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...…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 is available, then it should be administered to the person who has overdosed.  Naloxone is a medication that is generally safe and is able to quickly stop an opioid overdose.  It works by blocking the effects of the opioid on the body, and can be administered by injection or by spraying it into the nose.  Whether or not Naloxone has been administered, it is important to try to keep the person awake and breathing.  Because of the risk of vomiting, if the person is not awake or is awake but not really responsive, place them on their side to keep them from choking on any vomit.  Do not leave the person alone until medical professionals arrive.  

While overdose may be the main risk to opioid addicts, another complicating factor is that opioid withdrawal can be very difficult.  Symptoms of opioid withdrawal include anxiety, vomiting, abdominal pain, and nausea.  These symptoms can be extremely severe, but they are not life threatening.  The symptoms can also be managed with medications like suboxine, which works to prevent the symptoms of opioid withdrawal.  A more controversial approach to opioid addiction is the long-term use of methadone.  Critics suggest that is just substituting addictions.  However, when taken as prescribed, methadone is safe and effective.  It offers pain relief, while mitigating the effects of opiate withdrawal and blocking the euphoria associated with opiates and opioids.  Whatever approach is taken, medical supervision is an important part of a successful treatment and recovery plan. 

Conclusion

The opioid epidemic is a complex social problem with no easy solution.  Even managing addiction treatment and recovery for a single addict can be very difficult, because of how opioids interact with the brain and because of the failure to address the root causes of opioid addiction, which are often based in inadequate pain management.  This is a problem that is likely to get worse before it gets better, and can fairly be described as one of the worst health epidemics to impact the United States, and the world, in recent times.