Opioid Overdose Deaths

“Overdose deaths involving opioids have increased sixfold since 1999. In 2017, the most recent year for which data is available, opioid overdoses killed more than forty-seven thousand people, or more than six times the number of U.S. military service members killed in the post-9/11 wars in Iraq and Afghanistan” (Felter). This shocking statistic relays only part of the crisis threatening the US: The Opioid Epidemic. Since the early 2000s, the US has been sinking further into one of the worst drug crises in our history, and more people now are dying than ever. Opioids are class of drugs that affect the areas of the brain that control relaxation, pleasure, and pain relief. Though they can be used to treat problems like chronic pain, they are highly addictive and very difficult to stop using. They also can quickly become deadly due to their ability to cause overdoses. America and its leaders must find a way to quickly reduce the growing number of opioid addiction victims in order to stop this growing trend.

The seeds of the opioid crisis were planted in the early 90s, with a rise in addiction cases involving prescription opioids. During this era, the idea of using opioids to treat chronic pain and other related illnesses was very popular among medical professionals, pharmaceutical companies, and the American public alike. Doctors hoped to achieve this by prescribing newly developed opioids to patients, promising that they were completely non-addictive and would provide long term relief. The most prevailing of these drugs is Oxycontin, produced by the company Purdue Pharma. Many people blame the opioid crisis on mainstream pharmacy companies like Purdue pharma for marketing their products as non-addictive, without ever providing reasonable proof of this. These companies “reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates” (Public Affairs). However, as we now know, these drugs turned out to be very addictive. Many believe that the opioid crisis would not have had such a great effect if these companies had chosen to report how addictive they were so that medical professionals could have provided necessary precautions.

The effect of this overprescription has been devastating. One effect is obviously that more and more Americans are still becoming addicted to the pain killers that they were prescribed. These addiction victims are what really makes this epidemic different than those in the past. In the public opinion, many believe that addicts are just people who have made poor life choices and that is why they are dependant on drugs. There is a layer of judgement and stigma that comes with addiction, and this is one of the many reasons why it is difficult for addicts to get help. However, this is where the modern opioid crisis is different than those epidemics that have come before it. The people who became addicted to prescription drugs in the first place really did nothing wrong. They just followed their doctor's instructions, and they still became addicted without even knowing it. These addiction victims are not from the traditionally poor, minority demographic that is stereotyped as being the most likely to abuse drugs. Anyone can become addicted to opioids, and this is one reason why the crisis has gathered so much national attention. In a 2014 study by The JAMA Psychiatry Network, it was found that the average opioid users today are equally male and female, and can be found in urban, rural, or suburban areas (Cicero). In term of locations affected by of the opioid crisis, “(The opioid epidemic) is not confined to a small number of states nor to lower-income areas, but instead has spread across the whole country” (Kommenda). The fact that this crisis affects everyone, regardless of race, gender, or socioeconomic status, is one of the reasons that the opioid epidemic is so deadly and must be controlled quickly.

However, the effects of this epidemic didn’t stop with prescription opioid abuse. It actually created a far more serious problem when people started turning to illegal opioids like heroin and later fentanyl when they either were cut off from or were not getting enough of a high from their prescription opioids.They are easy enough to interchange, as “Both heroin and prescription opioid pain relievers belong to the opioid class of drugs, and both of their euphoric effects are produced by their binding with mu opioid receptors in the brain”(National Institute on Drug Abuse). So many people began turning to these illegal alternatives that it became an even bigger problem than the first wave of opioid abuse in the late 90s and early 2000s. The second wave started around 2010 with a sharp increase in deaths related to heroin abuse. “Deaths due to heroin related overdose increased by 286% from 2002 to 2013, and approximately 80% of heroin users admitted to misusing prescription opioids before turning to heroin”(Liu). Because of the growing number of heroin abusers, the US not only has to deal with the medical problems of addiction, but also with complications that come with illegal opioid use. But the problems that resulted from the initial crisis are far from over. As more illegal opioids are developed and distributed, more people are using and becoming addicted to them. The most deadly and recent of these are synthetic opioids like Fentanyl, which have effectively started a third wave of the opioid crisis. This is the most deadly of all three crises so far, with “The sharpest rise in drug-related deaths occurring in 2016 with over 20,000 deaths from fentanyl and related drugs” (Liu) -

The opioid crisis has not only had effects on addiction and overdose rates. It has actually added to the once again rising rates of blood borne diseases like HIV and Hepatitis C in America. Many addicts have to resort to sharing needles with strangers in order to inject illegal opioids like heroin and fentanyl, which can easily lead to the spread of many bloodborne diseases. A recent example of this comes from Scott County, Indiana, where “on March 27, 2015, then-Indiana Governor Mike Pence declared a state of emergency after public health officials there confirmed a total of 81 new cases of HIV among injecting drug users…By early April, the number of confirmed cases had risen to 190” (Myhere). If we do nothing to stop this opioid crisis, it will lead to even greater consequences like new epidemics and higher death tolls, even if they are not through overdoses. Another problem that can be connected to the opioid crisis is the rise in instances of neonatal abstinence syndrome. In which an infant is born already addicted to a drug because the mother used it while she was pregnant. This causes the baby to then go through terrible withdrawals and greatly increases their chance of neonatal death. According to the Council on Foreign Relations, “Incidences of neonatal abstinence syndrome almost quadrupled from 2000 to 2012”(Felter). Because of the rising rate of opioid addicts in the US, we are not only harming our current generation, but also future generations that are born already addicted to these drugs. If we would be able to control the situation now, we could stop this from happening.

There are many possible solutions to the opioid crisis, and it is difficult to see which might actually work. With so many different parts of the opioid crisis, a solution to one problem will not completely solve the full crisis.

One possible solution is presented by Neuroscientist Rachel Wurzman in her TED Talk, “How Isolation Fuels Opioid Addiction”. In her presentation, she suggests that opioid receptors in the brain can control both a person’s longing for social connection along with other pleasure-reward systems, like food, technology, or drugs like opioids. So according to her theory, “If we don't have the ability to connect socially, we are so ravenous for our social neurochemistry to be rebalanced, we're likely to seek relief from anywhere. And if that anywhere is opioid painkillers or heroin, it is going to be a heat-seeking missile for our social reward system” (Wurzman). In her TED talk, she suggests that using this theory as a basis for a solution to the opioid crisis could be the key to solving it. She claims, “I believe that the solution to the opioid crisis is to explore how social and psychospiritual interventions can act as neurotechnologies in circuits that process social and drug-induced rewards”(Wurzman). So if we were to integrate more programs based on different reward systems that could be used as a substitute for opioids, like social interaction or other social recovery groups, then perhaps this would allow more recovering addicts to stay in the programs and make a full recovery. However, I would argue that this is not the best solution to the opioid crisis because as a concept, it is far too broad. This idea of substituting one pleasure reward system in for another, while sounding good in theory, seems to not be very reasonable and not a complete solution to the problem. And that is the main problem with this proposed solution: It is far too abstract to be able to put into any use right now. These ideas could be tested over several subject groups and then see if they have any practical application, but we are desperately in need of a solution that we know will work now, in order to stop the crisis from getting worse. So while this solution might be valid in a few years after more testing and trials, it is not the best solution for the current problem.

Another potential solution that has been tested and put into place in other countries in order to control their own opioid crises are government funded heroin clinics. These programs supply qualifying addicts with a regular supply of medical heroin or other drugs, free of charge to the addict. The idea behind this is that if addicts are given a supervised and decreasing supply of medical heroin, than many problems can be avoided, like the dangers of impure street heroin and the crimes that can come with obtaining illegal drugs. The first of these programs in Europe was put into place in Switzerland. According to an article by Time Magazine about the program, “Today, there are 23 clinics across the country that treat roughly 2,200 drug users, or about 6% of the nation's heroin addicts. The average stay is three years — a quick stint for users who average 15 years of heroin use. Less than 15% relapse into daily use”(Faure). This statistic is far higher than other addiction recovery programs, where many addicts relapse quickly after leaving the program. However, this program is less than perfect. By the very nature of the clinics, addicts are not being offered detoxification from the drugs, they are just having their addiction maintained. Also some argue that it should not be up to taxpayers to pay for an addicts heroin, which can cost up to $14,000 per year per person. Another problem with this program is that it can treat only the most severe of addicts, so it is not having a huge impact on the crisis as a whole. Ultimately, this program, while noble in its idea, is not a realistic solution for the american opioid crisis. It would be very hard to pass this sort of program though an American congress, and even if it was passes, there would be far too many other problems for this solution to be practical.

While there is no perfect solution to the opioid crisis, the best way to slow and hopefully end the opioid crisis is a combination of three different proposals: preventative measures, containment programs to help the currently addicted, and treatment clinics that have more of a focus on mental health.

The first of these solutions would have to be preventative measures. We can try to solve the current opioid crisis by treating everyone who gets addicted, but we won’t actually stop it unless we get to the root cause. In this case, the way to do this would be to further regulate doctors ability to prescribe long term doses of opioid medications. While opioids can be helpful in pain management, it is not helpful for patients to be prescribed 30 days worth of opioids after a surgery when they really only need 4-5 days worth of them. According to the Substance Abuse and Mental Health Services Administration, the high number of people who became addicted to and abuse the medical opioids they are prescribed suggests that “physicians and other medical practitioners may consider talking with their patients or clients about the potential health consequences of misusing their prescriptions, not sharing their prescription medications, preventing others from accessing their medications, and disposing of remaining dosage units. (Lipari). If more regulations and guidance can be given to doctors and health professionals, then it will be much harder for more people to become addicted in the first place, therefore stopping the opioid crisis at its roots. However, the downside to this part of the solution is that the more doctors try to restrict prescription opioids for those who are addicted, the more people who will turn to more dangerous alternatives like street drugs. So with this part of the solution, there also needs to be immediate recovery programs for people who are at risk for prescription opioid addiction, especially when they recently have had their dosages restricted or ended. By encorporting systems like this into the healthcare system along with regulations for opiate restrictions, we can stop more people from becoming needlessly addicted to the opioids they have been given by their doctors.

The second part of the best solution to the opioid crisis is a further instatement of harm reduction solutions. While long term solutions like the one mentioned above will be the best option to completely end the opioid crisis, they will only help the next generation, leaving all of those currently addicted without help. So the best option is a combination of both preventative and harm reduction policies that will be the most help both to current addicts and in stopping the crisis in the future. One of these policies would be the implementation of further needle exchange programs Through these programs, addicts can trade out dirty used needles for clean needles. This can prevent the spread of bloodborne diseases like Hepatitis C and HIV, which can spread very quickly through communities with addiction problems. Another positive that can come from these programs is that less needles will be left out on the streets. Areas with lots of addiction are known for having streets with lots of needles just laying around. This in itself can cause a separate health crisis and overall is very unsanitary for the community. However, it is easy to see that these programs aren’t perfect. Critics of this solution say that needle exchange clinics aren’t actually helping any addicts, they are just supplying them with a way to inject more drugs. However, it can be seen that many of these addicts are going to keep using drugs unless they have access to recovery programs, so it is important make sure they are doing it as safely as possible, and doing as little harm to themselves and the community as possible.

A second harm reduction strategy that is gaining popularity is the idea to provide easier accessibility to overdose-reversal drugs. According to the National Institute on Drug Abuse, “Three medications are currently FDA-approved to treat opioid addiction, one medication (lofexidine) has just been approved to treat physical symptoms of opioid withdrawal, and naloxone is available in both injectable and intranasal formulations to reverse overdose”(NIDA). Drugs like Naloxone can help to prevent deaths from overdoses, thus saving countless lives. However, these medications are not nearly as available as they should be. “Only a fraction of people with (Opioid Use Disorders) receive any treatment, and of those, less than half receive the medications that are universally acknowledged to be the standard of care, or they only receive medications for too short a duration”(NIDA). If we could provide greater access to these medications, so many people could live past an overdose and go on to a full recovery. Some people have presented the idea of placing government provided Naloxone stations around public buildings in areas with known drug problems, similar to AED machines. This would allow for quick responses to overdoses before ambulances can even arrive at the scene. If this opinion is not the most reasonable, then another more likely scenario would involve simply allowing insurance companies to provide further access to these life saving drugs in hospitals for a lower cost than is currently presented. By offering this as a more viable option for addicts and recovering addicts, countless overdose victims’ lives may be saved.

A final piece of the solution to the opioid crisis is providing further access and funding for addiction recovery programs. In 2017 under President Trump, the Department of Health and Human Services released a 5 point strategy for ending the opioid crisis, including “Improving access to treatment and recovery services”(Public Affairs). In 2017, The HHS allotted $485 in grants for each state to pay for prevention and treatment programs. Addiction recovery programs can be the most influential part of an addict's journey to sobriety, and through further funding to these programs, they can become available to so many more low income people who are struggling with opioid addiction.

However, we won’t be able to accomplish any of these changes if the American public continues to held addiction victims in contempt. While many people understand that addiction is a disease and that there is a point where an addicts might not even be in full control of their actions anymore, many still blame addiction on the addict and feel no need to help them. Through this logic, a layer of stigma is placed on the opioid and other drug crises, seemingly separating them from other epidemics over the years. Luke J. Nasta, the executive director at a large drug treatment facility on Staten Island, New York, compares the government’s slow response to an earlier failure to face the AIDS epidemic, saying “There was a stigma about being gay. There is also a stigma about being addicted to drugs. The entire society is suffering and the government can’t seem to get their arms around this epidemic. (Higham)” If we can’t get the public to help face this epidemic then none of these possible solutions will work. We need to receive full support of important government officials and the voters in order to create real change.

Works Cited

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11. NIDA. ""An Ambitious Research Plan to Help Solve the Opioid Crisis."" National Institute on Drug Abuse, 12 Jun. 2018, https://www.drugabuse.gov/about-nida/noras-blog/2018/06/ambitious-research-plan-to-help-solve-opioid-crisis. Accessed 26 Apr. 2019.
12. Public Affairs. “What Is the U.S. Opioid Epidemic?” HHS.gov, Https://Plus.google.com/+HHS, 22 Jan. 2019, www.hhs.gov/opioids/about-the-epidemic/index.html.
13. Wurzman, Rachel. “‘How Isolation Fuels Opioid Addiction.’” Ted, Ted, Oct. 2017, www.ted.com/talks/rachel_wurzman_how_isolation_fuels_opioid_addiction/transcript#t-1099720

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