Costs of Substance Abuse The abuse of tobacco, alcohol and illicit drugs has cost the United States more than $700 billion in annual costs related to crime, lost work productivity…
The National Safety Council found that your risk of dying in a motor vehicle crash in 2017 was 1 in 103. But your risk of dying due to opioid overdose was 1 in 96.
For the first time since the agency started keeping records, opioids were considered riskier than cars.
How did we get here?
It’s a complicated question. Answering it means digging into:
- Prescriptions written.
- Hidden addiction variables.
- The shift to heroin.
- Community response.
Prescription Painkiller Prescribing Trends
When opioids first hit the market in the 1990s, they were considered revolutionary solutions for pain, and doctors used them for almost everything. That’s changing, but rates remain too high, and people are still losing their lives due to opioid abuse.
Opioids work by boosting pleasure chemicals in the brain. They do not numb or block pain receptors, but they can make the sensation of pain easier to ignore.
Initially, these medications were used for people with pain caused by cancer. Later, pharmaceutical companies began encouraging doctors to give these drugs to people with other types of pain. By 1999, according to the National Capital Poison Control Center, 86 percent of people using opioids had pain that wasn’t caused by cancer.
As prescription rates rose, so did the number of people dying due to overdose. Opioids cause death by:
- Slowing breathing rates.
- Slowing heartbeats.
- Reducing body temperature.
- Inducing lethargy.
The central nervous system stops functioning, and people slide into a sleep that doesn’t end.
When doctors discovered that people were dying due to opioids, they reduced the number of times they handed out these drugs. Researchers writing for JAMA point out that the number of prescriptions per 100 people rose from 72.4 in 2006 to 81.2 in 2010. Then, by 2015, that rate dropped to 70.6 per 100. That’s a 13 percent decline.
Death rates also dipped accordingly. The National Institute on Drug Abuse (NIDA) reports that 1,906 people ages 18 to 24 died due to overdose in 2010. By 2014, that number dropped to 1,741.
Don’t celebrate quite yet.
While overall numbers are trending down, some population subsets are particularly vulnerable to opioid use and abuse. Their statistics paint a grim picture of prescription abuse in this country.
Your Addiction Risk May Vary
While it’s true that numbers are trending downward as a whole, there are pockets of people in this country who remain very vulnerable to opioid dangers. Your risk could rise depending on how your doctor uses these drugs, where you live, and your age.
Examining Your Doctor’s Habits
Opioid addictions aren’t immediate. They develop due to repeated drug exposure. Each hit causes subtle damage to brain cells, and when they add up, you lose control of your medication use. The longer you take opioids, the higher your risk.
The Centers for Disease Control and Prevention notes the average length of a prescription is rising. In 2017, it stretched to 18 days.
Some doctors are happy to discuss addiction risks with their clients. If you ask for more pills, these professionals will tell you why that’s not a great idea. They may also push you toward other solutions, such as:
- Physical therapy. Stretches, strengthening, and massage can help to soothe some types of pain.
- Meditation. Mindfulness techniques can distract you from discomfort.
- Nonopioid solutions. NSAIDs, Meloxicam, and aspirin are sometimes the best pain therapies.
- Pain clinics. Therapy, nonopioid painkillers, and other treatments are bundled into one comprehensive program to ease discomfort.
But busy doctors may not have the time or energy to hold these conversations with their patients. To them, refilling the prescription is the quickest and easiest way to keep their schedule manageable.
The Role Your Community Plays
Research also suggests that some types of communities have higher rates of opioid dependence.
The Centers for Disease Control and Prevention says communities with high use rates typically have high rates of:
- Caucasian residents.
- People with disabilities, arthritis, or diabetes.
- Dentists and physicians per capita.
Researchers don’t quite know why this relationship exists. They’re looking into the numbers and testing theories now. But the data does seem to suggest that a rural lifestyle increases opioid use risks.
Your Age Matters
Prescription drugs work the same way regardless of age. But younger people seem especially vulnerable to opioids’ allure.
Typically, addiction rates rise with age. It takes both time and expense to develop an addiction, and young people often lack both of those things. But opioids are different.
NIDA says people ages 18 to 25 have the highest opioid abuse rates. Of people in this group, 12 percent abused opioids in 2014. Among people 26 and older, rates dropped to 5 percent.
Opioids are drugs of opportunity, and since they’re so frequently prescribed, they’re easy for young people to get. They can pop open the medicine cabinet of almost any household in America and find the drugs they’re hoping for.
Opioids are also remarkably powerful, and they deliver a drastic change in just minutes. During young adulthood, the brain is vulnerable to damage caused by drugs. It’s possible that young people dabbling in opioid abuse are causing damage that leads to addiction and then overdose.
Heroin Abuse Rates Are Also Rising
It’s easy enough for people to experiment with opioids. They’re handed out frequently, so they’re readily available in small amounts in most homes. But as addiction deepens, more of the drug is required. As opioid addictions mature in the United States, some users are moving to a different solution.
Prescription painkillers and heroin are structurally similar. Both work to boost brain pleasure chemicals, and they both work quickly. But heroin is much stronger than prescription drugs, and that’s part of its appeal to opioid abusers.
Constant exposure to drugs makes the brain slightly immune. Small amounts just don’t bring the same reaction they once did. Experienced users might need to take dozens of pills to get the same high.
One needle of heroin is stronger than those dozens of pills.
As soon as people realize that fact, it makes sense to switch. Unfortunately, that’s common. NIDA reports that 80 percent of heroin users tried prescription painkillers first.
The drug market is responding to meet demand. Researchers say that heroin is purer than it once was, and it’s less expensive than prescription painkillers. For people who want a powerful high at a low price, heroin can seem like a good choice.
Abuse rates sparked by heroin haven’t caught up to painkillers. The American Society of Addiction Medicine reports that 2 million people had a substance use disorder caused by painkillers in 2016, and 591,000 had an issue caused by heroin.
But as abuse rates rise and tolerance develops, more people might choose to shift to heroin. Researchers are concerned about a second wave of addictions and overdose deaths linked to heroin.
Fentanyl Is a New Drug of Concern
Just as people develop a tolerance to opioids, they can experience a blunting of heroin’s effectiveness. When that happens, they may slide back to opioid abuse. This is a new aspect of the opioid epidemic, and it’s one researchers are very concerned about.
Fentanyl is an opioid, and it’s one of the strongest drugs in its class. This synthetic medication is designed to ease extreme pain, and it works very quickly. For people who can’t get high with a big heroin dose, fentanyl seems like a good solution.
Experts report that fentanyl use is rising. According to NIDA, about 3,000 overdose deaths were attributed to fentanyl in 2010. By 2016, that had risen to nearly 19,500.
This is an alarming trend. Fentanyl is so potent that it can quickly overwhelm the body and lead to overdose. In 2016, NIDA says, about 50 percent of opioid overdose deaths were due to fentanyl.
Statistics like this demonstrate that the opioid epidemic is deepening and that more people are losing their lives. But our enemy is also changing, and that means we need to come up with new solutions we haven’t tried before.
How Communities and Officials Respond
Rising rates of abuse, addictions, and overdoses are alarming. They’re also widely publicized, and that means there’s public pressure for officials to make adjustments. There are many federal, state, and local programs established to curb abuse rates.
- Treatment suitability. Doctors learned more about conditions that responded to opioids, and they were given advice on other options to try if these medications weren’t appropriate.
- Appropriate use. Guidelines about the length of use, proper dosing, and follow-up care were released.
- Risk reduction. Doctors learned more about what addiction looked like, and they learned how to test their patients for abuse.
These guidelines are optional, as the Centers for Disease Control and Prevention has no authority to oversee doctors. But this was a very influential report, and many professionals took notice.
Research from Elsevier suggests that opioid prescriptions dropped by almost 57 per month after the release of these guidelines. That’s a big drop, and it suggests that doctors tried to follow the advice contained in the report.
Doctors aren’t just persuaded by large organizations. They can also be motivated by healthy competition.
That’s what the Ochsner Health System tried. This organization posted opioid prescription rates sparked by emergency room visits. Providers’ names were hidden, but their locations were not. During the one-year study period, rates dropped by 70 percent.
Doctors were not told to lower the number of drugs they used. They weren’t even given a financial incentive to stop handing out opioids. But when they saw their colleagues taking these steps, they chose to do the same.
For some states, persuading doctors just isn’t enough. As Athena Health points out, states have created bills that:
- Increase the frequency of updates to drug monitoring programs.
- Limit written prescriptions for opioids.
- Require a substance use disorder test before opioid prescriptions are written.
- Mandate a pharmacy identification check before opioids are dispensed.
- Give doctors additional education if they prescribe opioids.
These laws make getting an opioid prescription harder, and they might make patients understand just how dangerous these drugs are. When you can only get a few pills at a time, and you’re watched closely before you take them, it’s clear that you’re dealing with a drug you should take seriously.
What Else Can We Do?
Doctors and legislators are working hard to reduce the number of drugs that flow through cities and towns in America. But they are not the only groups that can help to curb the epidemic.
Families can help too. Opioid intoxication comes with visible signs.
- Slurred speech
- Low motivation
- Shallow or slow breathing rates
- Poor coordination
It may be hard to talk with someone during acute intoxication, but when it wears off, families can start a talk about addiction treatment.
Denial is part of the disease, and it isn’t uncommon for people to claim that their use causes no problems, is voluntary, and can be stopped at any time. But when reality sets in, these same people may need a great deal of help from the people they love.
Families that spot the signs of addiction can and should discuss how treatment works, and they should get the person they love into care. They can support that person during treatment and ensure that early dropout doesn’t occur. In time, they can mark their family as free from addiction.
These same steps work for non-family members. Coworkers, neighbors, friends, and classmates may all need help to overcome an addiction, and they may not know where to start the healing.
As a community, we’re struggling with an opioid epidemic. We can overcome it using the power of fellowship. Those people untouched by a personal brush with addiction can lift others up. Working together, we can heal both our communities and our country.