In October 2017, President Donald J. Trump declared the opioid crisis in America to be a public health emergency. This stops just short of naming the crisis a national emergency, but still underscores the dire predicament in which our nation finds itself. As with any crisis, there are many causes that contributed to the situation in which we currently find ourselves. By examining the reasons for the crisis and how the opioid epidemic started, we can begin to find ways of reversing the problem.
The year 2015 was a history-making time in the opioid epidemic crisis because a historic number of deaths from opioid overdose occurred that year. Those already alarmed at the growing epidemic were beginning to gain the attention of the public and awareness was increasing of the deadly threat opioid abuse posed to our nation’s health.
In 2016, however, there were even more deaths from opioid abuse. In fact, according to the Centers for Disease Control and Prevention (CDC), there were more than 52,000 deaths from opioid drug overdose in 2016. The problem has grown so severe that for the first time since the 1960s, life expectancy has dropped two years in a row in the United States.
The CDC has recently released preliminary numbers for 2017 and so far the number of deaths from opioid drug overdoses has risen yet again to more than 64,000 deaths. This is a 21 percent rise over 2016, and the CDC highlights the fact that these preliminary numbers probably underreport the actual number.
Experts predict that we will likely see more than 650,000 opioid drug overdose deaths in the next 10 years. If serious steps are not taken now to stem the tide, this problem is likely to kill well more than half a million people in the next decade.
Origins of the Opioid Epidemic
In the 1990s, there was increased attention in the medical field addressing the needs of those suffering severe or chronic pain. As doctors became more aware of the serious health effects on patients dealing with pain, they sought a solution that would give patients relief while healing from injury or illness. Unfortunately, the answer that many doctors turned to was not the safe alternative they were led to expect.
Purdue Pharma offered the drug OxyContin as a safe solution for managing pain. A massive marketing campaign went into gear convincing doctors and patients that OxyContin was an effective, non-addictive solution to pain relief. The marketing was extremely successful, and patients began asking for OxyContin by name. Doctors were happy to have a safe solution to give to patients, so they began writing prescriptions for the drug.
The evidence showed that OxyContin was not as safe as Purdue Pharma had represented. Especially in cases of chronic pain, the risks of opioid pain relievers often outweigh the advantages. Purdue Pharma would later pay more than $600 million in fines for their misleading advertisement.
Purdue Pharma was not alone. Other drug manufacturers rushed to flood the market with pain relievers based on opiates or completely synthetic opiates. At this time, many of these drug makers face similar lawsuits over their marketing of these drugs and questions about what they knew of the risks of the drugs involved.
Doctors often caved to pressure from patients and the drug manufacturers to prescribe opioids more often than was necessary, or for longer periods of time than was warranted. Problems that might be expected to resolve over a few days would receive an opioid prescription for a few weeks. Other problems that might be better handled with over-the-counter medications nevertheless received prescription pain relievers. The doctors were rewarded with happier patients who returned for more visits asking for more prescription opioids. Pharmaceutical representatives also rewarded doctors for the numbers of pills being prescribed.
Recreational Opioid Abuse Rises
The United States is far and away the largest prescriber of opioid pain relievers: Approximately 50,000 daily opioid doses are prescribed per 1 million people. Canada, in second place worldwide, prescribes just over half that many doses per 1 million people. This flood of pills available on the American market led, almost inevitably, to their becoming widely available for recreational use.
Opioids work by stimulating the opioid receptors in the brain. These are responsible for telling the body to produce more of the chemicals involved in feeling intense pleasure. This hijacking of the body’s reward system is what leads to addiction in those who succumb to the opioid problem. The pleasure derived from taking opioids is very real and creates both a physical and emotional dependence on the drug.
This pleasure is the body’s response to opioids regardless of whether you are in pain. With the ready availability of opioids, many people were exposed to the intense pleasure that the drugs create. In many cases, it only takes one use of the drug to create a strong desire to try the drug again. However, as the body becomes more tolerant of opioids, more doses and stronger drugs are sought to achieve the same feeling.
The Move To Illegal Sources
In 2011, recognizing a problem with opioid prescriptions, the government imposed limitations on prescribing opioid pain relievers. In fact, this had very little effect on the actual number of drugs prescribed. While the growth of opioid prescriptions has dropped off, America continues to lead the world by a wide margin in the number of opioid doses prescribed per 1 million people.
The restrictions did create a perception among the public that opioid prescription drugs were harder to acquire. With demand for drugs still very high, illegal drugs rushed in to meet the demand.
Heroin overdoses and other illegal opioid drugs are responsible for the majority of opioid drug overdoses that result in death. Heroin and fentanyl are both significantly more powerful than prescription opioid medications. For those seeking the intense pleasure opiates provide, illegal sources proved to be a powerful and convenient way of dealing with the body’s tolerance to opioids and the perceived lack of supply from doctors.
Heroin also has an advantage in that it is often cheaper than prescription opioids. While heroin use was on the rise before 2011, the restrictions on prescription opioids further pushed users to find illegal substitutes for opioids.
Traditional Problems Overcoming Abuse
It is often easier to get prescription opioids for pain than it is to explore other types of treatment. This has created a bigger market for the drugs. Health insurance does usually not cover options such as acupuncture or chiropractors. Referrals to a pain specialist may often be denied as unnecessary. This has left many people with serious pain problems that they could not afford to address other than to accept prescriptions for opioid pain relievers.
In the same way, insurance in some cases will not cover painkiller addiction treatment or oxycodone addiction if dependency becomes a problem. There is also a social stigma attached to requesting help for addiction that is not attached to requesting help for pain. Where many patients may not hesitate to ask for relief when in pain, they may be reluctant to ask for help when they discover they have developed an addiction to the pain reliever.
More work remains to help stem the availability of opioid pain relievers, as well as providing help to those who have become addicted. Failure to take action now will result in the numbers of overdose deaths continuing to rise as predicted in the coming years.
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