to healthcare. The U.S. Department of Health and Human Services(HHS) has identified people at lower socioeconomic statuses to be those that are on Medicaid. Individuals that use Medicaid are more likely to be prescribed opioids and when they are, they receive higher dose prescriptions for longer durations.6
Fortunately, there are a number of organizations working to fight the opioid epidemic. Among them are well known institution such as the CDC and NIH( a subset of the HHS).
The CDC has circulated regulations on the prescription of opioids for chronic pain outside of cancer treatment, palliative care, and end-of-life care. Presently, there is an emphasis on non-opioid pain relievers, with opioids essentially last on the list of medications to use. When prescribed, they are now to be heavily regulated and carefully distributed.1
The HHS has decided to focus their efforts on five main areas: the improvement of access to recovery/treatment, promotion of the use of opioid overdose reversal drugs, increased public health surveillance to enhance comprehension of the crisis, support to research on pain and addiction, and examining better practices for pain regulation. The NIH, a portion of the HHS, focuses specifically on research on opioid misuse, treatment, and pain management. The NIH is coordinating with pharmaceutical companies to discuss safer methods to handle chronic pain, treatments for opioid addiction, and ways to improve both prevention and intervention for overdoses. In April 2018, the NIH launched the HEAL (Helping to End Addiction Long-term) Initiative that focuses on the aforementioned goals. Notably, they have developed an overdose reversal drug in the form of nasal spray Naloxone. Read more on the HEAL Initiative here.