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The Opioid Crisis

What are opioids? Think: prescription pain relievers, fentanyl, heroin

Opioids are pain-relieving drugs derived from opium, i.e. opiates, as well as synthetic drugs that act like opiates, e.g. fentanyl. Common opiates are heroin (an illegal opiate) as well as prescription medications: oxycodone (OxcyContin), hydrocodone (Vicodin), morphine, and methadone. [1] Fentanyl is a synthetic opiate typically used for treating severe pain, e.g. in advanced cancer patients, but is now commonly made and distributed illegally. [1] Biological effects of fentanyl are indistinguishable from those of heroin except for fentanyl is 40-50 times, sometimes up to hundreds of times, more potent than heroin. [2,3]

When did it begin?

A handful of journal articles in the 1980s falsely allayed prescribers’ fears of opioids in stating that addiction is rare with long-term opioid use. [4] Later in the 1990s, a multifaceted campaign underwritten by pharmaceutical companies responding to these articles reassured the medical community that patients would not become addicted to opioid pain relievers. [5] This led professional societies, hospitals, and even state medical boards to advise physicians in prescribing opioids to their patients suffering from pain. Thus, opioid prescription rates began increasing and the current opioid crisis was fueled. [5]

Why is this such a big deal?

Drug overdose is the leading cause of accidental death in the US [6]. About two-thirds of these drug overdose deaths involve an opioid [7]. Everyday in America, about 115 people die from an opioid overdose [7].

In the 1960s, opioid abusers were predominantly young men and 80% of opioid abusers started using heroin as their first-choice of opioid. [8] In the 2000s, however, opioid abusers are seen in all demographics and 75% of them are introduced to opioids through prescription drugs. [8] This reflects a nearly complete reversal in the span of about 50 years.

Local treatment centers in the Permian Basin, especially methadone clinics, report that the vast majority of their clients who claim opioid abuse were using heroin. Why heroin? When prescription opioid addicts are unable to obtain more prescription opioids, they often turn to heroin. Heroin is cheaper and more accessible, often found for a tenth of the price of an opiate pain medication. [9] Furthermore, in late 2013 to early 2014, fentanyl began making its appearance. [10] Fentanyl is, often unknowingly, mixed with heroin and sold to buyers looking for a stronger high. [10] The Drug Enforcement Administration (DEA) now warns law enforcement about fentanyl and urges detectives to forego field testing of the drug, as some detectives have collapsed after inhaling a small amount of fentanyl due to its potency. [3]

What has the response been?

Opioid addictions are a clear public health problem, but prescription opioids are still in high demand for people with physical pain. In 2016, the Centers for Disease Control and Prevention (CDC) released a “Guideline for Prescribing Opioids for Chronic Pain” in response to the opioid crisis. [11] There have also been a number of prescription drug monitoring programs, national strategies and plans, and task forces initiated, as well as, most recently, a national public health emergency declared directing certain federal agencies to provide more grant money to combat the epidemic. [12,13]

For now, optimal treatment for opioid addicts consists not only of counseling and social support groups, but also of physician-prescribed methadone. Methadone is a medication that lessens the pains of withdrawal for an opioid addict and blocks the euphoric effects of opiates. [14] Opioid addicts seeking treatment have the best chance of overcoming their addiction by not only seeking rehab but also taking methadone. [14] Methadone can be addictive as well and requires a withdrawal process once completing treatment, but it is considered effective as part of a comprehensive program in treating opioid addictions. [14]

Kayla Fishbeck

Regional Evaluator

Region 9 Prevention Resource Center

kfishbeck@pbrcada.org

References: [1] Centers for Disease Control and Prevention. Opioid Overdose: Opioid Basics. Accessed February 28, 2018, <https://www.cdc.gov/drugoverdose/opioids/index.html>

[2] U.S. Drug Enforcement Administration. Drug Fact Sheets: Fentanyl. Accessed February 28, 2018, < https://www.dea.gov/druginfo/concern_fentanyl.shtml>

[3] Police Foundation. DEA Officer Safety Alert: Fentanyl Can Kill You. Accessed February 28, 2018, < https://www.policefoundation.org/dea-officer-safety-alert-fentanyl-can-kill-you/>

[4] Leung PTM, Macdonald EM, Dhalla IA, Juurlink DN. A 1980 Letter on the Risk of Opioid Addiction. NEJM. 2017;376:2194-2195. doi:10.1056/NEJMc1700150.

[5] U.S. Department of Health and Human Services. About the U.S. Opioid Epidemic. Accessed February 28, 2018, < https://www.hhs.gov/opioids/about-the-epidemic/index.html>

[6] American Society of Addiction Medicine. Opioid Addiction 2016 Facts & Figures. Accessed February 28, 2018, <https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf?sfvrsn=100c76c2_12>

[7] Centers for Disease Control and Prevention. Opioid Overdose: Understanding the Epidemic. Accessed February 28, 2018, <https://www.cdc.gov/drugoverdose/epidemic/index.html>

[8] Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United StatesA Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. 2014;71(7):821–826. doi:10.1001/jamapsychiatry.2014.366

[9] CNN. Unintended consequences: Why painkiller addicts turn to heroin. Accessed February 28, 2018, <https://www.cnn.com/2014/08/29/health/gupta-unintended-consequences/index.html>

[10] Centers for Disease Control and Prevention. Increases in Fentanyl Drug Confiscations and Fentanyl-related Overdose Fatalities. Accessed March 1, 2018, <https://emergency.cdc.gov/han/han00384.asp>

[11] Frieden TR, Houry D. Reducing the Risks of Relief – The CDC Opioid-Prescribing Guideline. NEJM. 2016;374:1504-1504. doi:10.1056/NEJMp1515917

[12] Centers for Disease Control and Prevention. Opioid Overdose: What States Need to Know about PDMPs. Accessed March 1, 2018, <https://www.cdc.gov/drugoverdose/pdmp/states.html>

[13] U.S. Department of Health & Human Services. HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis. Accessed March 1, 2018, <https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html>

[14] Substance Abuse and Mental Health Services Administration. Medication-Assisted Treatment: Methadone. Accessed March 1, 2018, <https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone>


Published March 1, 2018.

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