If you follow the news, or just read the headlines, you know that America is in the middle of an opioid epidemic. The roots of the crisis can be traced back to the mid-1990s when numerous healthcare professionals were invited to learn about OxyContin® and its promise of helping with pain management. This painkiller, originally used to ease cancer-related pain, is a close cousin to morphine with some aspects of opium poppy added in. When pain management cases became more common, pharmaceutical companies took notice and soon began marketing OxyContin® and other opioid-based painkillers aggressively for chronic pain. Despite concerns, pharma companies downplayed risks and assured the medical community that the opioids were safe and effective. In turn, healthcare providers prescribed opioid pain relievers more often. In fact, between 1996 and 2002, U.S. prescriptions for Oxycontin® increased tenfold from 670,000 each year to more than 6 million, according to a study conducted by the U.S. General Accounting Office. With increased usage came widespread misuse of both prescription and non-prescription opioids. This allowed the highly addictive nature of these painkillers to be revealed, creating a crisis along with it. By 2011, the Centers for Disease Control and Prevention (CDC) announced that opioid painkiller overdose had reached epidemic levels. In 2017, the U.S. Department of Health and Human Services (HHS) declared a public emergency to address the national opioid crisis. The staggering opioid epidemic stats leading up to this declaration tell the real story and illustrate the extensive nature of the problem.
Opioid Epidemic Trends
Drug overdoses are responsible for more U.S. deaths than traffic-related incidents or suicide. According to a CDC report, from 2010 to 2015, annual opioid-related overdose deaths rose by almost 57 percent in five states. The HHS reported that in 2016 alone, 116 people died daily from opioid-related drug overdoses. With the rise in opioid prescriptions came opioid overdose deaths—until 2011. By then, deaths from prescribed opioids began to level off, only to be replaced by an increase in deaths due to heroin overdose. According to the CDC, between 2010 and 2016, heroin-related overdose deaths increased by more than five times with 15,469 deaths in 2016. By 2013, heroin became even more dangerous when the highly potent, synthetic opioid called fentanyl was added to it. Fentanyl is reportedly 50 times more potent than heroin and 100 times more potent than morphine. Its danger is also made worse due to the fact that it is not regulated by suppliers, so consumers can never tell how much of either opioid they are actually getting. Until 2013, heroin overdose victims were not routinely tested by medical examiners for the presence of fentanyl. However, when this testing began, a disturbing trend became apparent. Fentanyl-related deaths surpassed deaths from opioid prescriptions and heroin. Deaths from synthetic opioids increased 219 percent between 2010 and 2015 in five states, according to a CDC report. Illegally manufactured fentanyl appears to be a major contributing factor to opioid-related overdose deaths with significant impact in mid-western and eastern regions of the United States.
States hit hardest by the crisis
The increase in prescription opioids also fueled the incredible rise in opioid dependence, which often results in overdose deaths. In response, some areas of the country have focused on educating consumers and physicians alike. However, growing use of heroin and fentanyl have dimmed any potential progress. In fact, four states—West Virginia, Ohio, Kentucky and Pennsylvania—have the highest U.S. death rates from opioid overdose, according to a DrugRehab.com report. Nationwide rates for opioid overdose death rates is reportedly 10 for every 100,000 people. In those four states, the rates are considerably higher:
- Pennsylvania’s rate is 10.5 per 100,000 people.
- Kentucky’s rate is 20 per 100,000 people.
- Ohio’s rate is nearly 22 per 100,000 people.
- West Virginia’s rate is 35 per 100,000 people.
West Virginia was the first state to file a lawsuit in the early 2000s against a pharmaceutical company for misrepresenting the potential dangers of its painkillers. Kentucky, on the other hand, is one of the most recent states to file a similar lawsuit against the same company. More than 15 years after West Virginia’s lawsuit, West Virginia had the highest overdose rate in the nation, with Ohio having the third and Kentucky with the fourth. In 2016, the opioid epidemic stats continued to grow even more:
- In one 24-hour period, 31 overdosed in Louisville, Kentucky.
- In one six-day period, 174 overdosed in Cincinnati, Ohio.
- In one month, 52 died of overdoses in Cleveland, Ohio.
- An estimated 4,642 died of overdoses in Pennsylvania—totaling more than any state in 2015.
In addition to increased use of opioids, these four states have another thing in common: isolation. Regions where overdose rates are high are in rural areas that may not have easy access to health care and have a lack of resources to treat addiction. Also, those in recovery reveal that loneliness, feelings of defeat and boredom can feed addiction.
Solutions to the crisis
Since the opioid epidemic was helped in great part by the number of prescriptions, addressing the crisis began there. Groups such as doctors, government agencies and regulators have implemented strategies aimed at reducing prescriptions for opioids. Some methods have included:
- Guidelines set forth by the CDC that direct doctors to prescribe opioids sparingly
- A stricter regulatory schedule developed by the federal government for some opioids
- Limitations on the number of opiates doctors are able to prescribe in some states
These and similar efforts have helped decrease the total number of opioid prescriptions since 2010, however, it has created other issues. By limiting access to opioids and not offering additional treatment options, users can be put at greater risk for withdrawals and they may seek alternative opioids such as fentanyl and heroin, which can be deadly. Comprehensive treatment, particularly for addiction, seems to be one of the best courses to reduce the number of opioid-related overdose deaths and help effectively address the crisis. According to a 2016 study, as of 2013, the estimated total economic burden of prescription opioid abuse, overdose and addiction was $78.5 billion. One-third of that amount was attributed to greater health care and substance abuse treatment costs. Government spending on addiction treatment has increased with the passing of the 21st Century Cures Act. The law reserves $1 billion in grant money for states in dire need to help fight the opioid epidemic, however, more money is needed to keep pace with the overwhelming cost of the epidemic. Studies and experts alike agree that one area that could particularly use more funding is medication-assisted treatment (MAT). This approach uses U.S Food and Drug Administration (FDA)-approved medications methadone, naltrexone and buprenorphine along with behavioral therapy to treat substance use disorder. MAT has been shown to reduce opioid-related deaths for those who struggle with addiction by at least 50 percent. Although this is an evidence-based intervention, it often goes underused because of the misconception around the idea of substituting one prescription medication for another. In reality, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), the medications used in MAT help fight the cravings and withdrawal symptoms that cause chemical imbalances in the body because they are delivered in a controlled manner. Unfortunately, there’s no one solution that will solve the crisis. It requires a multifaceted approach. In an effort to tackle this, HHS is focusing on improvement in the following five areas:
- Addiction, treatment and recovery services
- Targeting of medications that reverse overdoses
- Pain management
While the roots of the crisis run deep, there is hope. The national attention being given to the epidemic began a conversation that is reducing the stigma of addiction and improving access to treatment in all forms, important steps in getting us where we need to be.