The Opioid Crisis Phenomen

Of the many phenomena described as “epidemic” throughout history, the opioid crisis stands apart from the rest (Porucznik, et. al). Unlike the plague, yellow fever, smallpox, or cholera, opioids are administered willingly, taking advantage of the weak and the addicted (Weiss-Burke). However, the nature of such an epidemic does not weaken its effects; the elusive nature allows it to be mishandled by prescribed patients and abused thereafter with ease (Weiss-Burke). The opioid crisis has grown a web of complications, from staggering fatality rates to combative prescription codes, and the fatality toll will only rise as a solution has yet to be reached (Porucznik, et. al; “Regulations Governing Prescribing of Opioids and Buprenorphine”).

From 1999 to 2012, fatalities due to drug overdoses rose each year in the United States (Levy, et. al). In 2007, 6.6% of all prescriptions taken in the US were opioids (Levy, et. al). From a Utah sample study from the same year, 5.842% of all opioid prescriptions led to fatality (Porucznik, et. al). With the Utah sample as a representation, an estimated .386% of all prescriptions taken in the US were opioid-related deaths, and with total prescriptions per capita of 13.1 and a population of 301.2 million, approximately 15,230,479 people died in the US from opioids in 2007 (Levy, et. al; Porucznik, et. al). And it only increased from there as both total opioids dispensed and total prescriptions dispensed rose in the following five years, raising the chance of an overdose with each and every bottle (Levy, et. al).

Although overdose fatality overall was found to be uncomfortably high, looking within medical specialties uncovered dark secrets about how differing prescribers’ misguided their patients (Porucznik, et. al). The Utah study--organized by Christina A. Porucznik, PhD, Erin M. Johnson, MPH, Robert T. Rolfs, MD, and Brian C. Sauer, PhD--analyzed the correlation of medical specialty and overdose fatality incidence in opioid patients from 2002 to 2010 (Porucznik, et. al). They found that specialties writing fewer opioid prescriptions tended to yield higher rates of fatality (Porucznik, et. al). For example, specialties such as pain medicine, writing 1% of all opioid prescriptions, and anesthesiology, writing 1%, had high rates of death (Porucznik, et. al). For every 1,000 prescriptions written by an anesthesiologist, there were two times as many deaths as an internal medicine physician, writing 10.8% (Porucznik, et. al). Dentists, writing 8.7%, had a comparatively lower chance of death in patients (Porucznik, et. al). Additionally, specialties involved with chronic pain such as pain medicine and physical therapy led to higher incidences of fatality than those of acute pain tolerance (Porucznik, et. al). And these specialties involved with chronic and continuous pain are most cautioned for their chance of addiction and fatality (Levy, et. al; Porucznik, et. al). But that was all studies like the Utah study could do, caution prescribers, as their practices were already growing increasing fatal, and patients were forced assuming trust in them (Levy, et. al; Porucznik, et. al).

With all these statistics surrounding opioid overdoses, the faces of the sufferers are often lost in the noise (Weiss-Burke). Many of them feel as if they have been brought into the addiction against their own accord--they are not addicts but monsters controlled by the substance (Weiss-Burke). In Cameron Weiss’ obituary, his mother, Jennifer Weiss-Burke, lamented on his life before drug use and its parasitic relationship with him (Weiss-Burke). He was a courteous student with ambitions for the future, but he endured multiple injuries due to sports, prompting an opioid prescription to aid in his recovery (Weiss-Burke). Cameron soon became addicted to the drug, forcing him to turn to smoking heroin after his prescription ran out (Weiss-Burke). Still holding onto his ambitions for the future, he told himself he would never resort to injecting heroin, but he eventually succumbed to those desires (Weiss-Burke). With the loss of his dignity by shooting heroin, he had lost all that he was (Weiss-Burke). According to his mother, Cameron became a new person during his battle with addiction: he was no longer considerate, he never looked brightly towards the future, and he was just a mindless zombie, searching for the source of his next high (Weiss-Burke). He went through multiple jail sentences and rehabilitation programs, slowly taking him off of the drug, but just as things were looking up, Cameron’s mother came into his room to find him collapsed at the side of his bed, foamed at the mouth, overdosed (Weiss-Burke). Due to the many treatments he had gone through in jail and rehabilitation, Cameron no longer had a high tolerance for heroin, so the moment he shot another injection, his body could no longer handle it (Weiss-Burke). Cameron’s mother called the paramedics and began CPR as his sister found the scene herself (Weiss-Burke). When the paramedics arrived and attempted to revive Cameron, even his mother knew it was a lost cause (Weiss-Burke). Cameron’s story is unfortunately like many others that fall into opioid addiction (Weiss-Burke). With the feeling of being controlled, one has no dignity to claw themselves out of the hole, and when they finally see themselves improving, one mistake can cost them their life (Weiss-Burke).

With all of these factors surrounding the opioid crisis, many remedies have been passed, but none seem to be working too effectively (“Regulations Governing...”). For example, many hospitals offer presentations similar to the US Department of Health and Human Services’ “Opioid Overdose Prevention Toolkit” to families of overdose victims while their family member is recovering (“Opioid Overdose Prevention Toolkit”). Although offering advice on how to aid a loved-one after and through an overdose revival, its solutions are provided with vague promise (“Opioid Overdose...”). Many points hinge upon the overdose survivor being actively involved with their family and community, an unrealistic expectation for such individuals (“Opioid Overdose...”). Additionally, the presentation does refer to specific specialties that may be able to help survivors or their families, but when discussing counseling, it is passed-by as an afterthought to the pain and addiction specialists (“Opioid Overdose...”). For a more hands-on approach, in Pennsylvania, a “warm hand-off” system was adopted to ensure overdose survivors are efficiently and quickly placed into rehabilitation (Wenner). Through the warm hand-off program, patients recently treated for overdoses are given to a carer to monitor their condition until they can be handed over to a therapist to seek further rehabilitation (Wenner). During this period, patients are given suboxone, a withdrawal suppressant that, when taken along with therapy, has correlated to a decrease in or further addiction or overdoses (Wenner). However, this is still completely contingent on the patient’s will; they cannot be forced to participated in the warm hand-off (Wenner). Those who choose not to participate rely only on their family and community outreach for aid as many of them are too ashamed to seek the help themselves (“Opioid Overdose...”; Wenner). Outside of the emergency room, state laws across the nation have been passed, attempting to stop the chance of an overdose occuring in the first place (“Regulations Governing...”). In Virginia, for example, the “Regulations Governing Prescribing Opioids and Buprenorphine” was passed to regulate how opioids could be prescribed (“Regulations Governing...”). Among many regulations, prescribers must only prescribe opioids for the shortest time possible, treat acute pain with only short-acting opioids, prescribe an overdose treatment alongside high-dose prescriptions, and only prescribe opioids in a last resort (“Regulations Governing...”). While the passing of these regulations may be essential to stop the instance of overdoses, the law is written vaguely enough that prescribers may be abused or complacent (“Regulations Governing...”). For instance, some laws--such as those requiring monitoring of the patient to see signs of misuse, involving termination of the prescription due to lack of progress, or suggesting referral to an addiction specialist--are contingent on the prescriber being present and attentive to the patient throughout the prescription term (“Regulations Governing...”). And seeing that specialties such as dentistry and pain medicine are prescribing the bulk of opioids in addition to pain medicine’s correlation to high fatality rates, this technique seems not to be working (Levy, et. al; Porucznik, et. al; “Regulations Governing...”). Especially in cases such as Cameron’s where addiction starts during the prescription term and only becomes fatal he turned to alternative opioids afterwards (Weiss-Burke). Therefore, a more rigorous system of prescribing may make doctors more cautious in their practices, but in the long run, it will have little change on the fatality rate of overdoses (“Regulations Governing...”).

Those in opposition of the fight against the opioid crisis may cite the national inflection point in 2010 as a sign of policies’ positive effects (Levy, et. al). In 2010, there was a point in opioid prescription rates where, across all specialties, prescription rates either decreased or plateaued thereafter (Levy, et. al). Due to this inflection, from 2002 to 2012, all specialties except those directly related to pain relief and rehabilitation experienced a net decrease in opioid prescription rates (Levy, et. al). Therefore, there must be a higher awareness and attention aimed toward patients receiving opioid prescriptions, and prescribers are adjusting accordingly (Levy, et. al). In the Utah study, less than 1% of opioid prescriptions were found to be fatal over the entire study period, multiple of which possibly being related to a single death each (Porucznik, et. al). Additionally, the incidence of fatality was shown to decrease across all specialties in the Utah sample (Porucznik, et. al). Overall, the attention given toward the opioid crisis has caused prescribers to pay closer attention to their practices, and as a result, fewer fatalities have occured (Levy, et. al; Porucznik, et. al).

In refutation of the points regarding the inflection point in 2010, its effect did not nullify all of the crisis’ damages (Levy, et. al). For example, the rehabilitation specialty increased rapidly from 2007 to 2010, and although it did plateau slightly, this only solidified its prescription rates at the high end of the national percentage, still making up 9.3% of all opioids alone in 2012 (Levy, et. al). And this specialty in particular is dangerous since, as with many specialties involving chronic pain, it has a higher instance of fatality than most (Levy, et. al). In the Utah study, pain medicine and rehabilitation specialties were found to yield the most fatalities (Levy, et. al). On the point of less than 1% of prescribed patients dying from opioids, this argument is misguided in its scaling of the issue, especially when dealing with a national epidemic (Porucznik, et. al). From both the national and Utah studies as representations, the approximation of over 15 million people dying from opioids in 2007 alone is daunting (Levy, et. al; Porucznik, et. al). That could be 15 million stories just like Cameron Weiss’, and a nation where that appears commonplace is not one any ambitious child should have to fear (Levy, et. al; Porucznik, et. al; Weiss-Burke).

Cite this page