Opioids refer to drugs that work on the nervous system for pain relief, and they may come in liquid, capsule, or tablet form. However, abuse or the continued use of opioids may lead to addiction, which is demonstrated through the development of withdrawal symptoms and physical dependence on the drugs. Addiction refers to a prolonged, primary, and deteriorating brain sickness that causes a person to pathologically look for relief or reward through substance abuse as well as other behaviors. Opioids include heroin, which is an illegal drug in the United States, as well as such legal drugs as morphine, hydrocodone, oxycodone, fentanyl, and codeine among others. Opioids work together with opioid receptors found on the nerve cells found in the nervous system and the brain to relieve pain as well as to produce pleasurable effects. The United States has recorded a growing trend in substance abuse, with over 11 million Americans misusing prescription opioids in 2016, while approximately one million Americans consumed heroine, with an estimated 2.1 million individuals having an addiction to heroin or prescription opioids. This paper examines the opioid problem in the U.S. as well as an analysis of the measures that have been implemented in the prevention and treatment of the addiction.
Opioid Addiction Facts
The opioid problem is defined as the rapid growth in the consumption of non-prescription and prescription opioids in Canada and the U.S. starting late 1990s through the first two decades of the 2000s (American Society of Addiction Medicine, 2016). The availability and potency of the opioids have made the substances famous in America both as recreational drugs and formal treatments, despite their increased risk of overdose and addiction. Opioids possess sedative effects on the areas of the brain that regulate breathing, presenting the risk of respiratory depression, and thus the risk of respiratory failure and death. According to the Drug Enforcement Administration, drug-overdose related deaths, mainly from heroin and prescription drugs has attained problem levels, with approximately half of the total opioid overdose deaths recorded in 2013 involving prescription opioids (American Society of Addiction Medicine, 2016). By 2015, the number of deaths relating to heroin overdose had exceeded the number of fatalities emanating from both gun violence and car accidents. Presently, drug overdoses are the top sources of death for Americans below 50 years, where two-thirds of the drug-related deaths emanate from opioids. The opioid problem lowered the overall life expectancy in 2016 for Americans, from 78.7 to 78.6 years (American Society of Addiction Medicine, 2016).
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Moreover, over 11 million people in America were found to have misused prescription opioids in 2016 (American Society of Addiction Medicine, 2016). The report, additionally, highlighted that although cases of legal prescription opioids overdoses have declined in the past decade, overdoses of illegal opiates have increased since 2010, almost tripling. Some of the opioids that are most misused in America in heroin, oxycodone, and fentanyl. The most widely used opioid for recreational purposes in America is oxycodone, with the U.S. Department of Health and Human Services (2017) estimating that approximately 11 million Americans consume oxycodone for medically unrelated reasons. Oxycodone was initially introduced in the U.S. in 1939, and it was later classified as Schedule II drug by the FDA in the 1970s, demonstrating that the drug possessed a high risk for addiction and abuse.
On the other hand, it is estimated that approximately 4% to 6% of individuals who abuse prescription opioids embark on heroin, where approximately 80% of the individuals addicted to heroin started with the abuse of prescription drugs (U.S. Department of Health and Human Services, 2017). In 2014, approximately over half a million Americans were addicted to heroin. Fentanyl abuse is also associated with causing some deaths in the U.S., with the drug causing approximately 121 deaths in the first six months of 2015 in Maryland and 446 deaths within the same period in 2016. Deaths associated with fentanyl increased by approximately 540% across the U.S. since 2015, which accounted for the increase in drug overdose-related deaths in the region from 2015 to 2016 (U.S. Department of Health and Human Services, 2017).
The Centers for Disease Control and Prevention (CDC) (2017) postulate that approximately 91 drug abusers die every day in the U.S. from opiate overdose, while annually, more adults aged 50years and below die of opiate overdose compared to individuals in the same age bracket that die of cocaine. Approximately, incur costs of over $484 billion annually on opiate addiction. Opiate addiction in the U.S. was considered so extensive that the Trump administration affirmed that the opium crisis is a national emergency in March 2017. According to CDC (2017), out of the 20.5 million Americans aged 12 years or above that possesses a drug-related disorder in the year 2015, approximately 2 million individuals had a disorder relating to prescription pain relievers, while approximately 591,000 individuals demonstrated a disorder relating to the use of heroin (CDC, 2017). The report further illustrated that approximately 23% of people who consume heroin are addicted to opioids (CDC, 2017).
Further, reports presented by the CDC illustrate that over 64,000 individuals died due to drug overdoses in 2016, exceeding the highest number of drug overdose deaths, 53,000 deaths, recorded in 2015 (CDC, 2017). The CDC also notes that although the U.S. has registered a steady decline in the number of teen deaths relating to drug overdoses between 20017 and 2014, the number of drug-related deaths have increased recently following the opioid problem. The number of deaths related to heroin has increased by more than three times since 2010, with fentanyl, a synthetic opioid that is between 50 and 100 times more potent compared to morphine flooding the American market and a significant amount of the drug seized by the law enforcement agencies (CDC, 2017). According to reports by the CDC, deaths emanating from synthetic opioids have increased by more than 72% between 2014 and 2015 (CDC, 2017). Moreover, in 2015, out of the 52,898 drug-overdose deaths recorded in the U.S., approximately 33,091 related to opioids. The five states that recorded the highest drug overdose deaths in 2015 include New Hampshire, West Virginia, Kentucky, Ohio, and the Rhode Island, which recorded approximately 34.3, 41.5, 29.9, 29.9, and 28.2 deaths per 10,000 people respectively (CDC, 2017).
The CDC postulates that the number of such deaths may be more since the numbers presented in their reports exclude opioids utilized as pain relievers (CDC, 2017). Additionally, the CDC supposes that a significant portion of the increase in the deaths emanates from the illegally manufactured fentanyl since the data on deaths relating to drug overdose does not differentiate between the illegally mad and the pharmaceutical fentanyl. Individuals consuming fentanyl-laced heroin are at a higher risk of overdosing since they are unaware that they are consuming a more powerful drug. Moreover, the CDC establishes that fentanyl has exceeded heroin as a killer drug in several regions, including Ohio where 998 cases of fatal fentanyl overdoses were recorded in the first five months of 2015. Mexican cartels are primarily regarded as the primary sources of the heroin smuggled into the U.S.; however, Chinese suppliers have been associated with providing raw fentanyl as well as the machinery requires for its production.
According to the CDC (2017), the majority of overdose and addiction victims are the working class, Native Americans or whites due to the physicians’ tendencies to avoid prescribing opiates to blacks due to stereotypes associated with past cases of drug abuse. In America, people living in the rural areas are the most affected by cases of drug abuse. Canada is also significantly affected with West Canada demonstrating an overdose rate that is approximately ten times that recorded in the Eastern provinces. In the recent years, abuse of prescription drugs is growing among teenagers aged between 12 and 17 years, with the teenagers comprising a third of the total new abusers of the drugs in 2006. The CDC (2017), established that teens tend to abuse prescription drugs more than such illicit drugs as heroin cocaine, and methamphetamine, except marijuana.
Prevention Measures
Several bodies have been engaged in the prevention and management of opioid abuse. The government, for instance, started a crackdown on the doctors and pharmacists that prescribed opioid painkillers in 2010. However, one of the critical consequences of the repression was that the majority of the prescription opiates addicts embarked on the consumption of heroin. According to a survey conducted in Utah, approximately 80% of heroin users began with the abuse of prescription drugs (American Society of Addiction Medicine, 2016). In response, an amendment of the Controlled Substances Act with the Secure and Responsible Drug Disposal Act was conducted, allowing pharmacies to accept controlled substances from long-term care facilities or households for the drug disposal program.
In 2017, the FDA suggested the need for nurses, pharmacists, and physicians to undergo training for the first time about the prescription of opioid drugs since opiates had become FDA's greatest crisis. On the other hand, the Department of Health and Human Services established their opioid strategy in 2017, which aimed at improving the treatment, prevention, and the recovery support services to curb the economic, social, and health consequence associated with opioid addictions as well as to ensure individuals attain long-term recovery (National Survey on Drug Use and Health, 2016). Further, the strategy aimed at advancing the pain management practice to minimize the inappropriate utilization of opioids as well as the opioid-related harms. The strategy also focused on the distribution and availability of the overdose reversing drugs to ensure sufficient access to individuals who respond or experience an opioid drug overdose.
On the other hand, state and local governments are primarily involved in the implementation of measures that seek to prevent the inappropriate use of opioids. In 2016, governors from 45 U.S. states joined together through a program named Compact to Fight Opioid Addiction in a bid to end the opioid problem. The governor of Maryland responded to the crisis by declaring a state of emergency, which aimed at combating the rapid growth in the overdoses by speeding up and increasing coordination between the local and state jurisdictions. In 2016 alone, Maryland recorded approximately 2000 deaths emanating from opioid-related overdoses. Delaware, on the other hand, which recorded the 12th highest death rate in the U.S. relating to opioid overdose introduced bills which targeted to both improve treatment access as well as to limit the ability of doctors to overprescribe painkillers (National Survey on Drug Use and Health, 2016).
Similarly, Michigan introduced the Michigan Automated Prescription System, which allows doctors to check the painkillers that have already been prescribed to a patient and the time of prescription to prevent addicts from changing doctors to receive the drugs. On the other hand, laws were imposed in Maine to cap the maximum daily strength of the opioids prescribed to patients, and further limited the prescriptions to 7 days. Finally, West Virginia, which is leading in the overdose deaths per capita, lawsuits that seek to pronounce drug distribution companies as public nuisance were implemented with the aim of placing accountability on the drug industry for the costs relating to the problem.
The CDC has also played a crucial role in the prevention of opioid abuse through publishing the ‘Guidelines for Prescribing Opioids for Chronic Pain.' The guidelines recommend for opioids to be prescribed only in cases where the benefits for function and pain exceed the risks, where the opioids should be administered at the lowest possible dosage avoiding the concurrent benzodiazepine and opioid use whenever possible.
Treatment
Opioid addiction is so severe in the U.S. that President Barrack Obama allocated funds for the implementation of the Medical Assisted Treatment programs that aim at lowering the rate of recidivism as well as increasing the rate of abstinence from the abuse of drugs (U.S. Department of Health and Human Services, 2017). The dependence on opioids leads to some negative consequences, including overdose and the contraction of HIV. Hence, while prevention programs are essential in discouraging people from indulging into opioid abuse, treatment programs, which include behavioral and medical treatment approaches are crucial in helping individuals to overcome opioid addiction. In most cases, medical treatments are combined with behavioral interventions depending on the needs of each patient. Some of the most popular treatments for opioid addicted individuals include naloxone, kratom, buprenorphine, and methadone, and they demonstrate greater efficiency when administered in combination with a behavioral treatment intervention.
In most cases, naloxone is utilized in the treatment of opioid overdoses since it is an opioid antagonist. On the other hand, methadone is used in the treatment of opioid addiction since it functions through binding to the opioid receptor cells found in the spinal cord and the brain, where it activates the cells and reduces the cravings and the withdrawal symptoms thus suppressing the high that other addictive opioids elicit (U.S. Department of Health and Human Services, 2017). The decline in the cravings and the withdrawal symptoms allows users to slowly minimize the intake of the drug in a controlled manner, thus decreasing the chances of a relapse of the addiction.
Buprenorphine is administered similarly to methadone, where some doctors consider the drug as the most effective solution for the medication-assisted treatment for heroin addicts or other opiates. Buprenorphine is considered safer than methadone, with the key benefits of eliminating drug cravings and withdrawal symptoms without the induction of euphoria. On the other hand, behavioral treatment is considered less useful in the treatment of opioids addictions when used alone, especially in the initial detoxification process (U.S. Department of Health and Human Services, 2017). However, higher efficiency is achieved in the treatment of addiction when the behavioral therapies are applied together with medical treatments. Some of the most popular behavioral treatments include the Twelve-step programs, which include the Narcotics Anonymous, residential treatment centers, and individual or group therapy.
Resources
Numerous resources focus on helping individuals who seek help to overcome opioid addictions. In most cases, drug rehabilitation is often expensive, and most individuals may be unable to afford the treatment programs; however, such individuals may access such options as Medicaid, Medicare, the Mental Health Services Association and Substance Abuse grants program, the state and local funded addiction treatment programs, and the U.S. Department of Veterans Affairs among other (Comstock, 2018). Further, there are several helplines that addicts and their loved ones can access in person or anonymously for help, mainly to find out more details about addiction, the available interventions, rehabilitation programs as well as other dependency care options.
The helplines are accessible on a 24-hour basis, and they include the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline, which is a confidential information service that helps individuals facing substance abuse or mental disorders throughout the year on a 24-hour basis in the English and Spanish English (Comstock, 2018). Further, the helpline provides individuals with referrals to support groups, treatment facilities, and community based organizations that provide help for such disorders. Other helplines include the Partnership for Drug Free Kids, which helps parents with drug abusing children, and the Community Anti-Drug Coalition of America Technical Assistance Hotline.
References
American Society of Addiction Medicine (ASAM). (2016). Opioid Addiction 2016 Facts & Figures. Retrieved from https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdfcc
Centers for Disease Control and Prevention. (2017). Understanding the epidemic | Drug Overdose | CDC Injury Center. Cdc.gov. Retrieved 6 January 2018, from https://www.cdc.gov/drugoverdose/epideic/index.html
Comstock, B. (2018). Addiction Community Resources. Congresswoman Barbara Comstock. Retrieved 6 January 2018, from https://comstock.house.gov/services/addiction-community-resource
National Survey on Drug Use and Health. (2016). Results from the 2016 National Survey On Drug Use And Health: Detailed Tables. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf
U.S. Department of Health and Human Services. (2017). About the epidemic. HHS.gov. Retrieved 6 January 2018, from https://www.hhs.gov/opioids/about-the-epidemic/index.html
