The Opioid Crisis: Answers To Your 4 Basic Questions

Headlines across the United States are rampant with news about the “Opioid Crisis.” The deaths involved with opioid overdose are staggering, hence the terms “crisis” and “epidemic.” In this article I answer the 4 basic questions on everyones minds.

What is an Opioid?

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What exactly is an opioid or opiate? According to Inaba and Cohen, an opiate is “a refined from or synthetic version of the opium poppy’s active ingredients and include opium, morphine, codeine, hydrocodone, oxycodone, methyl morphine, methadone and heroin” (Inaba and Cohen, 2014, p4.2).  When speaking of the opioid crisis often times people imagine those who are doing illegal street drugs, with IV’s stuck in their veins. Nothing could be further from the truth. While heroin and opium (street drugs) are a problem, the core of opiate addiction lies in prescription drug abuse. In fact, more people die from overdosing on hydrocodone, oxycodone, and methadone than heroin each year (Inaba and Cohen, 2014).

What are the numbers?

Since the year 2000, over 300,000 Americans have died from overdoses involving opioids” (Office of the Press Secretary, 2017).

It is estimated that in 2017, the opioid epidemic kills 90 Americans every day.

In 2015, more than 52,404 deaths in the United States were due to drug overdoses, of which 63% involved an opioid.

In addition to the death toll, opioids have more Americans addicted than ever before. In fact, “in 2016, more than 11.5 million Americans ages 12 and older reported misuse of prescription opioids in the past year, and nearly 950,000 Americans reported heroin use in the past year” (Office of the Press Secretary, 2017).

What is the government doing about the opioid crisis?

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The nation is struggling so much with its addiction to opioids that the President has gotten involved. In October of 2017, President Trump has declared a Nationwide Public Health Emergency in response to the opioid crisis.

According to NY Times, Mr. Trump said his plan would include a requirement that federally employed prescribers be trained in safe practices for opioid prescriptions, and a new federal initiative to develop nonaddictive painkillers, as well as intensified efforts to block shipments of fentanyl, a cheap and extremely potent synthetic opioid manufactured in China, into the United States.” (Davis, 2017).

Here’s the problem. They declared the Nationwide Public Health Emergency without requesting additional funds to campaign treatment of the opioid crisis. The aim at the media attention appears to be more of a “Just Say No” campaign than an actual treatment plan.

How is opioid addiction treated?

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The most common method of treating heroin is methadone. Burpenorphine is also used, and pharmaceutical heroin is being discussed. While the withdrawals of opiates are painful and miserable, they are considered to be non lethal. Treatment for opiate addiction can be accomplished without adding fuel to the fire.

Methadone is used to curb physical withdrawal symptoms in heroin and opiate users. It acts as an interrupter for the reward system in the brain of the addicted.  Methadone is obtained through clinics, it is highly controlled, and it also has addictive properties. Methadone blocks withdrawal symptoms for 24 hours. It is also costly, and people have overdosed on it as well, as the clients aren’t screened for all substances prior to administration.

Buprenorphine is both an opioid agonist and antagonist. It works as a pain medication as an alternative to morphine at small doses, and at larger doses it blocks the opioid receptors (Inaba and Cohen, 2014). It is used as an alternative detoxification medication to methadone. This medication can be dispensed in a doctor’s office. But again, it is costly and reports show it is not as effective as methadone.

Also, in the opioid antagonist category is naloxone (Narcan). This is used for opioid drug overdose, but often times must be re administered as the user may slip back into a coma (Inaba and Cohen, 2014). There is a move to push the availability of naloxone as a nonprescription drug (Inaba and Cohen, 2014).

Closing thoughts.

Underneath the opioid crisis lies an issue of greed. The manufacturers continue to profit, as do the doctors that prescribe the medications, and even the government and politicians that run this nation benefit from big pharmaceutical companies that lobby to them. Long term pain management by opioids has shown to destroy muscle tissue, and the treatment for the dependence of the substance is more opioids. Catch my drift here? Until corrupt people stop benefiting from providing opiates to the masses, the crisis will continue.

The opioid crisis will resolve itself when those in power decide that the death toll, and the addiction factor is more important than the idolization of money and medication.

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References

Inaba, D. S., & Cohen, W. E. (2014). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (8th ed.). Medford, OR: CNS Productions, Inc. ISBN: 9780926544390.

Office of the Press Secretary (2017). “President Donald J. Trump is Taking Action on Drug Addiction and the Opioid Crisis” The White House. Retrieved from: https://www.whitehouse.gov/the-press-office/2017/10/26/president-donald-j-trump-taking-action-drug-addiction-and-opioid-crisis Accessed on 12/5/2017

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10 Comments

  1. What I don’t understand is how is it that addicts seem to be able to easily get painkillers and people with severe pain get told to take ibuprofen and hope for the best. I tore a rotator cuff and was given nothing for pain. There was no sleep for months and my health went into decline. Yet, people seemed to be dying all around me from overdoses. It seems that legitimate doctors are now afraid to treat pain at all and some doctors just prescribe opioids to whoever.

    1. Mike,
      I think the problem is there is no universal code or rules for the doctors that write these scripts. One would think that pain level pertinent to injury would suffice, but I’m not a doctor so I really don’t know. I do know that those who abuse the system often sell these scripts on the streets, and that’s how a lot of people get their hands on them.

      1. Yeah, I think you are right. Also, opioid deaths include heroin and it is solely a street drug. I do know that many doctors are just playing it safe and refusing to treat pain while others seem oblivious to the problems of abuse. One thing that would help is to get some of these doctors to exclusively use electronic medical records. The ones that are still resisting can do whatever they want with little accountability.

      2. Yup, again. Electronic records that feed a national database are essential to regulate opioid prescribing. I wrote a paper which was accepted by the White House with gratitude but time will tell how the political operatives who rely on the pharmaceutical companies for funding will react. One hopeful fact is that this President is not reliant on anyone for money. Congress on the other hand…

    2. You’re correct Mike. The doctors were convinced by the pharmaceutical companies that prescribing slow release opioids (oxycontin, MScontin) blunted the risk of addiction. When the error blew up in their face, they got shy about prescribing. Who suffered? The very people who actually needed the drugs, pain sufferers. Sorry you had to go through that ordeal.

  2. Methadone and Buprenorphine are simply long acting opioids. Methadone is not an “interrupter” although Buprenorphine may be considered such since it is both an opioid agonist and antagonist. A significant number of dependent people who attempt to substitute Buprenorphine for their usual opioid find themselves in a sudden abstinence syndrome or rapid withdrawal and require an opioid to rescue them from the distress. In either case, the person remains physically dependant on opioids. It is not a cure but rather a harm reduction approach to Substance Use Disorder. Withdrawal is a requirement to truly break the chains of opioid addiction. These long acting opioids are also very difficult to withdraw from due to their long half life. Most of the so called experts in the field have no idea what they’re doing. Prescribers should be required to be certified by a national government agency.

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