From President Obama to Prince, Opiate Addiction is a Growing Health Concern

“When you look at the staggering statistics, in terms of lives lost, productivity impacted, costs to communities, but most importantly cost to families from this epidemic of opioid abuse, it has to be something that is right up there at the top of our radar screen.” – President Barack Obama, 2016

pills_HelpThis statement by President Barack Obama is reflective of our national opiate addiction epidemic. Opiates are a class of drugs that include heroin, morphine, and its synthetic analogs: oxycodone, hydrocodone, codeine, fentanyl, and others. These chemicals interact with opioid receptors in the nervous system to produce pleasurable results and relieve pain. They also decrease respiratory drive and are mood depressants.

Drug overdose has been the leading cause of accidental death in the US, with 47,055 lethal overdoses in 2014. Although opiate addiction constitutes 10-20% of all addiction, death by opiate overdose comprises over 50% of lost lives. There is a close correlation between access and use. Sales of opiate medication increased by four times between 1999 and 2004, which was the same increase in both number of addicted individuals and overdose deaths. One of the most recent, high profile overdoses occurred in April when the singer, Prince, died of an accidental overdose of the opiate fentanyl.

 

Use Among Adolescents and Women

Two particular populations heavily impacted by opiate use are adolescents and women. In 2014, 28,000 adolescents had used heroin in the previous year, mostly because prescription agents that they used early in their addiction were too expensive and harder to obtain. Most adolescents polled reported that their first access to these agents were from leftover or unused prescriptions of others.

Additionally, statistics have shown that women are more likely to suffer from chronic pain and be prescribed higher doses of opiates for longer periods of time. Several studies performed by the Centers for Disease Control indicate that women may develop addiction to opiates more rapidly than men. In addition to females overdosing with opiates increasing by 400% (compared to 237% for men during the same time period), overdose death rates have tripled for women from just 2010 to 2013.

 

Recognition and Prevention

Identification of illicit opiate use is often difficult, since in the early stages opiate use usually accompanies a bona fide injury or pain management problem. However, chronic use can lead to tiredness, decreased productivity, diminished interest in previously enjoyed activities, and a change in behavior towards focusing on obtaining the drugs. Physical signs can consist of shortness of breath, dry mouth, constricted (small) pupils, disorientation, cycles of hyper alertness followed by suddenly nodding off, and wearing long sleeves in terribly hot weather.

It is often quite difficult to confront someone abusing these agents, in that so often they are convinced of the necessity of these drugs as medication. It would not be uncommon for someone to self-justify the use of chronic opiate medication for back pain or migraine headaches, even when all recent literature indicates that long term use lowers one’s pain threshold, thereby worsening the benefit of these agents even in the short term.

Prevention is best summed up by one word: access. Although the United States comprises 20% of the world’s population, we consume 80% of all opiate medication produced. In 2015, 259 million prescriptions were written for opiates, which is more than enough to provide every adult person with a bottle of pills. Recent changes in FDA guidelines, passed by Congress on July 13, 2016 and forwarded to the White House for Presidential approval at press time will change prescribing habits of physicians and access to treatment for impaired persons. Newer and safer pain management options will be available before opiates can be used.

 

Treatment

Finally, treatment options have been expanded and insurance companies are now recognizing that one of the best approaches towards treatment is rapid and early referral. Insurance companies and public programs may be able to provide access to group and individual therapy, medically-assisted replacement and craving suppression (such as methadone, suboxone, and Vivitrol), and residential treatment if necessary. These programs are supported by aftercare programs in an effort to decrease misuse, abuse, addiction, and stigma. In addition, Employee Assistance Programs (such as the District’s Claremont EAP), are often able to provide on-going case management to assure that patients stay focused on recovery once primary treatment is complete.

The new century ushered in a group of medications intended to ease physical pain and suffering, and its second decade will end with rational pain management that does not lead to anguish and addiction.

 

Resources and Support

Avante Health LogoIf you need to seek mental health or substance abuse treatment, Avante Health is here to assist you. The first step in this process is to call and speak with one of our clinical staff. They will evaluate your needs and make the appropriate referrals. The number to call is (559) 261-9050 or you may also visit the Resources and Tips page for more details on Avante Health services and resources.

 

Employee Assistance Programs (EAPs) are often effective in motivating employees to seek help. EAP counselors routinely screen for substance use and are well-positioned to facilitate referrals to treatment programs. Claremont EAP provides you and your family members in the immediate household with free and confidential counseling sessions for issues such as addiction, depression, anxiety, stress and grief. Call Claremont EAP at (800) 834-3773 for a referral for counseling.

 


References

  1. The author conducted an independent analysis of the National Survey on Drug Use and Health (NSDUH), 2010. The data and materials can be found here: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/64External link, please review our disclaimer.
  2. The author conducted an independent analysis of National Survey on Drug Use and Health (NSDUH), 2004- 2010. The data and materials can be found here: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/64External link, please review our disclaimer.
  3. Data on the number of people who abused or were dependent on pain medications can be found here: http://www.samhsa.gov/data/NSDUH/2011SummNatFindDetTables/NSDUH-DetTabsPDFWHTML2011/2k11DetailedTabs/Web/HTML/NSDUH-DetTabsSect7peTabs1to45-2011.htm#Tab7.40A.  To determine the percentage of people who used heroin among those who abused or were dependent on pain medications the authors conducted an independent analysis of National Survey on Drug Use and Health (NSDUH), 2010. The data and materials can be found here: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/64External link, please review our disclaimer.
  4. The author conducted an independent analysis of National Survey on Drug Use and Health (NSDUH), 2004- 2010. The data and materials can be found here: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/64External link, please review our disclaimer.
  5. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760,DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.This publication may be downloaded from http://store.samhsa.gov. See Table 9, page 34.
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