Opioids: Death Toll Out of Control

Opioid abuse is at epidemic proportions!

The opioid epidemic is one of the ‘great mistakes of modern medicine!’

Opioids are now a leading cause of death in the United States!

The headlines are nearly apocalyptic. It’s breaking the internet and trending on social media. The President is talking about it and even our current Congress, the one famous for its unproductivity, has been spurred into action. Hospitalizations related to use and dependence on opioids have skyrocketed¹. And that above quote about the opioid epidemic being one of the “great mistakes of modern medicine?” That was said by a former head of the FDA. He also said that the responsibility for the epidemic must be shared by physicians, pharmaceutical companies, and the FDA².

Not the First, But the Worst

This is not our nation’s first drug epidemic – there was heroin in the 70s and crack cocaine in the 80s – but this one is by far the biggest. According to the results from a 2015 National Drug Threat Assessment (NDTA), drug overdose deaths are the leading cause of injury death in the U.S., more than motor vehicle accidents and firearms. As of 2013, death from prescription drugs (13.9 per 100,000) was almost twice as common as gun homicides (7.2 per 100,000)!

Of those drug overdose deaths, opioids represented nearly 60 percent. They are the leading cause of unintentional death for Americans.

Rising Together

Opioid overdoses, tripling since 2000, have risen as opioid prescriptions have also skyrocketed. The opioid hydrocodone alone – sold under the brand names Vicodin, Norco, Lortab, and Zohydro – was prescribed 136.7 million times internationally in 2011. In 1991 the number of global prescriptions for opioids was 76 million; in 2013 it had risen to 207 million. The U.S. is the world’s biggest consumer of opioids accounting for almost 100 percent of the world total for hydrocodone and 81 percent of oxycodone (OxyContin, Percocet, Endone, and others)³.

In the U.S. over 34 million suffer from chronic pain. It’s estimated that in 2012, 2.1 million people in the U.S. suffered from substance abuse disorders related to prescription opioid pain relievers⁴. From 2013 to 2014 the opioid overdose rates rose another 14%. In the U.S. it is the number one cause of unintentional death; someone dies every 19 minutes from an opioid overdose⁵.

The Big “H”

And then there’s heroin: Past misuse of prescription opioids is the strongest risk factor for heroin initiation and use, specifically among persons who report past-year dependence or abuse.

How is heroin related to prescription drug abuse?

When someone like Prince, Philip Seymour Hoffman, or Michael Jackson needs painkillers, they can find access to doctors or high-end drug dealers who will deliver. Not getting your pills from the pharmacy comes with a cost, though. According to a report in CNN Money⁶, a sampling of street prices of one tablet of some commonly abused prescription painkillers reveals they can cost as much as 13 times more on the street. Heroin, on the other hand, is available, of a high purity, and relatively low-priced by comparison. Ninety-four percent of heroin users claimed that they got into heroin because the pills they started on became too expensive or too difficult to find⁷. This boom in supply and decline in cost has made heroin increasingly popular in the U.S. As a result, heroin use has been rising since 2007, growing from 373,000 yearly users to 669,000 in 2012, this according to the Substance Abuse and Mental Health Services Administration (SAMHSA). As should be expected, heroin overdoses have also been on the rise, increasing 45 percent from 2006 to 2010 according to recent data for the Drug Enforcement Administration (DEA).

No Needles

The market and manufacture of heroin has changed. Ten years ago it was a different type of heroin: It was being sold on the street at a 2-3 percent purity and it sold for $50-$150, when it could be found. Depending on where you are, today a standard bag of heroin sells for $10 at a 7-10 percent purity. Higher purity means it can be taken without a needle⁸. This purer version of heroin now available allows it to be smoked or snorted to achieve the same kind of high that it once took a needle to achieve. This makes heroin more appealing to teenagers, the college-educated, and anyone who might be wary of needles. Call it a user-friendlier heroin. According to SAMHSA, some 6.8 million Americans abuse prescription pills. This provides a wide demographic pool of potential heroin users. Add to that the fact that popular opiates like OxyContin, Percocet, and Vicodin have become increasingly hard and costly to obtain and that in 2010 OxyContin changed its formula to make the pill harder to crush and dissolve for abuse.

A SAMHSA study from 2012 found that people aged 12 to 49 who had abused prescription pills were 19 times more likely than those who hadn’t to try heroin in the previous year. In the last decade, heroin abuse among first-time users has increased by nearly 60 percent⁹. And heroin’s dramatic comeback shows no signs of slowing anytime soon.

Use as Directed, Become an Addict

Opioids are highly addictive, even when taken as directed. They are best used under limited circumstances. An estimated 90 percent of people with chronic pain are prescribed opioids¹⁰. But that doesn’t mean your pain, be it psychic or physical, is going to just go away. According to a 2010 study of more than 1,000 people suffering chronic pain, mostly common leg and back pain, even those taking opioids for relief still suffered moderate-to-severe pain that interfered with their everyday activities.

To be clear, not everyone who takes opioids becomes addicted. It can depend on your own personal risk of addiction. It’s best to get screened for addiction risk factors: your family history of addiction, personal history of alcohol and drug abuse – if someone uses recreational drugs, their likelihood for using pain medications inappropriately is very high, and certain psychiatric disorders.

This we know: Every time a patient is prescribed an opiate medication they take a significant risk of developing a dependence or addiction. They may also be at risk for diverting or abusing the medication or encountering side effects that can be worse than the primary complaint (such as severe constipation or narcotic bowel syndrome). At worst, there is risk of death from an overdose.

How the Myth of Non-Addictive Opioids Got Started

Once, doctors only prescribed narcotics for short-term pain, like that experienced after surgery or for pain related to cancer or end of life. This changed with two small articles published in medical journals in the 80s. One was a hundred-word letter to the editor in the New England Journal of Medicine. It reported that less than one percent of patients at a hospital who received narcotics became addicted. The other was a published study that concluded for non-cancer pain, narcotics could be prescribed safely to selected patients with relatively little risk of addiction. This was followed by aggressive marketing by the narcotic manufacturers. The published ads in highly regarded publications, they funded pain management non-profits, and created continuing education courses for doctors.

It worked. The paradigm shifted. The way narcotics were prescribed changed and greatly expanded. Later, pharmaceutical companies came under tighter scrutiny and one manufacturer was found to have misled the F.D.A., clinicians, and patients about the risks of their narcotics and were convicted on criminal charges¹¹.

And so begun the prescription drug epidemic.

Where We May Be Going

Some hope: Federal agencies have been aggressively working to implement new strategies to help fight the epidemic. Of these strategies, some have to do with prescription guidelines (opioids should not be first-line therapies), improved package warnings (called “black box warnings”), and encouraging manufacturers of generics to produce abuse-resistant formulations (generics make up 90% of the market). But the Feds are also offering up funding, not a lot but it’s a start.

If you or a loved one have an addiction to alcohol, contact BLVD Treatment Centers. At BLVD Treatment Centers we custom tailor our recovery programs within the safe and nurturing confines of our rehab treatment centers. Located throughout California, in Los Angeles, Orange County, San Diego and in Portland, OR, our mission is to assess the severity of your addiction to help you achieve true recovery within 30 days. Call us now at 1-866.582.9844.

Sources

1. Kaiser Health News. Opioid Epidemic Fueling Hospitalizations, Hospital Costs. Retrieved May 17, 2016
2. CBS News. Former FDA head: Opioid epidemic one of “great mistakes of modern medicine”. Retrieved May 17, 2016
3. IMS’s National Prescription Audit (NPA) & Vector One ®: National (VONA).
4. Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
5. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. Retrieved May 17, 2016
6. Prescription drugs worth millions to dealers. Retrieved May 17, 2016
7. Heroin Gains Popularity as Cheap Doses Flood the U.S. Retrieved May 17, 2016
8. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings and Detailed Tables. Retrieved May 17, 2016
9. Consumer Reports. 5 Surprising facts on prescription painkillers. Retrieved May 17, 2016

The New Yorker. Who is Responsible for the Pain Pill Epidemic? Retrieved M