Opioids in America
By CareerSmart® Learning Contributor, June 8, 2017, as published by Healthcare Hot Spot
For healthcare professionals, the word “opioids” brings to mind prescription opioids, like oxycodone (e.g., Percocet), hydrocodone (e.g., Vicodin), codeine, fentanyl, and morphine to name a few. But to solely discuss prescription opioids is to examine only half the issue. In the United States, “four out of five new heroin-users started out by misusing prescription opioids” (HHS, 2016). In a report by the National Institute for Health, evidence shows that people who began by misusing prescription opioids later shifted to using heroin once prescription opioids became harder to acquire, legally and illegally (NIH, 2014). These statistics and evidence would support the idea that prescription opioids are a gateway drug to heroin use.
The idea that prescription opioids are a gateway to heroin is a scary thought considering that more than 650,000 opioid prescriptions are written every day in the U.S. In 2012 alone, 259 million prescriptions were written for opioids, yet the adult population is only 242 million (HHS, 2016). The core issue is that while prescription opioids are extremely effective at relieving pain, particularly chronic pain, that efficacy comes with a very real risk of addiction for the patient.
While these statistics do not mean that every patient given an Oxycodone prescription will begin using heroin next year, it does mean that patients need to be educated about the risks associated with initiating prescription opioid therapies. In conversation with patients taking prescription opioids for chronic pain, very few understood that when those medications are taken long-term, tolerance and physical drug addiction is essentially expected. For many, this comes in the form of needing a higher dose over time to generate the same pain relieving effects and discomfort when missing a dose. While the physician is the ultimate gatekeeper with a prescription pad, the patient should be involved in their treatment plan. For patients to truly be involved in their treatment plan, they need to be educated about the pros and cons of both short and long-term use of prescription opioids.
Out of the 20.5 million Americans with substance use issues, 2 million of them involved prescription opioids and approximately half a million involved heroin (ASAM, 2016). With those numbers in mind, the rate of people with a prescription drug issue is nearly four times higher than those dealing with heroin. This should raise additional concerns as the country could see a drastic increase in heroin-users over the coming years if trends continue and people move from prescription opioid misuse to heroin.
As a result of the growing opioid usage in the U.S., drug overdose has become a serious crisis with 2015’s leading cause of accidental death in the U.S. being attributed to drug overdose (ASAM, 2016). With over 20,000 overdose deaths due to prescription opioids in 2015, prescription opioids were responsible for nearly twice as many deaths as heroin. Even though prescription opioids are designated as legal medications, that does not make them any less fatal.
The good news is that several government agencies have been working to combat this epidemic that is sweeping small towns, suburbs, and urban areas alike. The Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in March of 2016. These new guidelines establish recommendations for prescribing opioids to adult patients in the primary care setting. In addition, millions of dollars have been awarded to states from the Substance Abuse and Mental Health Administration and the Health Resources (SAMHSA) and Services Administration (HRSA) to help provide people with medication-assisted treatment for prescription drug and opioid addictions. The Health and Human Services (HHS), SAMHSA, and HRSA have all been working to increase access to Naxolone, a lifesaving medication able to reverse opioid overdose that was recently FDA-approved in an intranasal formulation, on top of its injectable predecessor. CURES (which stands for Controlled Substance Utilization Review and Evaluation System) is a database of Schedule II, III and IV controlled substance prescriptions dispensed in California. This drug monitoring program is committed to the reduction of prescription drug abuse and diversion without affecting legitimate medical practice or patient care.
While prescription opioids surely have a place in the treatment of pain, millions of Americans have been affected by the ravaging tolls these legal drugs have taken. Not every person given an opioid prescription starts using heroin, but the vast majority of heroin-users started out misusing prescription opioids. Healthcare workers are on the frontline of this nationwide epidemic, so finding an appropriate and safe strategy to manage patients’ pain is key in helping end it.
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Health and Human Services. (2016). The Opioid Epidemic: By the Numbers. Retrieved from https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf
National Institutes of Health. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
American Society of Addiction Medicine. (2016). Opioid Addiction 2016 Facts & Figures. Retrieved from http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
State of California. Department of Justice. (2017). CURES 2.0. Retrieved from https://oag.ca.gov/cures