Curtailing Prescription Opioid Misuse Won’t Be Enough to Stop the Opioid Epidemic

When we as a nation face a significant problem or threat that we struggle to resolve, we tend to err in one of two ways. Either we become overwhelmed by the issue as a whole, feeling more or less incapable in addressing it, or we get too focused in on one or two facets of the problem—never able to solve all of its parts. The result? Either the problem does not get resolved at all, or only parts of it do, while the rest of the issue is allowed to grow and expand.

This second result is precisely what has happened with our country’s opioid addiction epidemic. We’ve gotten too focused on just addressing the prescription drug side of opioids, which in turn has allowed for the growth and expansion of other opioid problems. The result is that, even though we’ve made some progress on the prescription drug side of the opioid crisis, the considerable growth in other, related opioid crises overweighs our progress. The revelation here is that if we are ever going to break free from the opioid crisis, we will have to do more than just focus on prescription opioids.

A Study from Harvard Medical School Paints a Dire Picture

Dr. Jagpreet Chhatwal is a professor at the Harvard Medical School, a senior scientist at the Massachusetts General Hospital’s Institute for Technology, and the co-author of a recent study into the opioid crisis. He said that “People who start using prescription opioids, at some point, may transition to the next stage, and as the supply-side shifts happen, we see increased availability of illicit opioids. Such is a complex problem, and it’s difficult to know how changing one thing in this whole equation will change the direction of the epidemic.”

Dr. Chhatwal is referring to increased supply-side availability of illicit opioids, not of legal opiates. The critical points of the study were that:

• More people are going to die from opioid overdoses. This problem is going to get worse every year if we don’t take bolder action in addressing it.
• Our methodology for addressing the opioid crisis has to change. We can no longer only focus on legal, pharmaceutical opioids. We have to take bolder action and treat illicit opiates, synthetic opioids, and heroin.

The published research information goes beyond pure speculation on where things have been with opioids and where they will be. The researchers compiled statistics and came up with some concerning projections. According to their information, annual opioid overdose deaths are projected to reach 81,700 by 2025, a 147 percent increase from 2015. Also according to the research, about 1.5 million Americans are projected to be using heroin, fentanyl, and other opioids by then. The researchers further extrapolated that about 700,400 people would die from opioid overdoses between 2016–2025.

Those future projections are based on historical trends. The rate of opioid overdoses has risen by more than 500% since 1999. In 2017, the more recent year for which we have verified information, there were 14.9 opioid deaths for every 100,000 residents—a new highest ever in fatalities per capita.

How the Opioid Epidemic Expanded

The history of the opioid epidemic so far can be summed up into three phases. First, the introduction of OxyContin in the 1990s and the painkiller era that shortly followed began the epidemic. Then, the second phase saw surging death rates due to opioid painkillers which led to a realization that our country had to crack down on opioid prescribing. We are currently doing this to some, limited success.

The third phase is the one we are most concerned about. Shortly after the crackdown on prescription opioids, the supply of the drugs was curbed, and addicts turned to heroin or illicitly obtained opioid medicines. Heroin trafficking from Mexico increased, as did the illicit smuggling of fentanyl and other synthetic opioid analogs from drug labs in China.

“Our attempts at solutions made things worse. Restricting opioid prescriptions, without programs in place to transition people addicted, ended up pushing people into the illicit injection drug world, with all the attendant consequences.”

Commentary from Dr. Mike Brumage, an assistant dean at the West Virginia University School of Public Health, is particularly applicable. He stated: “Our attempts at solutions made things worse. Restricting opioid prescriptions, without programs in place to transition people addicted, ended up pushing people into the illicit injection drug world, with all the attendant consequences.”

Successful Efforts So Far

As mentioned earlier, we’ve made some progress in addressing the opioid crisis, specifically as pertains to the prescription drug side of it. The Centers for Disease Control and Prevention released their “Prescribing Guidelines” which encouraged doctors to be far more reserved in their prescribing habits. The Drug Enforcement Administration, through their “360 Strategy” program, has worked diligently to prevent the diversion of legitimate prescription opioids into the hands of those who should not have them.

We can’t deny that we are making some progress so far. That’s something to be grateful for. But it’s not enough to reverse the growth trend of the opioid problem.

What Remains to Be Done

Our error as a nation has been to focus only on what started the opioid epidemic, i.e., prescription opioid pain relievers. But we now need to take it a step further. The American people need to realize that prescription opioids are only a minority part of the overall opioid crisis.

We need to address illicit synthetic opioids which are bought and sold in clandestine ways. We need to address heroin trafficking and heroin abuse as well. These things are in addition to continuing to curb the misuse of legal pharmaceutical opioids. This is a big job ahead of us, but we know what the future will look like if we don’t take action. We can’t let that happen.

Sources:

• https://www.usnews.com/news/health-news/articles/
• https://jamanetwork.com/journals/
• https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf
• https://www.dea.gov/360-strategy

Reviewed and Edited by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP