Opioid Epidemic in America

Title:  Opioid Epidemic in America Abstract  While many people are aware that there is an opioid epidemic in America, they may not understand exactly what that means.  While opioids are drugs, the term does not just refer to any type of drug.  Instead, it refers specifically to the types of drugs that interact with a specific type of receptor in the brain.  This article discusses what opioids are, what the opioid crises is, what caused the opioid epidemic, opioid deaths, and what can be done to help stop the epidemic.   Introduction The opioid epidemic refers to the rapid increase in opioid drugs that has occurred in the United States since the late 1990s.  It is considered a epidemic for a number of reasons.  The most obvious reason is that it is linked to an increase in opioid overdose deaths that has been so dramatic that it has impacted average life expectancy in the United States.  The second reason is that the problem is so significant that it has impacted healthcare in the United States, as medical professionals have become wary of prescribing opioids even for patients experiencing significant pain.  Finally, it is considered an epidemic because it is spreading; prolonged opioid use is increasingly globally, suggesting that the problem is more than just a regional one.     What are Opioids? In order to understand what the opioid crises is, it is important to first understand what opioids are.  Many people realize that opioids are drugs, but the term is not synonymous with any type of drug.  Instead, it refers to a very specific class of drugs.  Opioids are drugs that bind to the opioid receptors on cells located in the brain and throughout the rest of the body.  They are named opioids because of opium, which interacts with those opioid receptors.  However, not all opioids are actually related to opium or derived from the opium poppy.   There are actually different types of opioids, including naturally occurring opioids, synthetic opioids, and even antagonist opioids.  Some drugs, like heroin, which are derived from opium, which is a narcotic drug created from the opium poppy.

Other drugs derived from the flowering opium poppy plant include morphine and codeine.  These drugs are referred to as opiates.  However, there are some opioids that are created synthetically, but still bind to the opioid receptors.  Some examples of these synthetic opioids are hydrocodone, oxycodone, fentanyl, and methadone.  For simplicity, unless differentiating between naturally and synthetically derived substances, this article will use the term opioid to refer to all substances that interact with the opioid receptors.   In addition, sometimes people refer to opioids as narcotics.  While the term originally referred to any psychoactive compound that caused people to fall asleep, it was eventually used to describe opium and opium derivatives.  However, while the term narcotic gained popularity in common usage, it also became less precise.  Many people began incorrectly referring to any psychoactive compounds as narcotics.  Therefore, in this article, in order to avoid confusion, the term narcotic will not be used.   Opioids can create a number of different effects throughout the body by binding to opioid receptors.   These receptors are not just located in the brain, but at various locations in the body.

The reason that the opioid receptors exist is probably due to the fact that the human body makes its own opioid chemicals, including endorphins (Michigan Medicine, 2019).  These naturally-occurring chemicals can serve multiple functions in the body, such as suppressing pain and making people feel good.  Opioids interact with these same receptors, which makes them a good option for pain suppression, but also means that they can trigger a euphoria or high, which engages the brain’s reward system, and sets a person up for potential addiction.   Not all of the impacts of opioid usage are pleasant.  Some common side effects of opioid usage include constipation, nausea, sedation, itchiness, and respiratory depression.  Whether used to combat pain or to produce euphoria, people can develop a tolerance to the drugs.  This means that it takes a greater amount of the drug to produce the same effect.  This is part of how opioids create an addiction.    Not all opioid medications or drugs are identified as opioids.  Commonly used illegal and prescription opioids include: opium, heroin, fentanyl, morphine, buprenorphine, meperidine, hydromorphone/dihydromorphinone, methadone hydrochloride, tapentadol, oxycodone, hydrocodone, codeine, and oxymorphone.  There are two other medications that are opioids, though they do not produce the euphoria often associated with opioids: loperamide, an anti-diarrhea medication; and naloxegol, a medicine given to treat opioid-induced constipation.  Street names for opioids include?  What Caused the Opioid epidemic? Since the early 1980s, there has been a cultural emphasis on the dangers of drugs and drug use.  This cultural intolerance towards drug abuse, which many believed would lead to lower substance usage and abuse rates, has not had an impact on usage rates.

Instead, substance use rates are as high or higher than they have ever been.  This war on drugs led to an unusual approach to pharmaceuticals, with the presumption that the use of prescription medications was both medically and morally superior to the use of non-prescription medications.  It ignored the potential contributions that marijuana and its derivatives have to offer to the health-care field, and also punished possession of some less-dangerous drugs at the same level of possession of more dangerous drugs.  There are many who believe this mentality help set the stage for the opioid epidemic.  Wary of the dangers of drug addiction, doctors have always been concerned about prescribing true opiates to their patients because it was known that opiates could be addictive.  However, starting in the late 1990s, the pharmaceutical companies developed a number of synthetic opioids.  They marketed them as being safe and effective, non-addictive pain relievers.  The medical community responded by prescribing them in huge numbers and for ailments that probably did not require the use of any prescription-level pain medications.   However, these medications were, in fact, highly addictive.  This led to all sorts of addiction-related behaviors.  First, people would seek out the medications in order to achieve the high because of the addiction.  However, patients who had used them for pain management, but were no longer getting pain relief, were also seeking higher and higher doses of the medication.  When the opportunity for profit became obvious, people stepped in to create pain management clinics that were not focused on actually finding and solving the root causes of pain, but simply worked as medication farms.  In addition, the black market for the drugs began to thrive, as people began to seek alternatives to prescription medications when they could no longer get prescribed the drugs.   When the medical community and lawmakers began to really understand that an epidemic was occurring, they responded in a way that did not treat the root causes of the problem.  While opioid pain relievers had once been relatively easy to obtain, which was not appropriate, they became very difficult to obtain.  Patients truly experiencing pain, who could have benefitted from short-term and appropriate use of opioid pain relievers, were often treated like medication-seekers.  In fact, many patients in pain received no pain management at all, and there were even scenarios where terminal patients were denied adequate pain relief because of concerns about addiction.  This approach did not help those patients who were actually addicted to opioids, because they simply sought them out through illegal channels.  How Many Deaths Are Linked to the Opioid epidemic? Unless someone has personal knowledge of the impact of the opioid epidemic, it may seem dramatic to call it a epidemic.  However, it is so significant that it has actually reduced average life expectancy in the United States.  “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” (National Institute on Drug Abuse, 2019).  Of course, as with any addiction epidemic, the costs cannot be calculated solely by looking at deaths; addiction takes a tremendous toll, not only on the addicts, but also on families, employers, and communities.  In 2017, there were an estimated 1.7 million people in the U.S.

with prescription opioid addictions and 652,000 with heroin use disorders (there could be some overlap in those groups).  The economic burden of prescription opioid misuse is projected to be around $78.5 billion per year.   The opioid problem is not limited to the United States.  In 2016, it is estimated that about 34 million people worldwide used opioids and 19 million worldwide used opiates (WHO, 2018).  Not all of those people were addicts, but there were an estimated 27 million people experiencing opioid use disorders in 2016 (WHO, 2018).  While most of those people, worldwide, were using heroin, an increasing percentage was using prescription opioids.  This led to about 118,000 deaths, worldwide, which could be attributed to opioid use disorders (WHO, 2018).   One of the reasons that the opioid epidemic is so serious is that the risk of overdose with opioids is far greater than it is with many other classes of drugs.  To understand this, it is important to understand how opioids interact with the body.  They impact the part of the brain that regulates breathing.  In addition, people develop a tolerance to lower doses of the drugs, which can result in seeking greater and greater amounts of the drugs in order to achieve the same amount of pain relief or the same degree of euphoria.  Therefore, it is very easy for a user to take too much of the drug, causing respiratory depression and death.  While any opioid user is at potential risk of overdose, there are some groups that are higher risk than others.  Obviously, people who misuse opioids are at a higher risk than people who use opioids as prescribed by a doctor treating a short-term condition.  However, even among that group there are subsets who are at a greater risk.  People at a higher risk of opioid overdose include: those with opioid dependence, especially after they have had a period of reduced tolerance because of forced detoxification; people who inject opioids; people taking high dose prescription opioids; people who have medical conditions like HIV, depression, lung disease, or liver disease; people who use opioids with other sedatives; and household members of people in possession of opioids (WHO, 2018).   In addition, while any person could potentially witness an overdose, there are certain groups of people more likely to witness an overdose.  Obviously, this group includes the friends and family of people who have opioid use disorders.  It also includes people in the healthcare, law enforcement, and social work fields who are more likely to have contact with people who abuse opiates.  It is especially important for those who are more likely to witness an overdose to be able to recognize an overdose if they see one.  There are three common symptoms of an opioid overdose, which are referred to as the opioid overdose triad.  The symptoms include: respiratory depression, unconsciousness, and pinpoint pupils (WHO, 2018).  Other symptoms of an overdose include: a limp body; paleness; clammy skin; lips or fingernails turning blue or purple; vomiting; inability to speak; slow or stopped heartbeat; slow or stopped breathing; and unresponsive.   What Can Be Done Dealing with the opioid epidemic requires complex solutions.  That is because, while the epidemic is a large-scale, global problem, which prompted President Donald Trump to declare an opioid emergency, each individual with an opioid use disorder requires a personalized solution to their problem.   Therefore, when looking at what can be done, it must be looked at through both a macro and a micro lens.

On the macro level, it is important to stop creating new opioid addicts, thereby halting the spread of the opioid epidemic.

Because the opioid epidemic, at least in the United States, can be directly linked to the over prescription of addictive opioid pain relievers over a few decades, it is believed that a healthcare driven solution can help curb the problem.  The Food and Drug Administration (FDA) recognizes the severity of the problem of opioid addiction and the Department of Health and Human Services has developed an Opioid Strategy, which is specifically designed to help reduce addiction.  This strategy has five goals.  The first goal is to improve access to prevention, treatment, and recovery services in order to help reduce the impact of opioid use disorders on the addict and on the community (National Institution on Drug Abuse, 2017).  The next strategy is to increase the availability and distribution of overdose-reversing drugs in order to increase the likelihood of a successful response to an overdose (National Institution on Drug Abuse, 2017).  The third strategy is to strengthen public health data reporting in order to provide reliable information and statistics on the epidemic as it evolves, which can help verify the successfulness of other implemented interventions.  The fourth intervention is aimed at helping improve other approaches to pain and addiction, in order to address one of the causes of opioid addiction.  Finally, there needs to be a focus on pain management practices, which ensures that people have access to high-quality pain care, which may or may not include appropriate supervised use of opioids for short-term relief (National Institution on Drug Abuse, 2017).   The biggest and most immediate danger of opioid addiction for the addict is the risk of opioid overdose.  It is possible to prevent overdoses.  Patients should take their medications exactly as prescribed, never taking more medicine than prescribed or taking medications more often than prescribed.  Medications should not be mixed with alcohol, sleeping pills, or other drugs.  In addition, it is important that the prescribing doctor and the pharmacist are aware of all other medications, to prevent potential interactions.  Medications should be stored out of reach of children, pets, and people at risk of substance abuse.  Finally, medications should be disposed of promptly and properly when no longer needed.

If it appears that someone is having an overdose, there are steps a witness can take in order to improve the person’s chance of survival.  The first step is to call 911 and report that there is a suspected overdose and request medical help.  If Naloxone.