The Opioid Crisis in Perspective
Tune into any major news network on any given day and its difficult not to hear something about the Opioid Crisis. More people have died from drug overdoses in 2016 year than the total number of Americans in Vietnam. And opioids represented two thirds of those deaths, according to the Center for Disease Control (CDC). The CDC reports that as of 2014, two million Americans were abusing or dependent on prescription opioids. As one drug rehabilitation expert puts it, “No family has been left untouched by the Opioid Crisis.”
Scary numbers but they may leave inquiring minds with basic questions like: What is an opioid? What does an opioid do to you exactly? How can we measure how severe the opioid crisis is? What are major risk factors and signs of use? And what should I do if I suspect a friend or loved one of opioid use? These are questions that we will be exploring this week.
What is an opioid and what do opioids do to you?
Opioid is a catch all term for opiates, or drugs derived from poppy plants that include morphine, and synthetics opioids that mimic an opiates connection to opioid receptors in your body. Most, if not all, of these drugs have legitimate medical uses, but as the CDC points out there have been problems with dramatic over prescription of these pharmaceuticals across the country. “Providers wrote nearly a quarter of a billion opioid prescriptions in 2013—with wide variation across states. This is enough for every American adult to have their own bottle of pills.” These prescriptions were concentrated in narrow geographic areas, such as West Virginia and Ohio. For our purposes, there are basically three classifications of opioid:
- Prescription Drugs: a broad category of prescription medications that are given out primarily for pain management. Includes drugs such as Oxycodone (OxyCotin®), Methadone, and Hydrocodone (Vicadin®).
- Heroin: an illegal narcotic that is typically mixed with other drugs and thus puts people at risk for overdose. It is typically injected, but can also be snorted or smoked. Also runs the risk of contracting diseases, such as Hepatitis, through unclean needle sharing.
- Fentanyl: a pain medication that is fifty to one hundred times more potent than morphine and is also commonly used in combination with either heroin or cocaine for added effect.
These are drugs that connect to Opioid Receptors in your brain, causing a combination of euphoria and sedation. They desensitize these receptors, resulting in an increased tolerance and physical dependency. If left unchecked, these drugs will cause progressively shallower breathing resulting eventually in death from respiratory system distress.
How can we measure how severe the Opioid Crisis is?
The commercial value of opioids, both as a medicine and as a narcotic, is well understood. The British, for example, famously fought two wars with China to export the drug into Chinese territories. These wars—essentially state sponsored drug dealing—were creatively called “The Opium Wars”. Recreational use by American servicemen during the Vietnam War is well documented, as we talked about last week. In Central and South Asia, opioids are quite rampant. U.S. military planners have said that victory over the Taliban in Afghanistan is impossible without first crushing narco-traffickers. Incredibly large numbers of Indians and Pakistanis are addicted to heroin and other opioids. Clearly, it’s big business. Clearly, it’s also destructive.
As I just pointed out, the CDC noted that about two thirds of drug deaths in 2016 were attributed to opioids. Below are a map and death counts by region provided by the CDC showing how each category drug is distributed across the country. Do note that there is huge variance by county within a given state—just because your home state has low numbers doesn’t mean there aren’t counties or cities with very high rates of abuse.
|Table 1: Drug Deaths by Region and Fentanyl Cases Reported by State (2014, 2015)
Courtesy the Center for Disease Control
Are other, more clinical accountings of the Opioid Crisis: the economic and logistical costs. Most opioid users are in their mid-twenties to mid-fifties. These are people in the prime of life. When they die or are near death, they cost the tax payers in terms of emergency services allocated to attempt to save a life or investigate. They also cost local, state, and national governments in the form of lost tax payer revenue. The epidemic has been so taxing that an Ohio city councilman, trying to contain the damage to his town and its emergency services, proposed a “three strikes” policy for opioid revivals. Economists report that drug overdose deaths have cost the U.S. approximately one trillion dollars since 2001, with a rapidly growing rate of loss. Although it may be painful to examine such an emotional issue this way, it is instructive to see how else the Opioid Crisis impacts communities.
What are major risk factors and signs of use?
The CDC has identified major risk factors for both Prescription Opioid and Heroin use. The Risk Factors are as follows:
- Obtaining overlapping prescriptions from multiple providers and pharmacies.
- Taking high daily dosages of prescription pain relievers.
- Having mental illness or a history of alcohol or other substance abuse.
- Living in rural areas and having low income.
Prescription Opioids and Medicaid Patients
- Inappropriate prescribing practices and opioid prescribing rates are substantially higher among Medicaid patients than among privately insured patients.
- In one study based on 2010 data, 40% of Medicaid enrollees with prescriptions for pain relievers had at least one indicator of potentially inappropriate use or prescribing:
- overlapping prescriptions for pain relievers,
- overlapping pain reliever and benzodiazepine prescriptions,
- long-acting or extended release prescription pain relievers for acute pain, and
- high daily doses.
- People who are addicted to prescription opioid pain relievers
- People who are addicted to cocaine
- People without insurance or enrolled in Medicaid
- Non-Hispanic whites
- People who are addicted to marijuana and alcohol
- People living in a large metropolitan area
- 18 to 25 year olds
Major signs of use for non-heroin opioids include, but are not limited to:
- Doctor Shopping—frequent changes in doctors, typically for the purpose of receiving new prescriptions.
- Lack of Motivation—becomes disinterested in work or life more broadly. The lack of motivation is most noticeable in the sense that things that once brought joy are now secondary or below notice.
- Rapid Depletion of Prescriptions—goes through a month’s worth of prescriptions in a few weeks.
- Sickness—often a result from a failure to receive sufficient opioids.
- Social Disconnection—becomes withdrawn from family and friends.
What should I do if I suspect a friend or loved one of opioid use?
Seek help immediately! Time is your enemy and you need to act quickly to become informed. Below are several government agencies that can better inform you and help decide your course of action:
If you are in the LA area, please also consider calling one of our intake counselors. They will help you through the process and will also help refer you to a different provider if needed.
 IMS Health, National Prescription Audit (NPATM). Cited in internal document: Preliminary Update on Opioid Pain Reliever (OPR) Prescription Rates Nationally and by State: 2010-2013.