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Causes of the Opioid Epidemic

Opioids are drugs used to treat pain. Some are derived directly from the opium poppy, while others are totally synthetic, but have the same actions as opium-derived drugs because they act on the same receptors in the brain. Technically, drugs derived directly from the opium poppy are known as opiates, while semi-synthetic and synthetic drugs that have the same actions are called opioids. The terms are often used interchangeably, but for the purposes of this article we will use the opioid term.

Over 100 people a day die from opioid overdose. That’s more than are killed by car accidents and gun violence. The epidemic has spared no part of the country, but Ohio, Virginia and especially New Hampshire have taken the hardest hits.

Some facts about the opioid epidemic from 2015:

  • Prescription painkillers were misused by 12.5 million people. Misuse means using a drug in some way other than what it was intended for
  • Over 33,000 people died from overdose
  • Over 800,000 people used heroin
  • Almost 10,000 deaths from using fentanyl and other synthetic opioids
  • 2 million with a disorder related to the use of prescription opioids

Just a few days ago, in October 2017, President Trump declared a national public health emergency related to the opioid epidemic. But what caused it in the first place?

The Causes are Multifaceted

The causes of the epidemic are many. Most of it was unintentional. In fact, many doctors, in a misguided effort to reduce their patients’ pain, inadvertently over-prescribed powerful opioids such as hydrocodone and oxycodone without adequate supervision. They didn’t realize that the strong role that genetics and family history can play in the addiction process. They were trying to help.

The Medical Industry

The pharmaceutical companies played their part as well. They always have their eyes on the prize, often putting profit over safety. In 2007, Purdue Pharma, the makers of the powerful opioid OxyContin, admitted to lying to doctors and patients about the risks and addictive potential of their product. Several company executives pled guilty to a variety of federal charges.

Insurance companies may have played a role, too. They may be guilty of allowing payments on large amounts of cheaper, but addictive, opioids, while limiting patient access to certain drugs which may have been appropriate, and yet carried low to no risk of addiction.

To some degree, the lack of affordable treatment facilities has fueled the epidemic. Withdrawal from opioids, particularly strong ones, is very painful. Many people who might seek treatment if it were available just aren’t going to go through the withdrawal process alone and without detox assistance. There are many drugs, such as suboxone, which greatly reduce the withdrawal symptoms. If addicts had access to treatment centers, that might abate the situation, at least to some degree.

Then there are the social issues. Poverty, hopelessness and unemployment have always been and will always be factors in drug abuse of all types.

Heroin

Deaths from heroin use have skyrocketed. In 2016, over 13,000 people died from heroin overdoses. Why? What is the cause of the heroin epidemic? There are two main reasons. One, many doctors are now limiting or eliminating their prescriptions for strong opioids. Addicted patients, no longer able to get their drug legally, would seek out illegal sources on the black market, where prices can be upwards of 30 times higher. A single 30mg tablet of oxycodone can sell on the street for $30 and even more.

But not many people can afford that for long, if at all. So they turn to heroin, which is far cheaper and in many locations, quite powerful. Powdered heroin, or China White, is especially prized because it can be smoked or snorted.

The problem with any unregulated drug is that the user never knows what they are getting, especially in terms of purity and strength. Unlike pharmaceutical drugs, which are produced in laboratories under exacting conditions and which are also tested before sale, street drugs are always an unknown. Enter fentanyl.

Deaths from Fentanyl

More than 20,000 people died from fentanyl overdose in 2016. Fentanyl is a powerful synthetic opioid some 25-50 times stronger than heroin. It’s made cheap in Chinese laboratories and smuggled to the US. It’s not unusual for dealers to substitute fentanyl for heroin, or to cut the heroin with it, and sell it as China White. Users don’t realize they’re getting a drug far stronger than what they’re used to. They use it, and they die.

Even worse, fentanyl has extremely powerful chemical cousins known as analogs. One in particular is known as carfentanyl. It’s some 10,000 times stronger than morphine and is used to immobilize huge animals such as hippos and rhinos. Just 3 milligrams of carfentanyl will knock out an elephant. It’s not hard to understand why carfentanyl is killing so many people today.

What Now?

We can’t unwring the bell, nor can we legislate morality. However, most states are taking steps to at least stem the flow. Almost all now have databases that keep records of all controlled substances dispensed to a patient, and also there are regulations about identification requirements. In California, a pharmacist must either know the patient personally, or else require positive identification before dispensing any controlled substance. In most states there is not only a database, but laws that require doctors and pharmacists to use it before dispensing a controlled substance. Some states even have rules about how much of an opioid can be dispensed at one time, and for what purpose. In New York, early refills are virtually forbidden regardless of the reason.

Some doctors object, saying these rules tie their hands and cut into time they need to care for patients. They may have a point, but as long as people continue to die from opioids, there will be pressure to do something about it.

Laws are only going to be able to do so much. There is also a strong factor of personal responsibility. There’s just no easy answer. Most likely the epidemic will continue for some time.

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