Understanding the Opioid Epidemic

The Opioid epidemic has plagued America as a medical health crisis for the past thirty years. The crisis began in the early 1990s and has since occurred in three separate waves (Liu, Pei, & Soto, 2018). The first wave appeared in 1991 as doctors became unaware of how highly addictive the painkillers were that they were prescribing to their patients for pain management (Liu, Pei, & Soto, 2018). The second wave began in 2010 as many people began to die from heroin abuse (Liu, Pei, & Soto, 2018). These deaths were a direct result of those addicted to opioids no longer having access to painkillers and deciding to cure their fix with heroin (Liu, Pei, & Soto, 2018). The last wave of this epidemic occurred in 2013 when more and more people began to overdose on synthetic opioids such as fentanyl (Liu, Pei, & Soto, 2018). According to the National Institute on Drug Abuse, more than 47,000 Americans have lost their lives in 2017 to prescription opioids, heroin, and synthetic opioids such as fentanyl (Opioid Overdose Crisis, 2019). Some of the most frequent drugs involved with opioid overdoses include methadone, oxycodone, and hydrocodone (Opioid Overdose, 2018). The opioid epidemic is not only a public health concern but also an economic issue for Americans. The Center for Disease Control and Prevention found that the United States spends roughly $78.5 billion a year for the costs of healthcare, addiction treatments, and the involvement of the criminal justice system in relation to opioid addictions (Opioid Overdose Crisis, 2019). There are 3 main factors that have contributed to the growth of the opioid epidemic. These factors include opioids being overly prescribed as a means of pain management, opioids being prescribed to those with mental health problems, and the increase in opioid addictions via rural areas due to lack of resources and education.

During the 1990s, healthcare patients started to become more and more agitated with their doctors as they did not feel their needs were being met in terms of pain management. These patients wanted a stronger course of treatment to reduce their chronic pain issues. Up until the early 1990s, most chronic pain was treated via cognitive behavioral therapy or even hypnosis (Dasgupta, Beletsky, &, Ciccarone, 2018). According to an Institute of Medicine report, the reason for this increase in chronic pain can be attributed to a variety of factors which include: greater patient expectations for pain relief, obesity, increased survivorship after injury and cancer, increased frequency and complexity of surgery, and musculoskeletal disorders of an aging population (Dasgupta, Beletsky, &, Ciccarone, 2018). Pharmaceutical companies saw these recent patient complaints as a way to increase their profits. These companies began to sell items such as OxyContin while downplaying the addiction potential some of these drugs had in store for their consumers (Dasgupta, Beletsky, &, Ciccarone, 2018). The market for these painkillers has continued to rise over the past 30 years. From 1997-2007, the purchases of oxycodone increased four times, the purchases of hydrocodone increased nine times, and the purchases of methadone increased thirteen times (Elkins, 2019). Also, between 1992 and 2000, the number of opioid abusers in this country rose by 225% (Lembke, 2012). Doctors and physicians account for 60% of the opioids that are abused in this country by indirectly or directly prescribing patients these painkillers (Lembke, 2012). Most of these doctors are even aware that their patients are abusing these drugs or selling/distributing the drugs to other individuals (Lembke, 2012). The fear of receiving bad reviews from patients, being known as not wanting to help treat chronic pain, and the ignorance towards addiction potentials for certain drugs has led doctors to overly prescribe opioids and assist in the growing opioid epidemic.

Another reason the opioid epidemic continues to rise in this country is because more and more doctors have begun prescribing opioids to patients with mental health issues as a means of treating their chronic pain conditions. In 2017, adults with mental illnesses accounted for more than 50 percent of the 115 million opioid prescriptions that are prescribed each year in America (Connor, 2017). People with mental illnesses have the highest susceptibility to developing an addiction to painkillers. Dr. Brian Sites, an anesthesiologist at Dartmouth-Hitchcock Medical Center, says, “Because patients with mental health disorders are a vulnerable population, they’re probably more likely to develop addiction and abuse” (Connor, 2017). Sites further claims in order to fix this problem, doctors should operate off of different criteria when it comes to prescribing opioids to patients with mental conditions such as anxiety, depression, bi-polar disorder, borderline personality disorder, etc. (Connor, 2017). Another doctor, Andrew Saxon, who is the director of Addiction Psychiatry Residency Program at the University of Washington states that the best way to treat patients with chronic pain who also manifest a mental condition is to subject them to cognitive behavioral therapy, physical therapy, or meditation techniques (Connor, 2017). A separate study done by Dr. Sites and various other colleagues observing the effects of opioids on patients with mental health conditions found that having a mental disorder while taking opioids does lead to an increase in opioid abuse (Davis, Lin, Liu, Sites, 2017). Their study also found that in some cases mental health patients who take opioids reported an increase in pain levels which led to them taking more painkillers than needed (Davis, Lin, Liu, Sites, 2017). In summary, doctors who prescribe opioids to patients with mental illness have unknowingly increased the rates of opioid abuse within this country as those with mental illness are more likely to battle addiction.

Lastly, the opioid epidemic has dramatically risen in the past decade as a result of more people in rural areas being granted access to large amounts of opioids. Pharmaceutical companies target pharmacies in rural areas due to the fact that people in rural areas are more likely to develop opioid addictions, thus, purchasing more painkillers. The reason for this is related to the educational opportunities people in rural areas have as well as not having access to drug-treatment programs. In terms of education, people in rural areas tend to be less-educated and do not obtain college degrees as there are less educational opportunities to be offered than bigger cities. Thus, most of their jobs include work settings that tend to increase their risk of being physically injured and developing chronic health conditions (Scommegna, 2018). Less-educated individuals are also more likely to resort to selling opioids due to their limited incomes which increases their connection to opioids and the chance of developing an addiction problem (Scommegna, 2018). As a result of their low-income jobs, people in rural areas are less likely to have access to any sort of drug-treatment counseling or other kinds of doctors that specialize in addiction. Pharmaceutical companies are aware of all these factors that inhibit rural communities and aim to have their drugs sold in pharmacies within those areas. For example, between 2008 and 2015, drug wholesalers sent more than 20.8 million prescription painkillers to two pharmacies in a small town of 3,000 residents in West Virginia (Wamsley, 2018). In 2016, West Virginia accumulated 884 deaths as a result of opioid abuse; the highest rate the country has ever seen (Wamsley, 2018). If pharmaceutical companies continue to target rural areas with the distribution of opioids, more deaths will accumulate in these small towns and the opioid crisis will progressively worsen.

Although the opioid epidemic is still very much alive and progressing, there are steps being taken to lessen the number of opioid related deaths that accumulate each year in America. The U.S. Department of Health and Human Services (HHS) is working to end the opioid epidemic by priorities that include improving access to treatment and recovery services, advancing better practices for pain management, providing support for research on pain and addiction, strengthening the understanding of the epidemic through better public health surveillance, and promoting the use of overdose-reversing drugs (Opioid Overdose Crisis, 2019). The Center for Disease Control and Prevention has also stated new guidelines for prescribing opioids as of March 2016 (Opioid Overdose, 2018). These guidelines were constructed so that patients are being given access to safer and more effective chronic pain treatments while also focusing on the rules for prescribing opioids to patients 18 years or older; not just cancer or hospice patients (Opioid Overdose, 2018). The CDC and HHS have both contributed their efforts to ending the opioid epidemic and lessening the amount of opioid related deaths that occur in America each and every day. With their efforts in mind, hopefully America will no longer one day acquire such a high number of deaths or bear the financial burden the opioid epidemic has caused the United States.

References

1. Connor, V. (2017, June 27). Patients With Mental Disorders Get Half Of All Opioid Prescriptions. Retrieved from https://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/
2. Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. American Journal of Public Health, 108(2), 182-186. doi:10.2105/ajph.2017.304187
3. Davis, M. A., Lin, L. A., Liu, H., & Sites, B. D. (2017, July 01). Prescription Opioid Use Among Adults with Mental Health Disorders in the United States. Retrieved from https://www.jabfm.org/content/30/4/407
4. Elkins, C. (2019). Hooked on Pharmaceuticals: Prescription Drug Abuse in America. Retrieved from https://www.drugwatch.com/news/2015/07/29/drug-abuse-in-america/
5. Lembke, A. (2012, October 25). Why Doctors Prescribe Opioids to Known Opioid Abusers | NEJM. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMp1208498
6. Liu, L., Pei, D., & Soto, P. (2018, February). History of the Opioid Epidemic How Did We Get Here? Retrieved from https://www.poison.org/articles/opioid-epidemic-history-and-prescribing-patterns-182
7. National Institute on Drug Abuse. (2019, January 22). Opioid Overdose Crisis. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
8. Opioid Overdose. (2018, December 19). Retrieved from https://www.cdc.gov/drugoverdose/data/prescribing.html?CDC_AA_refVal=https://www.cdc.gov/drugoverdose/data/overdose.html
9. Scommegna, P. (2018, January 10). Opioid Overdose Epidemic Hits Hardest for The Least Educated. Retrieved from https://www.prb.org/people-and-places-hardest-hit-by-the-drug-overdose-epidemic/
10. Wamsley, L. (2018, January 30). Drug Distributors Shipped 20.8 Million Painkillers To West Virginia Town Of 3,000. Retrieved from https://www.npr.org/sections/thetwo-way/2018/01/30/581930051/drug-distributors-shipped-20-8-million-painkillers-to-west-virginia-town-of-3-00

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