The epidemic nobody saw: The opioid crisis in America
By Dr. Louise Stanger, Ed.D, LCSW CIP
A tidal wave of loss
Like a tidal wave that comes crushing to shore over the past year, the President, States, national news media, and families who have lost loved ones have cried out in crushing alarm about the tragedies of opioid addiction and overdose. With Prince’s untimely death, the tide has turned and there is not a news media outlet that does not feature this over sweeping dilemma.
We invite you to continue reading to learn more. Then, join us for some Q&A in the designated section at the bottom of the page. We welcome your questions and try to provide personal and prompt response.
The history of opioids in the world
Opioids have played a unique role in society. They are widely feared compounds, which are associated with abuse, addiction and the dire consequences of diversion; they are also essential medications, the most effective drugs for the relief of pain and suffering (Portenoy et al, 2004). Historically, concerns about addiction have apparently contributed to the under treatment of disorders widely considered to be appropriate for opioid therapy, including cancer pain, pain at the end-of-life, and acute pain (Field and Cassel, 1997; Schnoll & Weaver, 2003; Portenoy & Lesage, 1999; Breitbart et al. 1998; Smith et al., 2008)
The Sumerians in Mesopotamia were among the first people identified to have cultivated the poppy plant around 3400 BC. They named it Hul Gil, the “joy plant” (Booth, 1986). It eventually spread throughout the ancient world to every major civilization in Europe and Asia and was used to treat pain and many other ailments (Schiff, 2002; Askitopoulou, Ramoutsaki, & Konsolaki, 2002; Booth, 1986; Dikotter, Laaman, & Xun, 2004)
Developments in the 19th century transformed the practice of medicine and initiated the tension between the desire to make available the medicinal benefits of these drugs and recognition that the development of abuse and addiction can lead to devastating consequences for individuals and for society at large (Booth, 1986; Musto, 1999): http://www.opioids.com/timeline/
The history of opioids in the U.S.
During most of the twentieth century, the widely held perception among professionals in the United States was that the long-term use of opioid therapy to treat chronic pain was contraindicated by the risk of addiction, increased disability and lack of efficacy over time. During the 1990’s, a major change occurred, driven by a variety of medical and nonmedical factors. The use of opioids for chronic pain began to increase, showing a substantial year-to-year rise that continues today.
This increased use of opioids for legitimate medical purposes has been accompanied by a substantial increase in the prevalence of nonmedical use of prescription opioids (Zacny, et al., 2003). The National Survey on Drug Use and Health reported that the number of first time abusers of prescription opioids increased from 628,000 in 1990 to 2.4 million in 2004, that emergency room visits involving prescription opioid abuse increased by 45% from 2000 to 2002, and that treatment admissions for primary abuse of prescription opioids increased by 186% between 1997 and 2002 (SAMHSA, 2004a, 2004b). Opioid abuse incidents rose most for two frequently prescribed opioids, hydrocodone and controlled-release (CR) oxycodone (Cicero, Inciardi, Munoz, 2005).
Current opioid drug abuse in America
Today it is estimated that between 26.4 million and 36 million people abuse opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin. The consequences of this abuse have been devastating and are on the rise. For example, the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States.
The number of prescriptions written for opiods like hydrocodone and oxycodone products went from about 76 million in 1991 to 207 million in 2013 with the US being the biggest consumers. Several factors are likely to have contributed to the severity of current drug abuse:
1. A drastic increase in the number of prescriptions written and dispensed.
2. Greater social acceptance of drug use and aggressive marking by pharmaceutical companies.
3. Increases in dosage and frequency, and the common misconception that if a person comes in seeking a high dosage for pain relief it did not mean that he was addicted to opioids rather he would just need more opioids to control the pain. David Kessler NY Times March 15, 2016
WHY the switch from prescription pills to street heroin
So, how did we get from prescription pain killers to illegal dope or heroin? About 5.1 million Americans abuse painkillers and about 0.3 million Americans use heroin, according to the National Institute on Drug Abuse. Because both are opiates, there’s a certain fluidity between the two drugs with users transitioning from one to the other. In almost all cases, the switch is from prescription drugs to heroin.
Over the last several years drug-makers have introduced tamper-resistant painkiller pills, which are impossible to crush, liquefy, and inject, and at the same time, lawmakers have established more restrictions, such as prescription-drug monitoring programs. Together, these two changes have resulted in greatly reduced access to pain pills. Folks that were addicted were left high and dry when new regulations came into play and so there only recourse was to buy street drugs.
The face of today’s opiate addict
Researchers from Penn State University headed by Dr. Shannon Mannat and Dr . Khary K Rogg from the University of South Florida discovered that the simultaneous use of heroin and prescription drugs has increased among whites, especially young white males. Using data from the 2013 National Student on Drug Use and health they were able to identify characteristics of people who use heroin only, groups that used both heroin and prescription pills simultaneously and those who used only prescription pills.
Their findings suggest that different treatment modalities may be necessary for different groups. There is also a trend today that heroin, which was primarily an urban drug, has found its way to rural backroads as well. The three groups which were discovered are:
1. Heroin Only
This group was the most economically disadvantaged group, least likely to be white, have children living with them, least connected to religious services, and least physically healthy. Heroin only users are also most likely to live in large urban areas and most likely to have legal offenses.
2. Heroin and Prescription Painkillers
This group was more likely to have the worst outcomes. They are the most likely to have medical problems (HIV espcially), ER visits, and overdose. Most likely to have started using in their teens, greater risk for co-occurring mental disorder and more likely to shoot (intravenously) rather than snort.
3. Prescription Pills and Patches
This group was most connected to social institutions (marriage, religion, employment), best mental health, and not likely to live in high density urban areas.
Worried about a loved one? 19 signs of opioid addiction
No matter what category the opioid user may fall into and no matter what their age, loved ones will be worried. If you suspect that someone close to you may have a problem with opioid use, there are tell-tale signs that can help you identify the problem. A person may be an addict if they:
- Hide the use of alcohol and other drugs.
- Take multiple prescriptions from multiple places ( people walking around with random prescriptions, doctor shopping, internet shopping, etc.)
- They lie and cheat loved ones.
- Do not show up for meetings or work or get fired from jobs.
- Are suspects in cases of missing money.
- Have legal problems.
- Have a short temper.
- Do not remember what they said or did (a.k.a. brown outs or black outs).
- Deny there is a problem, blame others, display an explosive behavior when confronted.
- Need increased frequency and dosage of painkiller. I.e. pain is worse not better, they need more to feel ok, and take more not less (tolerance).
- Display signs of physical use such as shallow breathing, constipation, sleeplessness, runny nose, hot and cold sweating, yawning.
- Start to manifest itchy skin.
- Show needle marks, dry mouth, blurred vision, rapid blinking of eyes, tiny pupils, skin blotches, etc.
- Experience new physical or mental health problems (talking to self, hallucinating, walking around streets yelling).
- Change the way they dress.
- Complain of hallucinations, severe confusion , mania, substance induced psychosis, severe throbbing pain.
- Feel guilt and shame (doing things that are inconsistent with values).
- Spend an inordinate amount of time spent on getting and using drug.
- Display isolated behavior and social withdrawal.
HELP is available – Interventions can and do work
Substance Abuse and Mental Health disorders are diseases. If your loved one had a heart attack or diabetes or a broken leg you would reach for help. Blaming, yelling, nagging, screaming scolding, or even taking to your loved one when they are under the influence will not change the situation. Rather only you will get more upset.
On the other hand, working with a professional who can help guide and coach you through this is advisable and there are many good folks out there.
I specialize in what are called “invitational interventions”, a systematic process that helps everyone involved accept that the person they love and value has a serious problem. In its clearest form , an intervention is an invitation for your loved one to find solutions for their substance abuse and or mental health problems they are experiencing, seek treatment and discover new ways of living.
If you are worried about your loved one, then reach out and give a call. Interventions and addiction treatment do work for loved ones and those that are significant in their lives.
Is that easy? -No.
Is it Possible? – Unequivocally Yes!
Opioid epidemic and addiction questions
Do you have any questions or are looking for ways to help an opioid addicted loved one? Please post them in the designated section below. We try to provide a personal and prompt response to all legitimate inquiries, or refer you to someone who can help.