Opioid Crisis in the United States

What Can be Done to Stop the Opioid Crisis in the United States Today?
Introduction
Today, a veritable public health crisis exists with respect to the widespread use of prescription and illicit opioids such as heroin, pain relievers and synthetic opioids such as fentanyl by American consumers. In fact, opioid overdoses claim more than 130 Americans each day, and there are no signs this ugly trend will reverse itself in the foreseeable future (Opioid overdose crisis, 2019). Moreover, the social and economic costs that are related to the tens of millions of people who are currently addicted to opioids is estimated to exceed $78.5 billion annually, a figure that includes that costs of lost productivity, healthcare and addiction treatment as well as adjudication of  criminal cases by the law enforcement community (Opioid overdose crisis, 2019). The purpose of this paper is to review the relevant literature to provide a concise description of opioids, the causes of the current crisis, and a summary of the most recent statistics concerning the number of fatalities caused by opioids in recent years. In addition, an assessment concerning what can be done to stem this ugly trend is followed by a summary of the research and important findings concerning the current opioid epidemic in the United States in the conclusion.
Review and Discussion
What are opioids and what are the different types?
Simply stated, opioids are a class of drugs which includes both illicit and prescription preparations. Illicit opioids include drugs such as synthetic opioids (i.e., fentanyl) and heroin while legitimate prescription opioids include various types of commonly used analgesics such as codeine, oxycodone, hydrocodone, morphine, among numerous others (U.S. Department of Health and Human Services, 2019). 
What caused crisis?
Beginning in the late 1990s, there was growing support among both regulatory boards and the health care community concerning the value of prescribing strong opioids for chronically painful musculoskeletal conditions (Roth & Burgess, 2017). In addition, the pharmaceutical industry also began actively lobbying health care organizations and clinicians during the last 1990s concerning the efficacy of strong opioids for a wide range of painful conditions (Opioid overdose crisis, 2019). In addition, the pharmaceutical industry’s lobbying efforts also included reassurances to the health care community that patients would not become addicted to these drugs. Not surprisingly, the rate of prescribing opioids began to skyrocket during this period, and it has only been recently that greater attention has been paid to the dangers of these drugs for patients of all ages as well as the potential for addiction to develop (Opioid overdose crisis, 2019).
In response to this growing public health threat, President Donald J. Trump declared an national opioids emergency in October 2017, President Trump declared the opioid crisis a public health emergency. Since that time, the U.S. government has taken a number of measures that are specifically targeted at reversing the opioid crisis, including the following:
•    As of October 2018, the U.S. government had secured $6 billion in new funding over a 2-year period fight opioid abuse;
•    To curb over-prescription, the federal government a Safer Prescribing Plan that is projected to cut opioid prescription fills by one-third within 3 years;
•    Additional resources have been allocated for port security initiatives that are designed to prevent illicit opioids from entering the country;
•    In 2018, the U.S. Congress to passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (commonly referred to as the SUPPORT Act) which represented the single largest legislative package addressing a single drug crisis in the country’s history (White House, 2019).
Opioid deaths and current statistics
In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.  That same year, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder (not mutually exclusive)(Opioid overdose crisis, 2019).

Figure 1. National opioid overdose deaths:  2000-2017
Source:  What are opioids?, 2019
As can be seen from the disturbing trends shown in Figure 1 above, there has been a steady increase in the number of national opioid overdose deaths since 2000, with especially dangerous synthetic opioids accounting for a majority of these deaths. Likewise, although the deaths attributed to suspected heroin overdoses have leveled off since 2006, this drug still exacts a severe human toll on Americans as well as the economy. 
There are also some noteworthy regional differences in the number of opioid casualties across the country as depicted in Figure 2 below.

Figure 2. Quarterly rate of suspected opioid overdose by U.S. region:  3rd quarter 2016-3rd quarter 2017
Source:  Opioid overdose overview, 2019 at https://d14rmgtrwzf5a.cloudfront.net/ sites/default/files/quarterlyrate_cdc_3.18.gif
As shown in Figure 2 above, the Northeast region of the United States, an area that includes major cities such as New York City, Philadelphia, Boston, Baltimore, and Washington D.C., accounts for a majority of the opioid overdose deaths in the United States at present, but the Southeast region, an area that includes major cities such as Miami, Virginia Beach, Atlanta and Raleigh, is poised to overtake the Northeast region in the number of opioid overdose deaths in foreseeable future. Further, the Midwestern region of the United States experienced a staggering 70% increase in the number of opioid overdose deaths during the period from July 2016 through September 2017 (Opioid overdose crisis, 2019).
The research to date concerning the demographic breakdown, regional rates and other characteristics of opioid overdose victims are summarized below:
•    Approximately 21% to 29% of patients prescribed opioids for chronic pain misuse them;
•    Between 8 and 12 percent develop an opioid use disorder;
•    An estimated 4 to 6 percent who misuse prescription opioids transition to heroin;
•    About 80 percent of people who use heroin first misused prescription opioids;
•    Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states; and,
•    Opioid overdoses in large cities increase by 54 percent in 16 states (Opioid overdose crisis, 2019).
Taken together, it is clear that the current initiatives targeted at the national opioid overdose crisis may not be enough to effect meaningful changes in the epidemic, but there are some proven methods that can help mitigate the deadly effects of opioid overdoses and help addicts recover as discussed below.
What can be done?
The powerful addictive qualities of opioids make the use of interventions that are designed to encourage addicts to quit especially difficult, due in large part to the painful withdrawal symptoms that typically result.  One of the main pharmacological interventions for opioid addiction and overdoses at present is the use of Suboxone to mediate withdrawal symptoms as well as Naloxone (commonly known as Narcan), which immediately cancels the effects of opioid intoxication, including pain relief and the euphoria that can exacerbate the addictive qualities of opioids. In any case of suspected opioid overdose, though, it is vitally important to call 911 to ensure a rapid medical response to the crisis.
Conclusion
At present, 130 Americans die each day as a result of opioid overdoses, and this alarming figure continues to increase nationwide. Despite some modest progress in addressing the problem by the U.S. government and state and local public health agencies, the research was consistent in showing that much more needs to be done to achieve long-lasting results. The causes of the current opioid crisis were shown to multiple, but included primarily lobbying efforts by the pharmaceutical industry to reassure clinicians that these drugs are not addictive and physicians’ desire to provide the most powerful pain relief possible, especially to terminal patients. While the research continues, there are some steps that everyone can take to help save the lives of opioid users and addicts, including immediately calling 911. In the final analysis, it is reasonable to conclude the this time next year, lawmakers and health care providers will still be shaking their collective heads at this public health crisis, and the death statistics will continue to mount unless and until broad-based, multidisciplinary initiatives and implemented and administered over time.

    
 
References
Opioid crisis. (2019). National Institute of Drug Abuse. Retrieved from https://www.drugabuse. gov/drugs-abuse/opioids/opioid-overdose-crisis.
Roth, C. S. & Burgess, D. J. (2017, March-April). Medical residents' beliefs and concerns about using opioids to treat chronic cancer and noncancer pain: A pilot study. Journal of Rehabilitation Research & Development, 44(2), 263-266.
U.S. Department of Health and Human Services. (2019). Opioids overview. Retrieved from https://www.hhs.gov/opioids/prevention/index.html.
What are opioids? (2019). The Truth about Opioids. Retrieved from https://opioids.thetruth.com/o/articles/what-are-opioids.
White  House. (2019). Ending America’s opioid crisis. Retrieved from https://www.whitehouse.gov/opioids/.