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The Opioid Epidemic: Everything You Need to Know

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Opioids are a class of substances that have been the subject of a great deal of media attention recently due to the alarming number of people who abuse and overdose on these drugs. This article will explain what opioids are, why people abuse them, how serious the problem has become, and the effects the opioid epidemic has on society and individuals. In addition, this article will explore what the federal government is doing to combat opioid abuse and where you or loved one can get help for opioid addiction.

What Are Opioids?

Opioids are drugs that include prescription painkillers, such as oxycodone, hydrocodone, fentanyl, morphine, and codeine, as well as the illegal drug, heroin. Doctors prescribe the various opioids to manage pain and, to a lesser extent, to suppress coughing. When a person takes an opioid, the drug attaches to the opioid receptors in the brain, which initiates a neurochemical process that leads to pain relief and, potentially, a dose-dependent euphoria.1

The Drug Enforcement Administration (DEA) classifies many of the prescription painkillers as Schedule II, which means that the drugs have a known potential for abuse, and could place those who use them at risk for developing physical and psychological dependence. The DEA classifies heroin as a Schedule I drug, which means that it has a high potential for abuse, as well as no currently acceptable medical use.2

Why Do People Abuse Them?

While prescription opioids have legitimate medical uses for the management of moderate to severe pain, countless people abuse opioids merely to experience the euphoric rush that these drugs are capable of producing. When people abuse opioids, they may experience some desirable effects, such as: 3

  • Euphoria.
  • Relaxation.
  • Sedation.
  • Pain relief.

While opioids are generally safe when taken for a short time under the supervision of a doctor, many people enjoy the pleasurable feelings associated with their use and want to keep experiencing these feelings. This may lead to the misuse or abuse of opioids, as people may:3,4

  • Take larger doses of opioids than originally prescribed.
  • Take opioids more frequently than prescribed.
  • Take opioids without a doctor’s prescription.
  • Crush tablets to snort them, in an attempt to get high quicker.
  • Crush tablets, mix with water, and inject them.
  • Heat crushed tablets over an open flame and inhale the vapors.

Using opioids in ways other than prescribed, such as crushing the tablets to snort or inject the drug, is dangerous. A tablet may, for example, be specially-formulated to provide a person with a slow and steady supply of an opioid to control pain for several hours. However, crushing the table to snort it essentially bypasses this controlled-release mechanism and greatly intensifies the speed of onset and intensity of the drug effects. Such intentional misuse can markedly increase the risks of addiction and overdose, which can lead to severe medical consequences and even death. 5

How Many People Abuse Opioids?

Opioid abuse is a national crisis afflicting millions of people. Some alarming statistics related to opioid use and abuse include:1,6

  • In 2012, doctors wrote nearly 260 million prescriptions for opioids.
  • In 2015, about 2 million people in the U.S. were addicted to prescription opioids and an estimated 590,000 were addicted to heroin.
  • In 2015, more than 32,000 people died of opioid overdoses. 1
  • 4 out of 5 new heroin users progressed to heroin from prescription painkiller misuse.
  • In 2015, 276,000 adolescents abused opioid painkillers, with 122,000 having an addiction.
  • From 1999 to 2010, fatal prescription painkiller overdoses among women rose 400%.
  • In 2012, nearly 22,000 children were born with neonatal abstinence syndrome (NAS), a 5-fold increase from the year 2000.

How Did This Become an Epidemic?

With a problem this large, many people wonder how it all began. In the late 1990s, physicians began to prescribe opioids in greater numbers than ever before. To some extent, these prescribing practices reflected a push within the medical field to recognize the importance of adequate pain management in clinical settings, but also coincided with claims from the pharmaceutical companies who created these opioids that they were not addictive. The number of opioid painkillers sold to physicians’ offices, hospitals, and pharmacies almost quadrupled from 1999 to 2010, yet overall, Americans had not reported higher levels or greater amounts of pain. This increase in prescriptions led to nation-wide diversion, misuse, and abuse of opioid painkillers. 7,8 It came to light that these drugs are, in fact, addictive, leading us to where we are today.

What is the Economic Burden?

The emotional impact of the opioid crisis is overwhelming for individuals and families, but the economic burden of the opioid crisis is an immense problem as well. A recent study estimates that the economic impact of the opioid crisis amounts to 78.5 billion dollars a year.7,9

This economic impact is a result of: 7,9

  • Substance abuse treatment.
  • Criminal justice involvement.
  • Healthcare costs.
  • Lost productivity at work.

What Are the Effects of Opioid Abuse?

Prescription opioids can have negative short-term effects, including:10,11

  • Mood swings.
  • Nausea.
  • Vomiting.
  • Headache.
  • Dizziness.
  • Slurred speech.
  • Impaired memory, attention, or judgment.
  • Drowsiness or coma.

Chronic opioid abuse can lead to even more serious, long-term consequences, including:11

  • Problems with the gastrointestinal system, such as severe constipation and, potentially, intestinal obstruction.
  • Erectile dysfunction in males.
  • Irregular periods or reproductive dysfunction in females.
  • Problems with visual acuity due to chronically constricted pupils.
  • Excessive dryness of the mucous membranes of the mouth and nose.
  • Increased risk of depression, suicide attempts, and completed suicide.

If you use opioids intravenously, you may be at risk for additional health issues, such as:11

  • Skin abscesses.
  • Collapsed veins.
  • Infectious diseases, such as HIV, hepatitis, and tuberculosis.
  • Heart valve infections.

Some risks associated with snorting opioids include:11

  • Perforated nasal septum.
  • Irritation of the nasal mucosa.
  • Nose bleeds.

In addition, many people who abuse drugs get into legal trouble from selling drugs, or engaging in other criminal behaviors to support a drug habit, such as prostitution and stealing. Furthermore, people who abuse drugs are often at risk of experiencing accidents or injuries related to buying or selling drugs.11

Neonatal abstinence syndrome is another problem related to opioid abuse. Pregnant women who consistently take opioids greatly increase the chance that their baby will be born with significant physiological dependence to them as well. When the child is born, the child goes through withdrawal from opioids. The effects of neonatal abstinence syndrome can include:12

  • Tremors.
  • Fever.
  • Excessive weight loss.
  • Seizures.
  • Irritability.
  • Sweating.
  • Projectile vomiting.

Over time, a person develops tolerance to opioids. This means that the person will no longer experience the full effects of the drug as they once did. The body needs more and more opioids to experience the same euphoric sensations as before. However, as the person begins to take more opioids to overcome their tolerance, the danger of addiction and overdose increases.

Naloxone: The Opioid Overdose Antidote

Overdose is a constant concern with opioid abuse. The signs of an opioid overdose include:13

  • Failure to respond or awaken.
  • Limp body.
  • Vomiting or gurgling sounds.
  • Slowed heartbeat.
  • Slowed breathing.
  • Extreme paleness or clammy skin.
  • Blue-colored nails or lips. 

Shallow breathing is a sign of respiratory depression, which can result in death as it becomes progressively worse in overdose situations. Naloxone is an opioid antagonist drug that can quickly reverse an opioid overdose by competitively binding to opioid receptors in the brain, thereby blocking further drug effects mediated by those receptors. There are three formulations of naloxone approved by the FDA for treating opioid overdoses:14

  • Injectable naloxone, the use of which requires training before someone can administer it.
  • Autoinjectable naloxone, called EVZIO, which comes in a prefilled container that provides audio instructions to the user on how to inject EVZIO subcutaneously or intramuscularly into a person’s thigh.
  • Narcan, which is a prepackaged nasal spray, given while the person is on their back. It is easy to use and has two doses per package, in case one dose is not sufficient to counter the effects of an overdose.

In most states, injectable naloxone can be used only by trained professionals. Laws vary from state to state over who can administer Narcan and EVZIO. In some states, anyone can give the medications to someone in need, while other states require a doctor’s prescription to acquire these medications. Some states allow pharmacies to dispense Narcan and EVZIO without a prescription, including:14

  • Arkansas.
  • California.
  • Minnesota.
  • Mississippi.
  • Montana.
  • New Jersey.
  • North Dakota.
  • Ohio.
  • Pennsylvania.
  • South Carolina.
  • Tennessee.
  • Utah.
  • Wisconsin.

The cost of Narcan and EVZIO varies from state to state, and there are some organizations that offer these medications at a discounted cost. Some insurance plans also cover the cost.

If you give someone naloxone, call 911 and keep them under constant observation until medical help arrives. Do not attempt to move the person or provide any other type of treatment.14

Response to the Opioid Crisis

The federal government, through the U.S. Department of Health and Human Services (HHS), is responding to the opioid crisis by focusing on five main priorities:7

  • Improving treatment for opioid addiction, as well as increasing the availability of treatment.
  • Encouraging the use of naloxone to treat opioid overdoses.
  • Improving the oversight of the crisis to increase understanding of the causes of the epidemic.
  • Improving research on pain management and addiction.
  • Determining best practices for effective and safe pain management

In addition, the National Institutes of Health (NIH) is working with pharmaceutical companies and research groups to:7

  • Find new ways to manage pain, which do not involve addictive medications.
  • Discover and develop new strategies to treat opioid addiction.
  • Develop new medications to reverse overdoses and find methods to prevent overdoses.

How to Find Help

If you or your loved is struggling with an opioid addiction, help is available. A vital first step towards recovery is entering a professional detox program. Detox may sound like a scary and confusing process if you are not familiar with it but it is extremely beneficial and can reduce discomfort and pain. Detox is essentially the process of eliminating a drug from the body and stabilizing the patient. Detox medications are often used to mitigate withdrawal symptoms and reduce drug cravings.

Detox programs typically last for a few days to a week or two, during which time you will undergo a medical and psychological assessment, receive monitoring of your physical condition, and receive emotional support from a team of counselors and other mental health professionals.

Detox can take place in a variety of settings. These include:

  • Hospital: This provides you with intense care during detox, which is often best for people who have a long-standing opioid addiction or other medical conditions that may require intervention. Many people who experience an overdose related to opioid abuse may detox in a hospital after receiving opioid overdose treatment. A team of doctors and nurses will be able to work with you 24/7.
  • Inpatient program: This may be in a freestanding treatment facility, or it may be a detox center only. These inpatient programs can provide you with around-the-clock support during detox, and can handle many issues that arise, such as mental health problems that may worsen during detox.
  • Outpatient detox: A good option for people with less severe opioid addictions who have strong sober support systems. Outpatient programs provide the patient with detox services during the day and then the patient returns home at night.
  • Doctor’s office: This option is common for those who were taking opioid painkillers for therapeutic reasons and developed a dependence. A doctor can create a tapering schedule for the patient to gradually quit using opioids.

It is important to know that detox is only the beginning of recovery from opioid addiction. Once you have been stabilized and your body is free of mind-altering drugs, you may think that your opioid addiction is behind you. However, it is critical that comprehensive substance abuse treatment follows detox from opioids. Without addiction treatment, during which you learn to change the behaviors which led to the use of opioids in the first place, relapse becomes increasingly likely. There are several options for opioid addiction treatment, including:

  • Inpatient treatment: This form of treatment can last from 30 to 90 days, and sometimes longer if necessary. Staff provides 24/7 support and supervision during this time. Patients typically receive some combination of individual therapy, group counseling, family therapy, peer support, and medical care.
  • Outpatient programs: These programs vary in the intensity and frequency of services, depending on a person’s needs. The programs can range from a couple hours, one or two days a week, to several hours, seven days a week. These programs are ideal for those who wish to continue working or attending school while recovering from an addiction.

Whether a treatment takes place in an inpatient or outpatient setting, there are numerous therapeutic approaches and program varieties available to you:

  • Luxury rehabs: These provide extra amenities, such as gourmet meals, massage therapists, spa treatments, and private rooms, all of which give you an upscale experience.
  • Holistic programs: These focus on overall health and wellness as part of the recovery process. These programs may offer meditation, yoga, and nutrition classes, to name a few options.
  • Executive programs: These cater to working professionals who wish to continue working while recovering from an opioid addiction. Amenities may include high-speed internet, private work rooms, and private phones.
  • Population-specific programs: These have experience in treating special populations suffering from addiction. Options may include LGBTQ, men-only, women-only, veterans, and teens.

Sources

  1. American Society of Addiction Medicine (2016). Opioid addiction: 2016 facts and figures.
  2. U.S. Department of Justice. Drug Enforcement Administration. Drug Scheduling.
  3. U.S. Department of Justice. Drug Enforcement Administration (2017). Drugs of Abuse.
  4. National Institute on Drug Abuse (2017). Opioids.
  5. National Institute on Drug Abuse (2016). Misuse of prescription drugs. Opioids.
  6. National Institute on Drug Abuse (2015). Dramatic increases in maternal opioid use and neonatal abstinence syndrome.
  7. National Institute on Drug Abuse (2017). Opioid crisis.
  8. Centers for Disease Control and Prevention (2017). Understanding the epidemic.
  9. Florence, C. S., Zhou, C., Luo, F., & Xu, L. (2016). The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013Medical care54, 901-906.
  10. National Institute on Drug Abuse. (2014). America’s addiction to opioids: Heroin and prescription drug abuse.
  11. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing.
  12. McQueen, K., & Murphy-Oikonen, J. (2016). Neonatal abstinence syndromeNew England Journal of Medicine375(25), 2468-2479.
  13. Substance Abuse and Mental Health Services Administration (2016). Opioid overdose.
  14. National Institute on Drug Abuse (2016). Opioid overdose reversal with naloxone (Narcan, Evzio).

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