Opioids

The Opioid Crisis:

How Did We Get Here & What Can We do?

Since 2000, opioid-related deaths have increased by 200% and nearly 80% of heroin users state they have used prescription pain relievers for nonmedical use.

This means that there are approximately 115 deaths every day from overdose – for those who don’t get labeled as something else…heart attack, stroke, allergic reaction, etc.

ARTICLE — Jails and prisons: the unmanned front in the battle against the opioid epidemic

WEBSITE — Missouri Opioid State Targeted Response (STR)

How did we get here?

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates.

This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive. Opioid overdose rates began to increase.

In 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.

That same year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 591,000 suffered from a heroin use disorder (not mutually exclusive).

What do we know?

• Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.
• Between 8 and 12 percent develop an opioid use disorder.
• An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.
• About 80 percent of people who use heroin first misused prescription opioids.
• Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.
• The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.
• Opioid overdoses in large cities increase by 54 percent in 16 states.

This issue has become a public health crisis with devastating consequences including increases in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid use and misuse during pregnancy.

The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and hepatitis C. As seen throughout the history of medicine, science can be an important part of the solution in resolving such a public health crisis.

What are we doing about it?

In response to the opioid crisis, the U.S. Department of Health and Human Services (HHS) is focusing its efforts on six major priorities:

1 — Improving access to treatment and recovery services

2 — Medication Assisted Treatment (MAT)
* Vivitrol / Naltrexone – works for both alcohol and opiates
* Subutex – buprenorphine
* Suboxone – buprenorphine/naltrexone
* Buprenorphine was previously used as a pain reliever. It is a partial opioid antagonist that binds with opioid receptors in the brain, causing reduced pain and feelings of wellbeing. While buprenorphine isn’t a full opioid, it acts much like one, causing moderate receptor site activity, except it does not create a euphoric state or disorientation. As a result, buprenorphine will prevent withdrawal symptoms from, and reduce cravings for, opiate drugs like heroin and prescription painkillers. There are several advantages to using a medication like buprenorphine for treatment of opioid addiction. IT CAN help the individual remain safe and comfortable during detox, reduce or eliminate cravings for heroin and other opiates, minimize relapse by reducing withdrawal and cravings, allow the individual to focus on therapy without having cravings and other symptoms.
* Methadone — Methadone is a synthetic analgesic drug that is similar to morphine in its effects but longer acting, used as a substitute drug in the treatment of morphine and heroin addiction. However, approximately 1/3 of US prescription pain killer deaths are blamed on methadone.  This is due in part from misuse or mixing with other opiates and alcohol.

3 — Promoting use of overdose-reversing drugs
* NARCAN — Naloxone is considered to be an opiate antagonist. This means that it fills opioid receptor sites and will not allow other drugs to activate them. With these receptor sites full but not activated, a person attempting to abuse Suboxone will not experience any pleasurable effects. Hence, if a person attempts to snort or inject Suboxone, the buprenorphine won’t be able to activate the receptor sites. Since no euphoria or pleasurable effects can occur, this knowledge discourages abuse.

4 — Strengthening our understanding of the epidemic through better public health surveillance.

5 — Providing support for cutting-edge research on pain and addiction

6 — Advancing better practices for pain management

To accelerate progress, National Institutes of Health (NIH) is exploring formal partnerships with pharmaceutical companies and academic research centers to develop:

• Safe, effective, non-addictive strategies to manage chronic pain
• New, innovative medications and technologies to treat opioid use disorders
• Improved interventions to save lives and support recovery

What can I do?

• Educate ourselves and those around us
• Maintain open lines of communication with friends and family
• Ask for help!
• Advocate
• Refer someone to treatment if they need help!