By Abinav Sankaranthi, May 2018.
What replaced the neighborhood ice cream truck in many regions of America?
As many children, teens, and adults in America succumb to the highs of opioid addiction, the neighborhood ice cream trucks seem to be replaced by truck loads of addictive drugs to meet the demands of addicts. Thousands of Americans grapple with opioid addiction on a daily basis.
Dana Reisman from New Jersey was found in the hallway of her home, face down, cold, and blue when her parents returned from work one day. Dana was a member of her school swim team and a cheerleader in both junior high and high schools. She was trapped in a cycle of addiction, treatment, and relapse according to an article written by her mother, Kim Farinick that was published in a community blog from drugpolicy.org. Her mother wished she had the opioid overdose antidote, naloxone, that could have saved her daughter who died at the age of 22. There are many others like Dana who are clenched by the claws of opioid addiction and die of overdose.
The Proliferation of Opioids in the Suburbs of America (Source: Flickr)
The Opioid epidemic has been the cause of a drastic toll in the lives of many Americans. To put this in perspective, according to an article by the VOX, in 2016 “drug overdoses killed more Americans than the entire Vietnam War, car crashes, gun violence, and HIV/AIDS ever did in a single year.” Everyday, over 115 people die of an opioid overdose in the United States. Prescription opioid misuse in the US is $78.5 billion per year as per the estimates from the Center for Disease Control and Prevention. A 2015 national survey of drug use and health estimated that 91.8 million non-institutionalized adults used prescription opioids. Out of that, 11.5 million misused these drugs and 1.9 million had a use disorder. The rapid rise of the opioid epidemic has caused a plethora of lethal effects on Americans. If nothing is done, thousands of people will die. A projected estimate by STAT revealed that around 650,000 people will die in the next 10 years from opioid overdose -- that is equivalent to the entire city of Baltimore. This deadly opioid overdose crisis, that can potentially engulf an entire American city in just one decade, must be eradicated.
Opioids are prescription drugs that are used for the purpose of pain relief. Many patients with severe medical issues rely on these pain medications to help them live normal lives. However, prescription opioids have a variety of side effects. The majority of these drugs are extremely addictive. Consequently, many patients become hooked to these drugs, leading to overdoses and deaths.
In an article by the organization American Action Forum, drug overdoses are the primary cause of death for Americans younger than 50 years old. The article also states that the life expectancy of Americans has decreased by 2 months, which is shown to be related to America’s opioid crisis. The opioid epidemic has been prevalent for years and is the cause of an estimated 42,000 deaths per year. In addition, the American Action Forum also states that “there were more than 30 non-fatal overdoses for every opioid-related death”. Clearly, this shows that the public health emergency of opioids is rising and is in dire need of a solution.
Before looking at the various actions taken to reduce this epidemic, we must understand the reasons why the opioid crisis has come into play. First of all, according to The Hill, in the late 1990’s, doctors and health care providers were being put under scrutiny for the under-prescription of pain relieving medication. Thus, there were many advocates for the long-term use of opioids to treat chronic pain. Pharmaceutical companies all rushed to create a product to help those with chronic pain. These companies decided to market and advertise their product as non-harmful and non-addictive. However, the shift to overprescription and overproduction of prescription opioids have caused many to succumb to their addictive powers. The increase in the misuse of prescription drugs led to a slight restriction and a crackdown on prescriptions, but this did not stop many addicts. Many Americans in this boat have switched to illegal or synthetic opioids, a cheaper, more abundant, and easier to obtain set of drugs that can fulfill the addiction. A popular illegal opioid called Fentanyl is considered 50 times as strong as Heroin and is manufactured in China at minimal costs. Then it is imported illegally into the United States. The result is the rapid increase in overdose deaths of addicts who are not aware of Fentanyl’s narcotic strength. Clearly, there are many to blame for this mortifying crisis; however, the steps taken to slowly eliminate this problem should be focused on combating the issue.
Currently, doctors and drug companies are trying to stop the number of opioids being prescribed to limit cases of drug abuse. However, many opioid addicts are looking to illegal and cheaper alternatives to continue to consume without regard to their health and economic welfare.
According to the Politico, Dr. Rahul Gupta and his team in West Virginia has been working to find a solution to the Opioid epidemic in his region. They looked through data of all cases of opioid overdose and prescriptions in their region to figure out the most prevalent group of people susceptible to opioid addiction.
“Men were twice as likely as women to die of an overdose. And those with jobs in blue-collar industries like construction had a higher risk of overdosing than the general population, likely because they take prescription opioids or illicit substances to deal with chronic pain from injuries.”
Dr. Gupta and his team were able to reduce the cases of opioid overdose significantly in West Virginia, by limiting initial prescription and increasing the supply of naloxone (drug that combats opioid overdose) in all areas to reach as many people as possible who have access to this life-saving drug. Dr. Gupta knows that naloxone is not the final cure for the opioid crisis, rather, it is just a temporary bandage. He states that treating addiction is the main issue that needs more addressing if the crisis is to end.
The use of opioids for medicinal purposes can be seen throughout history from early civilizations to today. However, it was not until the early 1900’s where the war on drugs became prevalent. During the 1900’s there was a controlled effort to restrict the prescription of drugs. Doctors were scared to overprescribe drugs in fear of patients becoming addicted. However, this restrictive control of opioids caused many to claim that under prescribing patients is causing suffering to those with painful diseases, especially cancer. As the chart shows, from the late 1990’s to 2010’s there was a shift in the prescription landscape of opioid drugs. Pharmaceutical companies tried to market their drugs as life-changing painkillers, but the impacts of these opioid drugs were much worse.
The misuse of prescription drugs has led to many cases of overdose and death. The dramatic increase in consumption and prescription of opioids leads us to the epidemic where many lives are being taken control of by these addictive painkillers. From the 2010’s to today, many states in the US are coming to a realization of the massive negative effects of opioids and are implementing prescription drug monitoring programs and educational services to try to combat this issue. However, there is a constant debate on what can be done to slow the progression of this epidemic to hopefully end it for good.
US overdose deaths caused by specific drugs. (Source: Wikimedia Commons)
An abundant and cheap supply of drugs claims many victims of this opioid epidemic. Currently, the Opioid epidemic has an immensely devastating impact on the lives of a vast number of Americans. The graphic on the left, by the US Department of Health and Human Services, summarizes the shocking number of people who are affected by opioid drugs. Too many of our fellow Americans lives are put at harm through the spread of this crisis. Clearly, It is seen that there must be a change in this unacceptable status quo.
The numerical effects of the opioid epidemic by the US Department
of Health and Human Services. (Source: hhs.gov)
According to the VOX, experts are prioritizing the efforts to fight this crisis into four categories: treatment, demand, harm reduction, and supply. All experts agree that each category requires some amount of pursuit or investment and there is no one cure that can solve this issue. The increase in access to addiction rehab and treatment medications that combat addiction to opioids can be beneficial in resisting the urge for addicts to consume these deadly drugs. People who are most susceptible to become addicted to opioids reside in poorer communities. Thus, tackling the economic issue on the community scale can help reduce the occurrences of opioid addiction and overdose. Furthermore, the use of Naloxone, a drug that helps reduce the effects of opioids can help save lives for those who are overdosed. However, they are hard to find and not available in many public health facilities. Having a greater access to these harm reduction drugs can help save lives and greatly reduce the number of deaths caused by opioid overdose. The main issue of the opioid crisis is the overprescription of these painkillers. Thus, it starts with doctors, public health officials, and the government to take more aggressive steps to reduce the amount of prescriptions per year.
Christopher Ruhm from University of Virginia and Bloomberg owner, Michael Bloomberg recommend policies that curb supply and help recovery. A seven step plan that they laid out describes the need to stop doctors from over-prescribing opioids. First, only doctors who undergo specialized training in pain management should be able to prescribe opioids for more than a few days. The medical professionals need to implement effective monitoring programs and should curtail opioid prescriptions. Second, insurers and pharmacy managers must supervise the opioid prescriptions to ensure that people lead healthier lives. Third, pharmaceutical companies must be held accountable for the supply of opioids. Fourth, local and federal governments should take strong action against companies that do pill dumping, when opioids are over-supplied to particular areas. Often times, patients who are overdosed are not offered long-term treatment by the hospitals and emergency rooms that they are taken to. Fifth, more funding and state intervention is needed to start providing long term treatments to these patients. Sixth, politicians and others should stop stigmatizing the medications that have been proven to help with recovery. Federal government should incentivize states to offer treatment for inmates. Ready doses of Naloxone to reverse drug overdoses should be made available for all emergency health workers to treat patients. Seventh, better statistical information and data on misuse and overdose can help with monitoring the the extent of the crisis and implement effective interventions.
There are several complications to solve the opioid crisis. Experts say that billions of dollars are needed to setup the right policies. Funding needs to be set in place and that requires bold political leadership. According to the VOX, illegal drugs come from legal ports of entry. Fentanyl, a synthetic opioid is shipped through mail from China or smuggled through legal trade and transportation routes, based on an article from NPR. These create further complications for addressing the opioid epidemic.
This rise of this epidemic has led many to realize the false claims of pharmaceutical companies and many are taking legal action against them. The government is taking a stance against opioids. According to The Hill, in 2017 President Donald Trump “ declared the crisis a public health emergency and his 2019 budget proposal includes $17 billion to address the epidemic.” President Trump declared that opioid addiction is a public health emergency. However, his administration has not yet taken forceful action to combat the crisis. President Trump’s response to the opioid epidemic advocates for a southern wall to reduce the inflow of illegal drugs into America. His proposal of building a wall on the Mexican border and his declaration of having discussions with President Xi Jinping about heroin imports haven’t alleviated the lethal impact of the crisis. Trump’s strategy is to have stricter law enforcement efforts and get “tough on crime”. As per the Vox, many experts don't believe that Trump’s strategy will be effective and many call it irrelevant. The senior vice president at the National Council for Behavioral Health, Chuck Ingoglia summarized the general takeaway of experts:
“A lot of talk, little action. It’s great that the president says this is a priority. It’s great that he convened a task force so we have another paper that says the opioid crisis in America needs attention. But too little has happened to actually do anything about it.”
Considering the astonishing number of Americans addicted to opioids today, the most needed solution is to focus on treatment programs. Expanding access to medication-assisted treatments which show evidence of cutting mortality rates by more than half is the most reasonable and impactful solution. Furthermore, expanding Medicaid, a primary source of funding for addiction treatment is important because interventions work only when individuals have access to quality health care.
The number of opioid deaths are rising rapidly while business in Washington is the usual. The citizens of America should demand more from all the elected officials. Bold and drastic changes are needed to combat the deadliest drug overdose crisis in America and to completely eradicate it. Every one of us can push to make this happen. As a friend, daughter, son, and a fellow human being to those affected we can rise to be the warriors to fight the opioid epidemic. We can vote and elect representatives, senators, governors, and presidents who make significant moves to combat and erase the drug overdose crisis in the United States of America. It will also require our communities to come together to learn how to prevent and confront the thorny issues. Helping vulnerable people mitigate their adversity and creating resilient communities together will be a huge step to prevent opioid addiction. The fight to end the opioid overdose epidemic is a fight to save lives...let us save our friendly neighborhood ice-cream truck from the wrath of the opioid death rider!