Michelle Tribe



Status of the Opioid Epidemic in the U.S.: Respond to the Crisis

The discussion of opioid misuse and the devastating effects of addiction and overdose have become a major subject of concern in the United States. In 2015, Senator Tim Kaine (D-VA) said: “In every corner of Virginia, the drug abuse epidemic is hurting families, challenging local law enforcement and leaving business without a capable workforce.” In 2018, Kaine’s Virginia counterpart, Senator Mark Warner claimed that “opioid overdoses are the leading cause of accidental deaths in Virginia” and pushed for a holistic governmental approach “at the federal, state and local level to stop this deadly epidemic.”

Opioids are one of the most widely used and effective prescription pain relievers. Besides reducing pain, opioids also produce pleasure. An opioid is a compound that is synthetically derived and used to bind opioid receptors in the brain. Oxycodone, Oxycontin, Hydrocodone, Codeine, Morphine, and Fentanyl are commonly used opioids in the U.S. According to a 2018 report from Congressional Digest, heroin, which is derived from opium poppy has the same effect on the body as synthetically made drugs. The revolution in medical research has accelerated the development of new drugs to treat pain.

The opioid epidemic did not happen overnight. The recent increase in the use of opioid pain relievers dates back to the 1990s when doctors began prescribing them. Pharmaceutical lobbying efforts coupled with the promise of a drug to eliminate chronic pain resulted in the decline of legislative restrictions on regulating physicians. As pharmaceutical companies reaped their financial benefits, the unfortunate consequence was a growing demand for prescription opioids and the emergence of the opioid black market. Despite the fact that pharmacies and physicians alike know that opioids are highly addictive, they merely acknowledged the patients’ misuse of the drug rather than admit to the addictive qualities of opioids.

Extended use of opioids, like many addictive drugs, in time, leave unwitting patients to develop a tolerance to the drug. In other words, the drug may no longer be effective in the prescribed manner and the patient requires a higher dosage to alleviate their pain. This is where the sole patient misuse argument fails. Once the patient has developed a tolerance and a chemical need for the drug, the patient is left with few unappealing options. Patients may abuse the drug by increasing their dosages, frequency, or take opioids in combination with other pain relievers. When the drug runs out, patients may attempt to resupply from other patients or seek other physicians willing to prescribe opioids. If these avenues fail, patients take their search for opioids to the street – better known as the black market.

Academics believe that the share of the population reporting illegal drug use peaks among people in their late teens, the time in life when people are experimenting with the limits of personal freedom. When this population runs out of money or can no longer obtain opioid prescriptions, they will settle for cheaper alternatives such as heroin which is known to offer similar effects. Currently, one of the many illegal drugs that is most regularly used and abused in the United States is methamphetamine, commonly referred to as meth. This drug is produced in many different forms, therefore, can be abused in many ways. It can be smoked in its crystallized form, crushed into a fine powder and inhaled through the nose, or even melted down into a liquid form and injected directly into the bloodstream with a syringe. Sadly, misuse and abuse of drugs often lead to overdose, and in some serious cases, death.

Death rates involving cocaine and psychostimulants, with and without opioids have increased between 2016 – 2017. According to the Center for Disease Control and Prevention, in 2017 more than 47,000 Americans died as a result of opioid overdoses. Opioid deaths have quadrupled among individuals 18-25 years old and have tripled for women. According to the most current data from the National Institute of Drug Abuse, as of January 2019, every day, more than 130 people in the U.S. die from opioid overdoses.

Researchers believe that people who abuse prescription opioids are 40 times more likely to become addicted to heroin. The stereotype of heroin addicts tends to be men of low socioeconomic status. It is assumed that these addicts may be homeless, often have low educational backgrounds, and are non-white. Although it may be true that addiction continues to affect members of society in the lower-class population, the National Survey on Drug Use and Health report challenges this generalization. The report shows, between 2002-2004 and 2011-2013, that heroin use has increased the most among the middle-class population and female use of heroin has increased from 50% to 100%. Non-Hispanic Whites showed a 114% increase and the use of those between 18-25-years-old increased by 109% while people 26 years or older increased to 58%. Additionally, the drug use among the middle class has increased to 77% and upper-middle-class to 60%. Among those with private health insurance, the report showed a usage increase of 63%, while those with no health insurance increased to 60%. Fundamentally, the NSDUH data unveils that the opioid abuse transcends that of race, gender, and socioeconomic status.

The middle-class workforce is considered the backbone in the United States. If the increase of the opioid abusers is indeed among the middle-class population, then job performance may suffer, and the number of qualified candidates needed to fill positions may face shortages of supply. The employers who rely largely on skilled labor offered by the middle-class may have to cut back on their operations or shut down completely in certain locations. Does that mean opioid abuse is primarily a socioeconomic problem?

While the path to addiction can be quick and all-encompassing, the path to sobriety and recovery is long, rocky and difficult. Addiction to prescriptions and drugs not only impacts the user but also has the power to cripple their families and home communities. Unfortunately, there are only a few remedies for the addict and their local communities. One method is through punishing incentives such as the incarceration of drug abusers, dealers, and unscrupulous physicians. Critics disagree with this method for its lack of rehabilitative nature and the difficulty for felons to reintegrate into society after completing their prison sentences. Opponents of the criminal justice system see prisons as an incubator for prolonged abuse and argue that isolation from rehabilitative resources does little to address the addiction issue.

An alternative to criminalization, are those that view rehabilitation centers and organizations across the U.S. that offer specialized addiction services as the more proportionate response to support those seeking to overcome their addiction. However, most people are not able to afford rehabilitative services, while others feel unable to take prolonged time off. Despite the overall positive reputation of these rehab facilities, some of them do not accept all insurance and the more affordable facilities face space shortages due to demand. Another reason for the ineffectiveness of some rehab facilities are the underqualified or untrained staff. Some staff do not have the expertise to take mental illness into consideration. Commonly, legitimate mental health illnesses are brushed aside as general emotional issues.

In response to the alarming opioid-related deaths, the Department of Health and Human Services introduced a strategy to promote the use of overdose-reversing drugs such as Naloxone/Narcan, to prevent opioid-related deaths. In 2018, Senator Kaine proposed legislation to enable physicians to prescribe the antidote Naloxone. Public advocates, often led by family members who have lost loved ones to opioid overdoses, believe that the responses from government leaders are not sufficient. Despite the chorus of Congressional support to fight opioid addiction through increased funding, critics assert that the allocated funds are too limited to abolish the epidemic entirely. The lack of proper federal resources is a consistent problem in all states.

Drugs have been around for thousands of years and they are not going away any time soon. Opioid abuse continues to be a growing problem for the middle-class. The creation, distribution, and use of illegal drugs cannot be prevented completely. In order to educate youth and adults, leaders have turned to marketing campaigns to bring awareness and steer the public against the misuse of opioids. In October 2018, Congress passed the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment for Patients and Communities Act – or commonly referred to as the SUPPORT Act. The legislation allocates more funds to be directed to states to help address the issue and restricts how opioid medications can be prescribed.

As Americans, we are quick to condemn anything we may perceive as taboo. Who do we blame for the drug culture? Society as a whole or the failed war on drugs policy that has been buck passed from president to president? Why would people fall prey to the extensive use of drugs? Could it be peer pressure, a desperate need to escape the cruelty of society and the pressures of everyday life, recreational reasons that created a drug culture in the U.S., or the need to medicate an undiagnosed disorder such as depression? As you are reading this, the overdose deaths caused by illicit and other prescription drugs continues.