When you look at national trends in substance abuse, alcohol tops the list with 80% of Americans reporting drinking at least once in their lifetime. Among illegal drugs, marijuana is the most commonly abused substance. But another class of drugs is having devastating effects on the American population. An estimated 130 people die every day from opioid-related overdoses in the United States. Let that number sink in. And let there be no doubt that America is in the midst of a calamitous opioid crisis.
What is the Opioid Epidemic in America?
In the 1990s, there was a push towards stricter standards for pain management. Physicians were mandated to provide adequate pain control, so much so that hospitals were unlikely to receive federal healthcare funds if benchmarks in pain management were not met. This led to an increasing reliance on prescription opioid drugs for pain control.
Pharmaceutical companies heavily promoted opioids as a humane treatment option and reassured the medical community that opioid pain relievers were not addictive. As a result, healthcare providers began prescribing them at greater rates. Newer formulations, such as extended-release oxycodone (OxyContin) were presumed to have lower rates of abuse. Prescriptions of Oxycontin increased 10-fold from 670,000 in 1997 to 6.2 million in 2002. Overall opioid consumption climbed from roughly 47,000 kg in the year 2000 to 165,000 kg in 2012.
The increased use of opioid drugs led to widespread misuse of both prescription and non-prescription opioids (primarily the illegal drug heroin). It soon became evident that opioids did indeed have a high potential for abuse and addiction. In 2017, the U.S. Department of Health and Human Services declared the opioid crisis a public health emergency.
The Opioid Epidemic in Numbers
- There was a fourfold increase in opioid overdose deaths from 1999 to 2008. In the decade preceding 2018, almost 450,000 people died of opioid overdoses.
- In 2016, out of the 64,000 people that died from drug overdoses, 42,000 were attributed to opioids.
- In 2018, an estimated 47,600 people died from opioid overdoses.
- More than 10 million Americans misused prescription opioids in 2018, of which 2 million misused them for the first time.
- Over 800,000 people used heroin (an illegal opioid) in 2018, of which 81,000 used it for the first time.
- More than 15,000 people died from a heroin overdose in the 12 months preceding February 2019.
- In the 12 months leading up to February 2019, over 32,500 deaths were attributed to synthetic opioid overdoses other than methadone.
- Roughly 80% of people who use heroin report that they first misused prescription opioids and later transitioned to heroin use. Mirroring the increase in prescription opioid overdose deaths, there was a threefold increase in heroin overdose deaths from 2010 to 2014.
Consequences of the Opioid Epidemic
Premature death from drug overdose is the most dramatic consequence of the opioid crisis, but it is not the only one. The rates of emergency room visits related to non-medical opioid use, neonatal abstinence syndrome in babies born to mothers who abused opioids during pregnancy, and admissions to opioid addiction treatment programs have soared since the early 2000s. The CDC estimates that the economic burden of prescription opioid misuse in the US is nearly $80 billion a year, including healthcare costs, lost work productivity, criminal justice involvement, and addiction treatment.
While opioid overdose death rates have increased in virtually every population group in America, the worst affected are adults under the age of 50. One study in Massachusetts found that 3 out of 4 opioid overdose deaths occurred in people under age 50. Also, opioid-related deaths in men aged 18-34 are nearly three times higher than women in the same age group. Other high-risk populations for opioid overdose deaths include people recently released from prison and those who obtain opioid prescriptions from multiple pharmacies.
Reasons for Prescription Opioid Misuse
Misuse of prescription drugs is second only to marijuana which is the most frequently used illicit substance in the United States. Although opioid medication misuse is common, the majority of people who take prescription pain pills do not misuse them. What drives some people to misuse and potentially become addicted to opioid drugs?
The National Survey on Drug Use and Health collects information on why people misuse prescription drugs. Nearly 12 million adults who misused prescription pain relievers in the past year were asked about their reasons for doing so. Roughly 60% said it was to relieve physical pain (they used the drugs at a higher dose or more frequent dose than prescribed). Another 12% said they misused prescription opioids to get high and 11% used the drugs to relieve tension. Other, less common, reasons for opioid misuse include to help with sleep, experimentation, and to increase or decrease the effects of other illicit substances.
Strategies to Combat the US Opioid Crisis
Even as thousands of American families reckon with the effects of the opioid epidemic, the government is taking several steps to counteract it. The HHS has outlined a 5-point strategy to fight the opioid crisis, including:
- Improving access to addiction treatment for opioid use disorders
- Promoting the use of overdose-reversing drugs
- Strengthening understanding of the opioid epidemic through public health surveillance
- Supporting cutting-edge research on addiction and pain management
- Advancing better practices for pain management
Other efforts such as the National All Schedules Prescription Electronic Reporting Act (NASPER) and prescription drug monitoring programs (PDMPs) have been effective in reducing opioid prescriptions by 8% and overdose death rates by 12% in the past few years.
Much more needs to be done in terms of addiction treatment at rehab facilities for drugs and alcohol. At the current time, 90% of Americans struggling with an addiction do not receive the treatment they need. Making sure every American has access to addiction treatment will make a huge difference in overcoming the opioid crisis. And it will mean fewer families have to hear the devastating news of a loved one succumbing to an opioid overdose.