The American Opioid Epidemic
For most of the decade, stories regarding opioid over-prescription and subsequent addiction, overdose and death have proliferated the news, and for many of us, our lives. In 2017, more than 70,000 people died from drug overdoses involving opioids.
But what is the opioid crisis or epidemic? How long has it been happening? Is there a way to make it stop?
In this article we are going to cover:
-Opioid vs Opiate, what’s the difference?
-History of the opioid epidemic
-National response to the opioid crisis
-Legal action against opioid manufacturers
-Skepticism regarding substance abuse treatment
-Detox from opioids and entering recovery
Opioid vs. Opiate. What's the Difference?
The term opioid and opiate are often used interchangeably, but they don’t mean exactly the same thing. An easy rule of thumb is to think about rectangles and squares. All squares are rectangles, although not all rectangles are squares.
In this case, all opiates are opioids, but not all opioids are opiates. So what’s the difference?
Let’s start at the beginning. Opium is a latex that is excreted from the opium poppy seed. The opium latex contains several natural analgesics, such as morphine, codeine and thebaine. When consumed, these chemical compounds make you feel high.
Opium has been collected for thousands of years and used medicinally in many different ways. It was used for everything from treating headaches to mixing with the poison hemlock as a way to achieve a quick and painless death.
Opiate refers to any naturally or slightly modified component of opium. The chemical compounds, as well as the commercial medications made of morphine, codeine and thebaine, are considered opiates. The illicit drug heroin is made from morphine extracted from the poppy seed, increasing its potency fourfold. Heroin is also considered an opiate.
The term opioid includes not only the naturally or slightly modified opium compounds, but also any synthetically created compounds that impact the brain’s opioid receptors. Methadone, Buprenorphine, hydrocodone, oxycodone and fentanyl are all examples of opioids that are not opiates.
The History of the Opioid Epidemic
The national dilemma surrounding opioid use disorder and addiction to prescription drugs is frequently referred to as the opioid epidemic or crisis. This term is more accurate than to call it the opiate crisis. Although a significant portion of drug-related deaths and addictions are from heroin, codeine, etc, prescription drug addiction has become more and more prevalent since the 2000s.
According to the Centers for Disease Control, more than 700,000 people in the United States died from drug overdoses between 1999 and 2017. Opioids were involved in close to 86 percent of the 70,200 drug overdose deaths in 2017, which is 6 times higher than in 1999.
However, within that 18-year span, there have been three waves of opioid overdose deaths. The second, which lasted from 2010 to 2013, saw heroin overdoses become more prevalent. Perhaps then, a more appropriate name could have been the Opiate Crisis.
Between 2013 and now, synthetic opioid deaths have once again become more prominent, but not because the rates of heroin overdoses have declined. In fact, since 2010, the number of heroin-related overdose deaths have increased by 400 percent.
National Response to the Opioid Crisis
In 2017, the United States Government declared that the opioid epidemic is a public health emergency. During this period, there have been substantial decreases in both opioid prescriptions and subsequent deaths from them. However, deaths by opioids, largely because of the illicit manufacturing of fentanyl, have continued to steadily rise.
Health departments, agencies and harm reduction groups at local, state, and federal levels all have unique ways of fighting the opioid crisis. A few examples include:
In Baltimore City, where 692 people died from opioids in 2017, the city has committed to:
1- save lives with the overdose-reversing medication naloxone
2- increase access to evidence-based addiction services such as medication assisted treatment (MAT)
3- fight the stigma surrounding addiction through education services.
The Centers for Disease Control’s response to the opioid overdose epidemic contains 5 plans of action including :
1- conducting surveillance and research
2- building state, local and tribal capacity
3- supporting providers, health systems and payers
4- empowering consumers to make safe choices
5- partnering with public safety.
National nonprofit Harm Reduction Coalition’s overdose prevention plan includes:
-Providing overdose prevention, recognition, and response education to drug users and their neighbors, friends, families, and the service providers who work with them is a harm reduction intervention that saves lives.
-Providing Naloxone (Narcan) to reverse opioid overdoses.
-Opening supervised drug consumption sites in cities across the country, where people who use drugs can use safely, without the risk of overdosing, and administer their drugs with clean needles.
Supervised drug consumption sites are very controversial, as many in the substance use recovery community view it as an enabling practice. The other school of thought is that by allowing a person with substance use disorder another day to live they can eventually find help. Supervised drug consumption sites provide linkage to drug treatment options and other resources.
Legal Actions Against Opioid Manufacturers
In 2019, dozens of states and the District of Columbia sued pharmaceutical manufacturers including Purdue Pharma, Johnson & Johnson and Teva Pharmaceuticals.
In August, Oklahoma District Court Judge Thad Balkman judge ruled against Johnson & Johnson, calling the company a “public nuisance,” and finding it guilty of fueling the state’s opioid addiction epidemic.
Oklahoma sued Johnson & Johnson for more than $17 billion but the manufacturer was only ordered to pay the state $572 million. The $17 billion was meant to represent Oklahoma’s plan to combat the opioid crisis for the next 30 years. According to Balkman’s ruling, the amount would cover the first year of Oklahoma’s plan.
The Oklahoma court case was the first in a line of many. Until the August ruling, pharmaceutical companies that were sued mostly settled out of court.
Skepticism Around the Substance Abuse Treatment Industry
As overdose deaths continue to rise, the effectiveness of opioid treatment, opioid detox and alcohol rehab has been called into question. It’s true that many families have spent tens, if not hundreds of thousands of dollars sending a loved one to treatment, only to have them die from an overdose.
Contributing to the skepticism is the practice commonly known as “The Florida Shuffle,” where treatment centers broker patients with high-reimbursement health insurance policies, cycling them through their program many times. The practice began prominently in 2010 after the Affordable Care Act mandated that insurance policies cover substance use disorder treatment services.
The scheme is named after Florida, where a public reckoning occurred in the second half of the decade, although it has been known to occur in other attractive, warm climate states such as Arizona and California.
In Florida, a law was passed in 2017 to prevent the scheme from taking place. Other states have their own policies in place, but federal regulation has yet to be passed.