Opioid overdose kills over 115 Americans every day (National Institute on Drug Abuse), and as of June 2017, drug overdose was the leading cause of death among those under 50, according to reports by the Centers for Disease Control and Prevention (CDC). With numbers like these, few Americans remain unaffected, directly or indirectly, by opioid addiction; this is why America’s opioid problem has become an opioid crisis.
There are startling correlations between degrees of substance abuse and different substances. Roughly 80 percent of heroin users abused prescription opioids first, and heroin is becoming more and more dangerous, as synthetic opioid fentanyl— 50 times more potent than heroin and 100 times more potent than morphine (CDC)— is being illicitly manufactured at unprecedented rates.
Drug dealers are cutting heroin and cocaine with illicitly manufactured fentanyl (IMF) and selling pure IMF— cheaper and easier to produce than obtaining heroin— as heroin and cocaine. Others are marketing the drug as better or stronger than heroin.
Drug users may then unknowingly inject or inhale a fatal dose of fentanyl and overdose instantaneously. Still, others knowingly use the drug without realizing how deadly a substance it is; a 3-milligram dose of fentanyl is fatal, as compared with a fatal heroin dose of 30 milligrams. The potency of fentanyl has led to an association with the phrase “get high and die,” as users can fatally overdose in seconds.
From 2012 to 2015, the number of synthetic opioid deaths across the U.S. increased 264 percent, with the largest year-to-year increase being 73 percent from 2014 to 2015 (CDC). Prior to 2010, fentanyl was rarely seen on the streets; the synthetic was mainly prescribed by doctors to treat chronic pain and was given to patients in pill form or as a wearable patch. Now, since dealers discovered the economic advantages of selling fentanyl, the presence of IMF is skyrocketing.
Opioid users who have been introduced to fentanyl inject or inhale crushed pills, or inject or consume the gel found in prescription patches; all methods are incredibly dangerous, even more so when the fentanyl is of unregulated origin.
What are opioids?
Opioids are highly addictive drugs that bind to the brain’s “pleasure receptors,” releasing dopamine and creating an artificial sense of euphoria. Opioids include natural opiates derived from opium and man-made opioids that mimic opium’s pain-alleviating quality:
Legal painkillers/prescription opioids— morphine, oxycodone, hydrocodone, codeine
Illegal “street” drugs— heroin, illegally manufactured fentanyl (IMF)
Synthetic opioids— fentanyl, methadone
Opioid use can easily become opioid tolerance, as the brain rewires itself to require elevated levels of dopamine to experience pleasure, which becomes dependence and ultimately, addiction.
How did opioid misuse become the opioid crisis?
In 2016, overdose deaths from natural and synthetic opioids and heroin (not including methadone) numbered over 50,000. Synthetic opioid overdose deaths have seen the sharpest increase in the last few years, skyrocketing from around 3,000 in 2013 to over 20,000 in 2016. (CDC)
The epidemic has its origins in the late 1990s, when pharmaceutical companies hailed the non-addictive quality of prescription opioid pain relievers. Healthcare providers began prescribing opioids for pain at greater rates, and the rate of opioid overdose began to increase. One study found that around 21 to 29 percent of people prescribed opioids for pain misuse them.
Combining opioids with other drugs, like benzodiazepines (drugs like Xanax) and cocaine, or alcohol, makes them more dangerous and puts users at an even greater risk of death.
As if the death toll is not upsetting enough on its own, the financial cost of the opioid crisis to America is great— overall, the cost of prescription opioid abuse in the U.S. in 2013 totaled $78.5 billion (NIDA).
Who is using opioids?
The age of the opioid crisis is young, with 2.5 million Americans aged 18-25 misusing an opioid in just the last year, as well as 2016 (National Institute of Health). In 2016, one in five young adult deaths was opioid-related. Opioid abuse and death affects Americans of all ages, however; overdose rates from prescription opioids in 2016 were highest among those aged 25 to 54 (CDC).
Opioid exposure following routine surgeries puts patients at risk for developing an opioid dependence. A recent study found that taking prescription opioids for pain after wisdom teeth removal nearly triples one’s risk of long-term opioid use; most of the patients who develop an opioid addiction from prescription medications are in their late teens and 20s. Half of young people who are heroin users report abusing prescription opioids first, according to a spokeswoman with the NIDA.
What are the signs of opioid addiction?
Signs of an opioid problem might include:
- Misusing prescription opioids (e.g. taking more than prescribed, injecting or snorting pills)
- Seeking ways to obtain additional prescriptions (e.g. “doctor shopping,” requesting drugs for nonexistent pain)
- Engaging in high-risk behaviors, such as unprotected sex, needle-sharing, or mixing opioids with other drugs or alcohol
- Planning activities around opioid use
- Obsessive thoughts surrounding opioids/thinking you need opioids to function
- Withdrawal symptoms and/or opioid cravings upon cessation of opioid use
What is America doing about the opioid crisis?
At the federal level:
Department of Health and Human Services (HHS). The HHS is focusing its efforts on: improving treatment/recovery services access; promoting the use of overdose-reversing drugs, such as Narcan; strengthening department understanding of the opioid crisis through better public health surveillance; supporting pain and addiction research; and advancing better pain management practices.
National Institute of Health (NIH). The NIH is focused on researching new, improved ways to prevent opioid misuse, appropriate treatment for opioid abuse, and better pain management.
White House. In June, the federal government, in collaboration with the Truth Initiative, a non-profit public health organization dedicated to creating a tobacco-free youth culture, launched a multimillion dollar anti-opioid campaign targeting young adults. The ads depict reenactments of real-life addiction stories: a young woman crashes her car into a dumpster, a young man closes his arm in a door to break it, and another young man smashes his hand with a hammer— all to obtain prescription opioids.
The 21st Century Cures Act (2016) allocated over $1 billion in opioid crisis grants to states over a two-year period to fund expanded treatment and prevention programs. In February, President Trump authorized $6 billion toward funding opioid programs in 2018 and 2019 after declaring the opioid crisis a public health emergency in July 2017.
At the state level:
Needle exchange programs. Whether needle/syringe exchange programs encourage drug use is hotly debated in the U.S. If someone is going to use drugs, wouldn’t it be better if they have a safe, clean space to do so? On the flip side, does the presence of sterile needles and biohazard depositories give drug users the green light to shoot up? There are over 300 needle exchanges— places where drug users can safely dispose of used needles and obtain sterile ones— in 39 states.
Safe injection sites. Safe injection sites are what they sound like— sterile places where drug users can safely inject drugs and limit the potential spread of contagious diseases like HIV and Hepatitis C. These sites are supervised by medical staff who can administer Narcan in the event of an overdose. In spite of the potential life-saving power of safe injection sites, there has been a lot of resistance in the U.S.— mainly because people believe that, like needle exchanges, safe injection sites may encourage drug use— but there are at least 13 efforts underway in cities such as Seattle, Philadelphia, Denver, and San Francisco.
Fentanyl test strips. Several U.S. cities— San Francisco, Philadelphia, and Burlington, Vermont— have begun offering free fentanyl test strips that people can use to test drugs like heroin and cocaine for the presence of fentanyl.
Narcan boxes. Last year, officials in Cambridge, Massachusetts, considered placing Narcan boxes around the city to give the public the power to reverse overdose on the street, but no action has been taken since. Narcan, a naloxone nasal spray that can reverse the effects of opioid overdose, is now available without a prescription in pharmacies across the country, potentially giving millions access to a life-saving drug.
What can you do about the opioid crisis?
If you have an opioid use disorder:
- Dispose of used needles at a needle exchange or other safe depository site
- Do not share needles
- Do not mix opioids with alcohol
- Carry Narcan in the event of overdose
- Seek treatment
If you do not have an opioid use disorder:
- Dispose of old/unneeded prescription medications
- Do not use other peoples’ prescription medications
- Do not take more medication than you are prescribed
- Do not mix opioids with alcohol
What sort of treatment is available for opioid addiction?
There are several approaches to treating, or mediating, opioid addiction.
Vivitrol. A monthly injectable naltrexone drug, Vivitrol blocks opioid receptors in the brain; in effect, it prevents those addicted to opioids from getting high (Vivitrol blocks the effects of alcohol through the same chemical manipulation). The drug has also been found to curb cravings, particularly within the first several days of injection.
However, opioid users may be at a higher risk for overdose, especially after discontinuing Vivitrol, because a higher opioid dose is needed for the effects to be felt.
Methadone/Suboxone. Methadone and Suboxone are two addictive synthetic drugs prescribed to replace opioids. The ethics and effectiveness of these treatments are widely debated, as both drugs can be misused and create new dependencies.
Narcan. A naloxone nasal spray used to treat opioid overdose, Narcan cannot prevent overdose or curb addiction, only reverse the effects of opioid use.
A holistic approach to treating opioid addiction
Royal Life Centers is a network of full-service drug and alcohol medical detox, residential inpatient, and outpatient— PHP, IOP, OP, sober living— treatment centers. We treat dependence on alcohol, methamphetamine, cocaine, benzodiazepines, and opioids. Our holistic, evidence-based approach to psychotherapy incorporates individual and group sessions and activity, movement, and adventure therapies into one comprehensive program that treats mind, body, and spirit.
At Royal Life Centers, the guest is always our top priority, and we consistently do all we can to effect lasting change, that guests might continue to lead healthy, sober lives long after they have left our care.
If you or a loved one has an opioid use disorder, or any substance use disorder, please reach out to us about your detox and treatment options. Royal Life Centers admissions staff is available 24/7 at (877)-RECOVERY to answer your questions and address your concerns Because We Care.