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The Opioid Crisis

The public’s awareness of the seriousness of the opioid epidemic has been growing since the presidential election in 2016. The conversation continued to grow after Dr. Jerome M Adams was appointed the new Surgeon General. Then in October, President Trump declared the opioid epidemic a public health emergency.The discussion continues to grow as government officials, organized bodies, and members of our community call for change and awareness of the epidemic affecting Americans all over the country.

The NY Times states that “drug overdoses are the leading cause of death for Americans under 50.” In fact, there were 63,000 drug overdose deaths in 2016. According to the Washington Post, there were “174 deaths from drug overdoses every day in 2016, one every 8½ minutes.” Of these, approximately 115 deaths are from opioids. This is simply the tip of the iceberg. There are opioid users and abusers throughout the country, taking prescribed or recreational opioid medications. An estimated 11.5 million people have misused an opioid prescription and these numbers continue to rise.

What is an opioid? Opioids are a type of narcotic, a chemical pain reliever. These chemicals bind to receptors in the brain and spinal cord, blocking pain signals. It can also create a feeling or euphoria, known as a “high.” The first opioid was derived from a plant called opium. Originally this plant was found in the eastern Mediterranean. Now, the opium poppy grows throughout Asia and the Central and South Americas. Now, there are a multitude of medications in this category called opiates. Current medications in the opioid family are morphine, hydrocodone, oxycodone, heroin, codeine, and fentanyl. These medications are also known by their name brands, ie: Percocet, Vicodin, Oxycontin, etc. While drugs like morphine and codeine are found naturally in opium, drugs like hydrocodone and oxycodone are semi-synthesized and drugs like Fentanyl are entirely synthetic pain relievers.

How did this epidemic start? The Department of Health and Human Services offers a general time line of the emergence of the epidemic. Presumably, the epidemic began in the 1990s as physicians began prescribing more and more opioid medications that were (at the time) believed to be safe and non addictive. With the prescription of any medication, there is always the risk of misuse, whether accidental or intentional. In fact, misuse of prescription medication is second only to marijuana use as America’s choice of illicit drug use. So, naturally with prescription opioids, as the number of prescriptions increased, so did the frequency of medication misuse. Then, it became clear that these medications were addictive. Misuse of prescription medication occurs because there is a common misperception that prescribed drugs are less risky than illegal substances because they are controlled by regulating bodies. This is simply not true. Here are the statistics. Roughly 21- 29% patients taking opioids for chronic pain misuse them. The most common reason for drug misuse (using a drug at a higher dose or frequency as prescribed or without a prescription) is for pain relief. The second most common reason is to get “high.” A portion of those develop an opioid use disorder and some transition to the illegal drug, heroin. In fact, a majority of heroin users started their drug use first with a prescription medication. (Does the term “gateway drug” ring a bell?) The New York Times reports that the current epidemic is now no longer just about prescription medications. Instead, the crisis has taking a turn to illegal and non-prescribed medications like Fentanyl, which has been a major player in turning the crisis into an outright epidemic.</p

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What are we doing about this? There have been actions taken to control the growing epidemic over the past century, and efforts have increased as the epidemic has worsened. However, until recently, it appears that too little was done, too late. In 2007, federal government brought criminal charges against Purdue Pharma for their misleading advertisements about Oxycontin. More recently, Alabama has brought similar charges against the pharmaceutical production company. The Department of Health and Human Services has outlined a 5 step plan.
1.Better addiction prevention, treatment and recovery services
2.Better targeting of overdose reversing drugs
3.Better data
4.Better pain management
5.Better research

The National Institute of Health is also involved in the fight against the opioid epidemic. Their plan is also listed below:
1.safe, effective, non-addictive strategies to manage chronic pain
2.new, innovative medications and technologies to treat opioid use disorders
3.improved overdose prevention and reversal interventions to save lives and support recovery

Nongovernmental companies are also starting to step up. CVS has put new regulations on their manner of dispensing opioid prescriptions for certain conditions. Other organizations have also stepped up. The American Society of Addiction Medicine has formed the Coalition to Stop Opioid Overdose and Advocates for Opioid Recovery has formed to help drug abusers beat their addiction.The momentum for resources and solutions in the midst of this crisis continues to grow. As of 2018, there has been more funding funneled into treatment and law enforcement as well as the development of a Prescription Interdiction & Litigation Task Force.

If you are interested in more information about the opioid crisis, the CDC provides a plethora of information regarding the use and abuse of opioids in the USA.

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