There is no denying that the United States is right in the midst of an opioid crisis and for the first time since 1999, the life expectancy decreased for US citizens compared to other developed countries and the number of opioid overdoses was a big factor. According to NIDA:
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.
The opioid epidemic today includes both prescription and non-prescription (illegal) opioid drugs. This includes drugs like codeine, morphine, hydrocodone, oxycodone, fentanyl, and heroin. The opioid crisis that exists in today’s society has been developing over the past 30 years. The opioid epidemic so far has occurred in three different waves.
Early History of Opioid Abuse
Different opioids have been around for over a century and opioid misuse occurred even in its earliest times of existence. After the Civil War, many veterans who suffered from injuries during the war were given Morphine to relieve the pain. In the 1800s pharmaceutical companies began producing synthetic opioids. This is when Heroin first became available. During this time it became obvious that any derivative of opium is addictive. This is when the United States limited the importation strictly for medicinal purposes only.
In 1924, due to the misuse of heroin, The Heroin Act banned the manufacturing, importation, and possession of heroin, even for medicinal use. Even with this ban opioid problems still continued to surface. By the 1970s, other opioids such as oxycodone and hydrocodone were developed and marketed for relief of acute pain and cancer pain.
The First Opioid Addiction Wave
The first wave began in the early 1990s following a rapid and sharp increase in doctors prescribing opioid medication for the treatment of pain. This increase followed after pharmaceutical companies reassured the medical community that a patient’s risk for addiction to opioids was very low. That is when healthcare providers began to prescribe them at greater rates.
Doctors began to promote and prescribe the use of opioids for patients with non-cancer associated pain and although their intentions were good by attempting to improve patient care and decrease cost, there was a lack of statistics regarding the risks for these patients and by 1999, 86% of patients using opioids to treat pain were non-cancer related patients. Physicians were writing larger prescriptions of opioids not only to aggressively treat pain but was. The mindset was to charge less for prescriptions of larger numbers of pills rather than a smaller number of pills that would require more refills to obtain the same quantity of pills.
Some insurance companies also restricted higher-priced, less addictive pain medications, leading doctors to prescribe opioids when they weren’t necessary to have. Opioids were so readily available and liberally prescribed increasing the amount of opioid abuse. This high level of prescribing opioids for pain management without really understanding the level of addiction it had, really kick-started the prescription opioid epidemic.
The Second Opioid Abuse Wave
The second wave of the opioid epidemic began in the early 2000s when a rapid increase in heroin overdoses and death happened. During this time, a decrease in prescribing opioids for pain management began to take effect, making them harder to get. This is when the focus turned to heroin. Heroin is a cheap, readily available, and potent illegal opioid. Approximately 80% of heroin users admitted to misusing prescription opioids prior to turning to heroin use. Between 2002 and 2013, heroin-related overdoses rose by over 280%. As heroin is commonly injected, this also started the HIV/AIDS epidemic and also puts heroin users at risk for many other infections like Hepatitis, skin infections, and bloodstream and heart infections because of using dirty needles or sharing needles with other IV users.
With this decrease in doctors prescribing opioids for pain relief due to the crackdown on overprescribing, came the concept of doctor shopping. Doctor shopping is the practice of going to multiple doctors to obtain multiple prescriptions. This is a common practice in people who are abusing or addicted to opioids. They will often exaggerate or fake medical problems to obtain prescription medication. A statistic from the NIDA:
One out of every 143 U.S. patients who received a prescription for an opioid painkiller in 2008 obtained prescriptions from multiple physicians in a pattern that suggests misuse or abuse of the drugs.
In recent years, doctor shopping has been addressed by many states with the implementation of Prescription Monitoring Programs. These are effective tools utilized by government officials for reducing prescription drug abuse and diversion. PDMP’s collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing physicians.
Most Recent Opioid Epidemic
The third wave of the opioid epidemic began in 2013 and continues on today. This began during an increase in deaths related to synthetic opioids such as Fentanyl. Fentanyl is also a powerful opioid that is similar to morphine but is 50 to 100 times more potent. With higher potency come more deaths when abused. It is now one of the most common drugs involved in drug overdose deaths in the United States. Overdose deaths involving synthetic opioids increased by almost 47% from 2016 to 2017. According to the CDC:
Roughly 28,400 people died from overdoses involving synthetic opioids other than methadone in 2017.
When doctors prescribe Fentanyl, it is generally administered as a shot, a patch that is put on the skin, or in the form of a lozenge. Illegally used Fentanyl, related to the recent high amount of overdoses, is being made in labs and is sold illegally either as raw powder, dropped onto blotter paper, put in eye drops or nasal sprays, or made into pill form that looks like other prescription opioids.
Drug dealers are now mixing Fentanyl into other drugs such as Heroin, Methamphetamine, Cocaine, and MDMA. They do this because it takes a very little amount to produce a significant high with Fentanyl. This also makes a much cheaper option. This is extremely risky especially if you are unaware that the drugs you are taking contain Fentanyl. This is because you are unknowingly taking stronger opioids than your body is used to, making it much more likely for overdose and death.
The bottom line is 30 years into the opioid epidemic, more and more people are expected to die without any end to it in sight. However, glimmers of hope can be seen as a rapidly increasing awareness of the dangers of opioids begins to sink in. In response to the opioid epidemic, the US Department of Health and Human Services are focusing efforts on 5 major points in an effort to alleviate this epidemic:
- Improve access to treatment and recovery services
- Promote the use of overdose-reversing drugs
- Provide support for research on pain and addiction
- Strengthen our understanding of this epidemic
- Advance better practices for pain management
We at Recreate Life Counseling understand the seriousness of opioid use, and we believe opioid addiction must be treated as soon as possible. If opioid addiction is left untreated, the chances of fatality continuously increase. We focus on treating addiction with a combination of effective treatments, predominantly focusing on group and individual therapy. If you or someone you love has been struggling with opioid addiction, please feel free to give us a call today. We will discuss treatment options, and do our best to point you in the right direction. Now is the time to turn your life around. Let us help you do it.