What is the Opioid Epidemic?
Every news agency is reporting heavily on the opioid addiction, but what is the opioid epidemic exactly? In this article, we’ll explore the deadly truths surrounding drug overdose deaths and the link between substance abuse and mental health
What Exactly are Opiates?
The term “Opiates” actually refers to a roster of drugs. These range from legal drugs such as fentanyl, codeine, and morphine to illegal drugs such as heroin and opium. If you’re Googling “what is the opioid epidemic”, they are all part of the problem.
Opiate examples include:
- Morphine
- Heroin
- Hydrocodone (trade names include: Vicodin and Lortab)
- Oxycodone (trade names include: OxyContin and Percocet)
- Fentanyl
- Codeine
Often, the term “opioid” is used in reference to prescription opiates. Technically-speaking, the concept of “opiates” includes drugs naturally derived from the opium poppy. The “opioid” moniker is different. It includes synthetic and semi-synthetic drugs. These are modified versions of the opiate building blocks. Generally, the term “opioid” is usually used in reference to prescription drugs. The terms “opiates” and “opioids” are often used interchangeably.
The Growing Opioid Addiction Crisis
Opiate addiction and drug overdose deaths are a major issue in the United States. Prescription opiate addiction continues to be one of the biggest drug problems today. Opiate medications are surprisingly easy to obtain. According to data from 2010, it is estimated 210 million prescriptions for opiates were dispensed. That number continues to rise at an alarming rate. Even more alarming is that prescription opiate abusers are far more likely to develop a heroin addiction than a non-opiate abuser. This is partly due to the fact that heroin offers a similar high at a cheaper price. These factors are leading to an opiate addiction crisis.
Any long-term use puts you at risk of addiction, even if the substance is used as prescribed. Often, people who use opiates will develop a tolerance to them–a phenomenon that can trigger the cycle of addiction. This means that the same amount of the drug no longer has the same effect as it once did. When this occurs, users routinely take greater and greater quantities of the substance to achieve the desired response. This cycle places one at great risk for accidental overdoses and drug overdose deaths.
Effects of Opiate Abuse
Often, the facts about the effects of opiate use are misleading because they usually only focus on the short-term impact. The short term impact includes vomiting and diarrhea, sedation and delayed reactions.
What’s not often mentioned, however, are the long-term and more severe symptoms. These include:
- Weakened immune system functioning
- Gastric problems ranging from the troublesome (e.g., constipation) to severe (e.g., intestinal ileus, bowel perforation).
- A plethora of medical issues secondary to intravenous administration (e.g., localized abscesses, embolic events, systemic infection, contraction of bloodborne illnesses)
- Significant respiratory depression; cumulative hypoxic end-organ injury
- Significant, long-term damage and an increased probability of drug overdose deaths.
Prescription Opiates
Opioids of course include prescription drugs such as OxyContin and Vicodin. These are typically prescribed for the treatment of moderate to severe pain. They work by attaching to specific proteins called opioid receptors, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they reduce the perception of pain and can produce a sense of well-being; however, they can also produce drowsiness, mental confusion, nausea, and constipation.
With repeated use of opioid drugs (prescription or heroin), the production of endogenous opioids is inhibited, which helps to explain the discomfort that one experiences when the drugs are discontinued (i.e., withdrawal).
Opioid medications can produce a sense of pleasure and well-being. This is because these drugs affect brain regions involved in reward. People who abuse opioids often seek to intensify their experience by taking the drug in ever-increasing doses.
To combat this, extended-release oxycodone is designed to release slowly and steadily into the bloodstream after being taken orally in a pill; this minimizes the euphoric effects. People who abuse pills may crush them to snort or inject them which not only increases the euphoria, but also increases the risk for serious medical complications, such as respiratory arrest, coma, long term addiction and drug overdose deaths.
When people tamper with long-acting or extended-release medicines, which typically contain higher doses because they are intended for release over long periods, the results can be particularly dangerous. This is because all of the medicine can be released at one time. Tampering with extended release and using by nasal, smoked, or intravenous routes produces risk both from the higher dose and from the quicker onset.
What is the Opioid Epidemic’s Impact on the Economy?
It has been estimated that the non-medical use of opioid pain relievers costs insurance companies up to $72.5 billion annually in health-care costs) but may also be partly responsible for the steady upward trend in poisoning mortality.
In 2010, there were 13,652 unintentional deaths from opioid pain reliever (82.8 percent of the 16,490 unintentional deaths from all prescription drugs). There was also a five-fold increase in treatment admissions for prescription pain relievers between 2001 and 2011 (from 35,648 to 180,708, respectively).
In the same decade, there was a tripling of the positive opioid tests among drivers who died within one hour of a crash.
By all measures, it’s a national epidemic.
Relationship between Prescription Opioids and Heroin Abuse
The recent trend indicates a switch from prescription opioids to heroin seen in some communities. This signifies the complex issues surrounding opioid addiction and the intrinsic difficulties in addressing it through any single measure such as enhanced diversion control. Of particular concern has been the rise in new populations of heroin users, particularly young people.
The increasing likeliness of chemical tolerance toward prescribed opioids, perhaps combined in a smaller number of cases with an increasing difficulty in obtaining these medications illegally, may explain the transition to abuse of heroin. Heroin is cheaper and in some communities, easier to obtain than prescription opioids. This is a powerful influence on the growing problem of opioid addiction. In fact, this is true across a wide range of prescription drugs as cited in this data:
What was once almost exclusively an urban problem is has now spread to small towns and suburbs.
In addition, the abuse of an opioid like heroin, which is typically injected intravenously, is also linked to the transmission of human immunodeficiency virus (HIV), hepatitis (especially Hepatitis C), sexually-transmitted infections, and other blood-borne diseases This is mostly due to the sharing of contaminated drug paraphernalia but also through the risky sexual behavior that drug abuse may engender.
What is the Opioid Epidemic’s Link to Methadone?
Part of the growing problem of opioid addiction comes from the growing popularity of Methadone. Methadone is a painkiller that has been used to treat heroin addicts for decades, and in recent years it has emerged as an increasingly popular and deadly street drug. ,
In case you’re curious, here’s more information about methadone and its link to the opioid epidemic and drug overdose deaths:
- Nearly 3,850 people died from methadone overdoses in 2004—more than from any other single narcotic—and a 390% increase since 1999.
- Roughly 80 percent of those deaths were “accidental.” Although methadone may be dispensed only by regulated clinics when used for treating heroin and other opioid addictions, any physician can prescribe it for pain treatment.
- Physicians increasingly prescribe methadone, partly because of the drug’s low cost. At a typical retail price of $.19 to $.23 per dose, for example, methadone is by far the least-expensive narcotic one can prescribe.
- Physicians who prescribe methadone versus other narcotics “find it easier to get approval from Medicaid,” and might believe they draw less attention from law enforcement or licensing boards.
- Methadone’s addictive qualities and rapid spread as a pain medication have made it worth as much as $20 per tablet on the streets. Pharmacies rank methadone with OxyContin and Vicodin as a high-value theft target.
- Methadone can be so deadly that the FDA—as it did earlier with fentanyl—issued a public-health advisory in October 2006. It was titled, “Methadone Use for Pain Control May Result in Death.”
Methadone might be a cost saver for insurers, but it’s a curse for patients because of its large diversion impact. Diverters and abusers can obtain methadone more easily than OxyContin, but it features even more-serious patient safety concerns. It also calls more attention to the increasingly severe societal toll that diversion is taking.
Treatment for Opiate Abuse
The discussions exploring what is the opioid epidemic invariably culminate in treatment options. Opiate recovery typically starts with questions related to the nature of the addiction, such as:
- How long have you been taking the drug?
- When was the last time you took the drug?
- How do you usually get your supply?
These questions will help the clinic to decide what treatment approach would be most appropriate.
Three major options for opiate treatment include detoxification (or, simply, detox programs), inpatient rehabilitation, and outpatient therapy.
Detox involves withdrawing from the drug, often slowly with the use of stabilizing and maintenance medication under the supervision of a medical treatment team. If you’re detoxing from powerful opiates, you might be prescribed methadone or buprenorphine to make the transition more manageable. Detoxification is completed on an inpatient basis to maintain safety.
Following the transition from detox, most will be referred for continued treatment via residential rehab or outpatient therapy depending on a number of factors. Influencing the decision for treatment type is the individual’s level of opiate use, the presence of any home or family supports, amounts of insurance coverage/resources to cover care, as well as taking into account any previous attempts at recovery. Rehab typically lasts anywhere from 30 to 90 days with much of the time being devoted to individual therapy, group therapy, and other activities that help promote recovery from opiates and other substances.
During therapy, you will attend sessions with a therapist or counselor. This will help you to uncover the triggers of your addiction. It helps to impart effective coping skills to resist the temptation of drugs while seeking out helpful supports. It can also help you reconnect with your family and friends.
In conjunction with outpatient treatment, some in recovery may require more support. For someone in recovery from opiate addiction, this might take the form of a halfway house or sober living facility, which gives former users the chance to get sober and rebuild their lives in a safe and supportive environment. Others may simply need a peer support group, such as Narcotics Anonymous.
If you or someone you love needs help, we’re here. Contact us today for more information.