In a report released by the Centers for Disease Control and Prevention in December 2015, drug overdoses in the USA rose again in 2014, driven by surges in deaths from heroin and powerful prescription painkillers such as Vicodin and Oxycontin.
Overdosing is now the leading cause of accidental death in the U.S., ahead of traffic fatalities and gun homicides. Data from the Centers For Disease Control confirms that even as far back as 2010, approximately 120 people died every day from drug overdoses. And health officials warn that we’re in the midst of a new heroin epidemic that will only get worse before it gets better.
The number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. The report found that in 2014 alone, a total of 47,055 drug overdose deaths occurred, a 6.5 percent increase from the year before.
And, while prescription-related deaths have been steadily rising for the past 15 years, heroin-related deaths have jumped only recently.
(Pradip et al. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the US. Center for Behavioral Health Statistics and QualityData Review. SAMHSA. 2013.)
The use of Vicodin, the most popular pain relief drug in the country, has grown dramatically from 112 million doses prescribed in 2006, to 131 million in the U.S. in 2011, according to a national survey done by the consulting firm IMS Health.
Experts say most of those prescriptions are unnecessary. The United States makes up only 4.6 percent of the world's population, but consumes 80 percent of its opioids -- and 99 percent of the world's hydrocodone, the opiate that is in Vicodin.
"Vicodin is the most prescribed opioid mainly because it's been incorrectly scheduled as a class III rather than a II," says Andrew Kolodny, Chair of Psychiatry at Maimonides Medical Center in New York. "Many states have prescribing regulations linked to DEA scheduling. But it is no less abusable or addictive than Oxycodone or heroin."
(Jim Avila. "Prescription Painkiller Use at Record High for Americans."
ABC News. April 20, 2011.)
In a 2015 survey, individuals who, in the past 2 years, HAD taken a strong prescription painkiller,
such as Percocet, OxyContin, or Vicodin that was prescribed by a doctor for more than a few days,
were asked the following question:“Before or while you were taking these strong prescription painkillers, did you and your doctor talk about the risk of prescription painkiller addiction, or haven’t you talked about that?” Only 36% of Massachusetts residents said “yes," compared to 61% nationally.
("Prescription Painkiller Abuse: Attitudes among Adults in Massachusetts and the United States." Boston Globe and Harvard T.H. Chan School of Public Health. 2015.)
The Threat and the Future
I believe you might agree that the opioid epidemic in the United States is the domestic threat that promises to destroy life as we know it unless major measures are introduced to address the unbelievable devastation. We must increase efforts in prevention, intervention, treatment, and recovery support to stop widespread abuse.
Addiction is a disease that can be treated. The illness can be described, and it has definite characteristics:
• The course of the illness is predictable and progressive.
• The disease is primary – that is, it is not just a symptom of some other underlying disorder.
• It is permanent.
• It is terminal: If left untreated, can lead to morbidity and mortality.
A study published in August 2015 in the American Journal of Public Health indicates that increased access to methadone or buprenorphine-based medication-assisted treatment (MAT) is critical to fully address the epidemic of opioid abuse and dependence in the United States.
MAT is a comprehensive approach to address substance use disorders that combines the use of medication with counseling and behavioral therapies. Despite an increase in medication-assisted treatment capacity nationwide in the past decade, the rate of past-year opioid abuse or dependence significantly exceeded treatment capacity each year, increasing from 634.1 per 100,000 in 2003 to 891.8 per 100,000 in 2012.
The study showed that in 2012, the number of people who abused opioids or were dependent, had increased to an estimated 2.3 million people; however, the maximum number of people who could access opioid-agonist based MAT was approximately 1.4 million -- a gap of nearly 1 million people. Nationally, 82 percent of federally regulated Opioid Treatment Programs reported operating at 80 percent capacity or more.
HHS Secretary Sylvia M. Burwell has made addressing opioid abuse, dependence, and overdose a priority and work is underway within HHS on this important issue. The Secretary’s evidence-based initiative focus on three promising areas: informing opioid prescribing practices, increasing the use of naloxone - a drug that reverses symptoms of a drug overdose, and using medication-assisted treatment to slowly move people out of opioid addiction.
(Christopher M. Jones, Melinda Campopiano, Grant Baldwin, and Elinore McCance-Katz. "National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment." American Journal of Public Health: Vol. 105, No. 8. August 2015.)
And, what about a change in prescription drug attitudes and policies? The Johns Hopkins Bloomberg School of Public Health, the Johns Hopkins Center for Drug Safety and Effectiveness, and the Johns Hopkins Center for Injury Research and Policy reports:
"Prescription drugs are essential to improving the quality of life for millions of Americans living with acute or chronic pain. However, misuse, abuse, addiction, and overdose of these products, especially opioids, have become serious public health problems in the United States. A comprehensive response to this crisis must focus on preventing new cases of opioid addiction, identifying early opioid-addicted individuals, and ensuring access to effective opioid addiction treatment while safely meeting the needs of patients experiencing pain."
The group released a consensus statement with three guiding principles for actionable recommendations:
INFORMING ACTION WITH EVIDENCE.
"Some evidence-based interventions exist to inform action to address this public health emergency; these should be scaled up and widely disseminated. Furthermore, many promising ideas are evidence-informed, but have not yet been rigorously evaluated. The urgent need for action requires that we rapidly implement and carefully evaluate these promising policies and programs. The search for new, innovative solutions also needs to be supported."
"We support approaches that intervene all along the supply chain, and in the clinic, community and addiction treatment settings. Interventions aimed at stopping individuals from progressing down a pathway that will lead to misuse, abuse, addiction and overdose are needed. Effective primary, secondary and tertiary prevention strategies are vital. The importance of creating synergies across different interventions to maximize available resources is also critical."
PROMOTING APPROPRIATE AND SAFE USE OF PRESCRIPTION OPIOIDS.
"Used appropriately, prescription opioids can provide relief to patients. However, these therapies are often being prescribed in quantities and for conditions that are excessive, and in many cases, beyond the evidence base. Such practices, and the lack of attention to safe use, storage and disposal of these drugs, contribute to the misuse, abuse, addiction and overdose increases that have occurred over the past decade. We support efforts to maximize the favorable risk/benefit balance of prescription opioids by optimizing their use in circumstances supported by best clinical practice guidelines."
("The Prescription Opioid Epidemic: An Evidence-Based Approach. Johns Hopkins Bloomberg School of Public Health. November 2015.)
For specific recommendations, please read the entire detailed PDF document from Johns Hopkins here: www.jhsph.edu/.../2015-prescription-opioid-epidemic-report.pdf.
I write this plea for action not to understate the importance of fighting terrorism or of addressing economic issues. I write this to underscore the facts. The current opioid epidemic is a top priority -- a prevalent enemy -- that needs immediate action on many fronts. It is so ingrained in our populace, yet I fear people grossly underestimate the current death and destruction it is causing.
Rampant heroin addiction and prescription drug abuse are in all neighborhoods, cutting across every social and economic strata. It's all about pain -- physical and mental anguish -- and how Americans choose to avoid any trace of it at any cost -- tolls readily known and seemingly unknown. We must change hearts and minds with evidence-based treatment.