Since the release of OxyContin in the 90s, the opioid crisis has been a continuous problem. In spite of numerous legislative and social initiatives, usese of opioids has climbed significantly, particularly in the United States. But how did it reach this point and have any efforts to curb the crisis been successful?
With these questions—and so many others—in mind, this is our status report on the state of the opioid epidemic in 2022.
The Opioid Crisis: How We Got Here
Although public awareness of opioids and the problems they cause is at an all-time high, that hasn’t always been the case. The stage was set for the opioid epidemic in the eighteenth century when opium-based substances were prescribed legally and liberally, allegedly a miracle cure for virtually any ailment. Even well-known fictional characters like Sherlock Holmes used morphine regularly, further showing how normalized opioids were at that time.
This continued until heroin and morphine abuse reached such a point that legislators passed the Harrison Narcotic Control Act of 1914, which substantially reduced access to opioids.
In the 1980s, a series of poorly-conducted studies indicated that opioids were safe and rarely led to addiction when prescribed for pain. Around this time, pain management was becoming a bigger focus in healthcare; because of some increasingly potent prescription painkillers hitting the market around this same time, individuals suffering from chronic pain finally had effective medical care that helped them to achieve a better quality of life.
Meanwhile, stricter standards were being imposed on hospitals, ultimately leading even more providers to prescribe painkillers for pain. It was almost like it had become inhumane to even consider not prescribing opioids to a patient suffering from chronic pain. Both for patients and providers, this created a situation where there was an overreliance on opioid drugs.
Opioid consumption has thus been climbing for decades. As prescribing them became standard practice, opioid consumption began to climb at an astronomical rate. Clearly, all was well with opioids.
As was inevitable, we began to see the fatal consequences. But even as attitudes shifted, it took almost three full decades to even begin to curb opioid abuse. During that time, we continued to research addiction and learned some of the science behind our misconceptions. More recently, there’s even been research pointing out that there’s never been a single study that’s been able to establish the safety of opioids as a pain medication.
Fortunately, many of the efforts of our national and local governments have made significant progress. Access to opioid medication has been reduced significantly, leading to much lower diversion. However, heroin’s status as a street drug has made it very difficult to suppress.
The Current State of Opioids
Acknowledging the epidemic is one thing, but understanding the real impact that it’s had on millions upon millions of Americans is another matter. Let’s go over some of the relevant statistics to put the opioid epidemic into perspective.
Deaths from Opioid Overdose
Opioid overdose deaths have been on the rise for a while due to the prevalence of heroin; however, there’s been a notable spike over the past couple of years, believed to be attributable to the COVID-19 pandemic and the resulting lockdown.
Of the 64,000 drug overdose deaths in 2016, about 42,000 were from opioids. Since then, opioid overdose deaths have increased each year; while there were 21,088 deaths from opioid overdose in 2010, there were 68,630 in 2020 (and 70 percent were male).
We’ve seen a growing number of overdose deaths caused by synthetic opioids—in particular, fentanyl—over the past several years. Researchers have attributed 48,006 deaths to synthetic opioids (excluding methadone) in the six months between June 2019 and 2020. By comparison, there were 14,480 deaths attributed to heroin during the same period.
Opioid Painkiller Abuse
One survey by the National Survey on Drug Use and Health found that in 2015, 11.5 million adults misused prescription pain relievers, including opioids. The most common reason, which was cited by 63.4 percent of the participants, was to relieve physical pain, which is substantially higher than the 11.7 percent who misused medication to get high and the 10.9 percent looking for stress relief. If we assume those percentages hold true today, then it starts to become clear why the opioid epidemic continues to be a problem: Many people end up abusing their opioid prescriptions in hope of getting relief from their chronic pain.
However, filling an opioid prescription does not mean the person was going to abuse it although an estimated 9.7 million people misused prescription pain relievers in 2019. During the same year, 745,000 people—or three-quarters of a million—were found to still be using heroin. Because we’re looking at a mixture of different substances coming from different places, the only way to address the epidemic is to do so from multiple angles.
We’ve also seen people taking the initiative by ensuring they’re prepared in the event of a loved one’s opioid overdose. Prescriptions for Naloxone, a medication designed to rapidly treat opioid overdose, doubled from 2017 to 2018. Meanwhile, it’s estimated that 50,000 people used heroin for the first time in 2019. This tells us that, although efforts are being made to curb the epidemic, there’s still a long way to go.
The Most Problematic Substances So Far
There are multiple categories of opioids: prescription opioids, synthetic opioids, and natural/semi-synthetic opioids.
Prescription opioids include drugs such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone. Meanwhile, fentanyl is a well-known synthetic opioid that’s reserved by providers only for cases of the most severe pain. Heroin represents the third group as it’s an illegal substance derived from the opium poppy. Each group of opioids has its own characteristics to be considered.
Despite seeming harmless on the surface, prescription opioids will lead anyone who takes them to addiction if they’re not extremely cautious and following a doctor’s instruction. Taking too many of these can stop a person’s breathing and cause death.
More often than not, opioid overdose deaths are the result of mixing opioids with nervous system depressants like Xanax or other benzodiazepines.
On the extreme end of the opioid spectrum, fentanyl is estimated to be between 50 and 100 times more potent than morphine. For this reason, drug dealers have taken to mixing fentanyl with heroin or cocaine to increase the drug’s potency. This practice has become increasingly common, resulting in overdose deaths across the United States when users take large doses without knowing it contains fentanyl. In fact, the number of opioid deaths involving synthetic drugs like fentanyl in 2020 was more than 18x what it had been just 7 years earlier in 2013. We’re also seeing illegally manufactured fentanyl contributing significantly to the death toll. Synthetic opioids, primarily fentanyl, have led to 56,516 overdose deaths reported in 2020, a 6-fold increase since 2015.
Then there’s heroin, which is illegal, highly addictive, and often used simultaneously with other substances. When experiencing an overdose, the individual will exhibit slow, shallow breathing that could culminate in a coma or death.
Since 2010, heroin alone has killed nearly 143,000 people although the annual rate has actually decreased since 2016. Perhaps most telling of all, data tells us that over 68 percent of heroin overdose deaths also involve synthetic opioids like fentanyl.
Responses to the Opioid Epidemic
In the midst of the tragedy, many efforts have been made—and continue to be made—in hope of curbing the opioid epidemic and any further harm.
The Food and Drug Administration (FDA) changed its public policy in 2016 to better address the problem of opioid use. Among its many adjustments, new positions were implemented to re-examine the risks and benefits of opioids. The organization also expanded access to and encouraged the development of abuse-deterrent opioid formulations, further expanding access to treatments for opioid use.
Changes continue to be made regarding how companies dispense opioids. They are also being held to higher standards when it comes to acknowledging harm. In Ohio, there have been a series of court cases attempting to address the epidemic and hold pharmaceutical companies responsible for their role. CVS, Walgreens, and Walmart were ordered to pay $650.5 million to two Ohio counties. Those same companies are being held accountable for the role they played in dispensing these prescription painkillers while ignoring obvious warning signs. In West Virginia, these three distributors settled for $400 million for the role that their business practices played throughout the opioid epidemic.
Unlike federal law, each state can implement its own laws to alleviate the opioid epidemic. Ohio, which has one of the highest opioid overdose death rates in the country, has put together a comprehensive, inter-agency approach to reduce drug-related deaths. The plan involves promoting responsible use of opioids, reducing opioid supply, focusing on drug abuse prevention, and expanding access to treatment. Ohio’s law enforcement, public health, addiction treatment professionals, health care providers, educators, and the general public have been able to work together at every step and led to a very promising initiative that’s already seen overdose deaths on the decline.
New Hampshire’s approach to combating the heroin epidemic is unique for its emphasis on using screenings for early identification of addiction and to prevent overdoses. Meanwhile, in West Virginia—which happens to have the highest rate of opioid overdose deaths in the country—heroin, fentanyl, and prescribed opioids remain prevalent. Although opioid deaths in West Virginia decreased between 2017 and 2019, there is still a lot of work to be done. Healthcare providers are grappling with burnout and compassion fatigue; those struggling with opioid addiction are suffering from stigma. Alongside mobilizing law enforcement, West Virginia has established programs to expand treatment, reduce stigma, and distribute naloxone. Steps are also being taken to increase access to transportation across West Virginia, which could be a real game-changer for patients in rural areas.
The Centers for Disease Control and Prevention (CDC) has been collaborating with states to help them fight the opioid epidemic, funding health departments across the United States to aid in their prevention efforts. Their approaches have connected those with opioid addiction to resources as well as better prevention activities. Community efforts like New Hampshire’s Safe Station program show how the opioid crisis can be combated on a local level by a multitude of organizations. Opioid abuse disorder can also be treated medically and effectively with drugs like methadone, buprenorphine, and naltrexone.
Stay up to Date With Silicon Beach Sober Living
The opioid crisis is a tragedy that’s been decades in the making, but there is hope. Although harm has been done and many people have been hurt, significant steps have been made to help people struggling with addiction.
If you or a loved one is struggling with addiction, there is always a path to recovery. Silicon Beach Sober Living offers state-of-the-art services to help curb addiction. With sober living homes in Los Angeles and a cutting-edge Los Angeles IOP, we have plenty of services to help. Call our toll-free number to see how our resources could help you.