Faded-American-FlagOpioids are everywhere in the news. Celebrities are often entering rehab to kick their addictions to painkillers or suffering overdoses from prescription opioids or heroin. The opioid epidemic doesn’t just affect the rich and famous though. The Centers for Disease Control and Prevention (CDC) reports that the death toll from opioid overdoses, including heroin, synthetic opioids like fentanyl, and prescription opioids such as OxyContin and Vicodin, has quadrupled since 1999.1 In 2015, an estimated 2 million people 12 or older in the United States had a pain reliever use disorder.2 Heroin use is way up too, affecting nearly every demographic group.3

These days, drug overdoses cause more deaths than car accidents. In 2015, 52,404 people died from a drug overdose, with a sobering 63% of these deaths involving opioids.4 The number of drug deaths in 2016 is believed to be more than 59,000.5 Compare this to car accidents, which took an estimated 40,200 lives in 2016.6

But what’s fueling the epidemic? Why the drastic increase in opioid prescriptions, opioid use disorders and deaths from overdose? Why has heroin use skyrocketed? There are no simple answers to these questions.

Driving Factors Behind the Opioid Epidemic

Opioids are overprescribed. This is perhaps the single biggest cause of the opioid crisis. Sales for prescription opioids such as oxycodone, hydrocodone and methadone have almost quadrupled since 1999,7 and close to half of all deaths from opioid overdose involve a prescribed opioid,8 according to the CDC. In 2012, 12 states had more opioid prescriptions than they did people.9

Opioids may not be prescribed correctly.When this happens, the drug may create a feeling of euphoria in the patient, which can then lead to misuse, dependence or a full blown opioid use disorder. People with opioid use disorder are 40 times more likely to be addicted to heroin.10

A lack of physician education. A 2016 survey by the National Safety Council of 201 board-certified internal medicine and family doctors revealed that 99% of the doctors surveyed prescribe opioids for longer than the three-day period recommended by the CDC and that 74% believe that oxycodone and morphine, both opioids, are the most effective treatments for pain.11 However, evidence shows that other pain relievers, particularly ibuprofen, are actually more effective than opioids.12

Though this survey involved a small sample of physicians, it reveals the need for physician education when it comes to prescribing opioids and looking for other alternatives to treat pain. Interestingly, the CDC recommends only using opioids for patients in active cancer treatment, those who have serious illnesses and patients nearing death.13 If opioids are used for chronic pain, the CDC has published guidelines to help physicians prescribe them as safely and effectively as possible, noting that opioids should be used sparingly and for as short a time as possible, at the lowest effective dose.14

Graduating from prescription opioids to heroin. The CDC reports that 45 percent of heroin users were also addicted to prescription opioids.15 Heroin tends to be easier to get and less expensive than prescription opioids. It’s usually more potent too, and since it’s not monitored by a physician, it has a higher risk of overdose and addiction. People who have other substance use disorders are also more likely to become addicted to heroin.16

The availability of heroin. It’s clear that Mexican cartels are now bringing more heroin than cocaine or marijuana to the United States.17 The amount of heroin confiscated at the US border quadrupled between 2008 and 2013.18 Mexico’s heroin production increased sixfold between 2005 and 2009, making the availability of the drug higher than ever.19 What’s unclear is if heroin use is on the rise because of its easy availability or if it’s easily available because of the increased demand.20

Infograph of the history of the opioid epidemic started in 1775 with opium making its way to the united states.

What You Can Do

  • If you need surgery or other short-term pain relief, talk to your doctor about your pain management options. Be aware that using opioids involves the risk of addiction or accidental overdose. Your best bet is to use over-the-counter pain relievers such as acetaminophen and ibuprofen, which have been shown to be more effective at relieving pain than opioids anyway. You may also benefit from physical therapy and/or exercise.21
  • If you are prescribed an opioid, ask your doctor to give you the lowest needed dose for the least amount of time and be sure to follow the instructions you’re given. Never take more than you have been prescribed as this can result in accidental overdose or lead to addiction. Be sure to dispose of any leftover medication safely and never share it with anyone else.
  • If you suffer from chronic pain, opioids may be a part of your pain management plan. You will need to be monitored closely by your doctor and it’s important that you follow prescribing instructions exactly.22 Work with your doctor to supplement or replace opioids with other options such as exercise, Cognitive Behavioral Therapy (CBT) and pain relievers that are not opioids.23
  • Talk to your kids about opioid misuse and addiction. In the last decade, heroin use has more than doubled among 18- to 25-year-olds.24

Signs of Opioid Use Disorder

Physical symptoms of opioid use include the following:

  • feeling high (euphoria)
  • drowsiness
  • slurred speech
  • confusion
  • difficulty breathing
  • nausea
  • vomiting
  • itchy skin
  • constipation
  • small pupils25
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), symptoms of an opioid use disorder include the following:

  • feeling a powerful urge to take opioids
  • building up a tolerance to them, meaning that you need larger quantities in order to get the same effects
  • being unable to stop using opioids
  • having difficulty at work and/or in social situations
  • potential legal trouble due to your opioid use
  • devoting a large chunk of your time to getting and/or using opioids
  • experiencing withdrawal symptoms when you try to stop or decrease the amount of opioids you use26

Treatment for Opioid Use Disorder

If you or a loved one show signs of having an opioid use disorder, you are not alone. Comprehensive treatment is available at Calvary Healing Center for both the opioid addiction and any underlying psychological or emotional conditions that may be fueling the drug use.

It’s a complex problem with no immediate solution, but the opioid epidemic doesn’t appear to be going away anytime soon. Educating yourself and others about the risks of using opioids, whether by prescription or illicitly, can help reduce the number of people who misuse or abuse opioids.


Sources:

1. https://www.cdc.gov/drugoverdose/data/overdose.html
2. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015Rev1/NSDUH-FFR1-2015Rev1/NSDUH-FFR1-2015Rev1/NSDUH-National%20Findings-REVISED-2015.pdf, page 25
3. https://www.cdc.gov/drugoverdose/data/heroin.html
4. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm
5. https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html
6. https://www.nytimes.com/2017/02/15/business/highway-traffic-safety.html
7. https://www.cdc.gov/drugoverdose/epidemic/index.html
8. https://www.cdc.gov/drugoverdose/data/overdose.html
9. http://www.pbs.org/wgbh/frontline/article/how-bad-is-the-opioid-epidemic/
10. https://www.cdc.gov/vitalsigns/heroin/index.html
11. http://www.nsc.org/NewsDocuments/2016/Doctor-Survey-press-briefing-32416.pdf, page 5
12. http://www.nsc.org/RxDrugOverdoseDocuments/Evidence-Efficacy-Pain-Medications.pdf
13. https://www.cdc.gov/drugoverdose/prescribing/guideline.html
14. https://www.cdc.gov/drugoverdose/prescribing/providers.html
15. https://www.cdc.gov/vitalsigns/heroin/index.html
16. https://www.cdc.gov/vitalsigns/heroin/index.html
17. https://www.usatoday.com/story/news/world/2016/11/17/heroin-mexican-drug-cartel/94032394/
18. https://www.cdc.gov/drugoverdose/data/heroin.html
19. https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/increased-drug-availability-associated-increased-use-overdose
20. https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/heroin-use-driven-by-its-low-cost-high-availability
21. https://www.cdc.gov/drugoverdose/prescribing/patients.html
22. https://www.cdc.gov/drugoverdose/prescribing/patients.html
23. https://www.cdc.gov/drugoverdose/prescribing/providers.html
24. https://www.cdc.gov/vitalsigns/heroin/index.html
25. http://www.webmd.com/mental-health/addiction/painkillers-and-addiction-narcotic-abuse#2-2
26. https://www.samhsa.gov/disorders/substance-use
27. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction

Written by Sarah E. Ludwig