OPIOID CRISIS

Exactly what are “opioids?  How are they used and misused?  Do we have an “opioid crisis in the US as many have alleged?  If so, what do we do about it?  Good questions.  Read on for the answers.

Opioids are a rather diverse group of drugs, commonly prescribed to alleviate pain.  They include familiar names, such as OxyContin, Percocet, Vicodin and Fentanyl.  When taken as prescribed by a physician they can be very beneficial.  The problem comes when they are abused, which, unfortunately, is quite common.  Many people get “hooked” on them and use them as a “recreational “drug.  Taken to excess they, quite simply, can kill you.  Furthermore, in some cases they have served as a “gateway” to other “hard” drugs, such as heroin.

According to the US Drug Enforcement Administration the country is in the midst of an opioid crisis that has reached “epidemic levels.”  Moreover, Thomas Frieden, Director of the Centers for Disease Control, has declared that “America is awash in opioids; urgent action is critical.”  President Trump has characterized the opioid crisis as a “national emergency” and has appointed a “drug czar” to address it.

Some disturbing facts, with respect to opioids:

1. According to the USDA, almost 50% of opioid overdoses are now attributable to prescription opioids.  To put this in perspective, the total deaths from opioids exceeds the total deaths from both car accidents and guns.
2. Presently, drug overdose is the leading cause of death in adults under the age of 50, and 2/3 of those deaths are attributable to opioids.
3. According to the National Institute on Drug Abuse over 90 Americans die of an opioid overdose EVERY DAY.  Roll that statistic around in your head for a minute.  Ninety people, day after day after day.
4. The CDC has estimated the total “economic burden,” including factors such as healthcare, addiction treatment, lost productivity and criminal justice involvement, at some $79 billion annually.  This does not include non-measurable factors, such as the emotional stress on families that include a member suffering from addiction.
5. The National Institute of Health is the country’s pre-eminent medical research agency with respect to the opioid crisis.  It is charged with researching ways to prevent, treat and manage opioid use and misuse.  Some of its more disturbing findings:

a.  Some 25% of persons who take prescribed opioids “misuse” them, i.e. take too much, which leads to addiction or other problems.

b.  Approximately 5% of the above persons “graduate” to heroin.

c.  About 80% of heroin users started with opioids.

d.  Users’ injection of these drugs has contributed to the proliferation of infectious diseases, such as HIV and Hepatitis C.

According to Wikipedia:

1. Addiction and overdose victims are mostly white and working class.
2. Geographically, persons living in rural areas have been hit the hardest.
3. Teenagers account for roughly 1/3 of all new abusers of prescription drugs.  Such abuse exceeds that for all illicit drugs, such as cocaine, meth, and heroin.

So, how did we get here?   According to the Surgeon General it began in the 1990s with physicians’ excessive prescribing of these drugs.  According to Wikipedia between 1991 and 2011 prescriptions for opioids grew from 76 million to 219 million per year.  These drugs have proved to be very effective at enabling us to manage pain.  Furthermore, drug companies marketed them aggressively, and those suffering from chronic pain (some 100 million of us) saw them as a panacea.   Some physicians viewed them as an easy solution to their patients’ medical issues, and prescribed them when other treatments might have sufficed.  No one seemed to realize and appreciate their potency and ability to foster dependence.

Many patients acquired a tolerance and a dependency.  Some managed to feed their needs through doubling up on prescriptions from multiple providers, such as multiple doctors, foreign sources or drug “pushers.”  Some turned to heroin, which is cheaper, easier to obtain, and generally more powerful, particularly when “spiked with fentanyl, a devastating drug that is 100 times more powerful than morphine and 50 times more powerful than heroin.  In addition, the person using it often does not realize that it is present.  Fentanyl has caused an extreme escalation of this crisis.  The CDC reports that death rates from fentanyl and other “synthetics” increased 72% from 2014 to 2015, the last year for which such statistics are available.  There is no reason to believe that that trend has not continued.

CONCLUSION

So what are the solutions?  Are there any, or are we just doomed to become a nation of unproductive, drug-abusing zombies?

Consider the following:

1. In 2010 the Federal Government began cracking down on physicians and pharmacists who were over-prescribing opioids.  (In some cases, this action may have driven some users to heroin and other illicit drugs.)  I already mentioned President Trump’s appointment of a drug czar.
2. In 2016 the CDC published its “Guidelines for Prescribing Opioids for Chronic Pain.”
3. Most every state now has its own prescription drug monitoring programs.
4. The media has contributed to publicizing the opioid epidemic through tv special news reports designed to educate people as to the consequences of overuse of these drugs.
5. Today, physicians are generally very cognizant of the danger of these drugs and the consequences of over-prescribing.   For example, my pain management doctor has very stringent procedures for dispensing these drugs.  Also, many providers have hired security guards to deal with potential patient violence.  Finally, according to one of my personal physicians, many doctors simply will not prescribe any opioids for any purpose for fear of being accused of overprescribing.

All of the foregoing actions are fine as far as they go.  However, in a free society the government and other external sources can only do so much.

Recognizing that there is a problem is the first step towards solving it.  For the most part, we have done this.  Ultimately, I believe it will be the personal responsibility of each individual to take care of his own body.