To understand America’s opioid epidemic, you first need to define opioids. According to the National Institute on Drug Abuse, opioids are a drug class that include illegal drugs, such as heroin as well as synthetic drugs, such as fentanyl. Included in this class are prescription pain relievers, such as oxycodone, administered under the trademark of OxyContin®, or hydrocodone (Vicodin®). Other substances include morphine and codeine.
An Alarming Problem
What is alarming about the use of prescription opioids, such as OxyContin, is the fact that their use extends to young people at least 12 years old. Part of this problem relates to the “high” created by the drugs. For example, all opioids—prescription and illegal substances—interact with opioid receptors, located on nerve cells in the brain and throughout the body.
While doctors consider an opioid medication, such as OxyContin, safe for short-term pain relief, they do not prescribe it for long-term use. That is because OxyContin and similar medicines produce a feeling of euphoria, besides pain relief.
In turn, OxyContin may be misused, with some patients taking a larger quantity than what the doctor ordered. Regular use—even under a doctor’s care—can trigger dependence, which can lead to addiction, overdoses, and even death. Physicians administer a drug, naloxone, when a patient overdoses on a drug, such as OxyContin.
While the use of prescription opioids has dwindled to some degree, it has not prevented an increase in overdose deaths, especially from heroin. Fortunately, medicines exist that treat opioid abuse. These medicines include naltrexone, buprenorphine, and methadone. One study also showed that a treatment of naloxone and buprenorphine and an extended release of naltrexone treats opioids addiction satisfactorily.
What Arizona Statistics Reveal
According to one report, released in August 2018 by the Centers for Disease Control and Prevention, the use of opioids reached crisis proportions in terms of overdoses (ODs). In Arizona alone, prescription opioids and heroin drove fatal ODs up to 20% in 2017. Arizona officials believe that opioid use in the state is a “full-blown crisis.”
Reports from the Arizona Department Health Services (ADHS) show that 949 Arizonans died of opioid overdoses in 2017. In 2016, the number of opioid overdoses tallied 800. The number in 2017 was more than double 2012’s total of just over 450 deaths in the state.
Heroin accounted for just over half of the opioid surge, killing 344 users in 2017, up from the 311 deaths reported the previous year. Heroin also accounted for 36% of the deaths from opioid overdoses. Moreover, synthetic and prescription opioids tallied 605 deaths in 2017, up from 489 overdose deaths in 2017.
How Arizona Is Handling the Opioid Crisis
Like the rest of the US, Arizona continues to struggle with opioid abuse. However, medical professionals note good progress in terms of patient referrals to treatment programs after an overdose. In fact, centers, such as Recovery Oasis in Tempe, Arizona realized a 45% increase in 2017 and a whopping 73% increase in 2018. Those numbers, combined with a drop in opioid prescriptions (40%), show that Arizona continues to make a concerted effort to address opioid use and addiction.
The ADHS also reports that it will launch a chronic pain program and will license pain management facilities in 2019. In addition, the state plans to track real-time data from first responders and healthcare professionals who report incidences of suspected overdoses.
A Problem across the Globe
Whether you live in Arizona or any other place in the US, the abuse of prescription pain relievers or opioids, such as heroin, continues to be a problem – an issue that affects a community’s economy and social well-being.
However, this problem is not confined to the US, as opioid use and addiction prevails all over the world. Statics reveal that around 30 million people abuse opioids while around 2 million people in the US are addicted to prescription substances, such as OxyContin. Around 450,000 people in the US abuse heroin.
How the Crisis Began
Moreover, in the US, many of the people who are charged with crimes test positive for opiate use. They may either be addicted to OxyContin or heroin.
The current opiate crisis dates back to the 90s, when the pharmaceutical company, Purdue Pharma, introduced OxyContin into the marketplace. The FDA-approved drug, administered for chronic pain, made its debut in December 1995.
By 2000, the use of OxyContin had increased by an astonishing 2000%. Purdue, in turn, profited, realizing revenues of just over three billion dollars – an amount that led to the company’s role as an influencer in the prescription painkiller market.
The Crisis Escalates and So Do the Profits
Purdue shrewdly marketed the drug as being a chronic pain solution for non-cancer type pain. Therefore, the patients perceived the drug as a “cure-all” for all kinds of pain. Sales, in turn, spiked, especially when the FDA-approved remedy became available in a 160-milligram version during 2000. The drug, at the time, was tagged as a pain remedy for people who were tolerant to opiates.
The response to this marketing plan led to epidemic use – recreational drug users and addicts injected, sniffed, and crushed prescription opiates. The effects were likened to the high experienced by users of heroin.
Purdue enjoyed a short-lived success, though, as the company’s ethics were called to the forefront by the US District Court. The Western District of Virginia cited the pharmacy for misbranding OxyContin as a “safe and non-addictive” substance. The branding introduced by Purdue noted that OxyContin was “abuse-resistant.” Purdue supported this claim by stating that the risk of addiction was under 1%.
In fact, OxyContin gained such acclaim as being an “abuse-resistant” drug that the pharmaceutical company convinced doctors of its safety. Some reps told physicians that the drug did not trigger any type of buzz, which led to the filling of millions of prescriptions. Purdue ultimately shouldered $600 million in fines – one of the largest settlements in US judicial history.
Heroin Use Has Increased
Misleading marketing has led to OxyContin use that is simply, in the present day, out of control. Combine legislative mandates, general misuse, and less accessibility, and another issue develops. When abusers of OxyContin run out of the highly priced street drug, they turn to a more accessible and cheaper drug in the form of heroin.
The country’s concern over the opioid crisis has incentivized state government and federal legislators into action. In response to the current opiate crisis, the federal government has created a five-point plan. This plan outlines five methods to fight the current problem. The strategies include the following:
- Improve access to treatment and rehabilitation centers, such as Recovery Oasis in Tempe, Arizona.
- Encourage the use of overdose-reversal medications.
- Strengthen the public’s knowledge and understanding through public health venues.
- Support research efforts in the reduction of pain and the effects of opiate addiction.
- Promote better practices medically in pain management and reduction.
Opioids bind to the brain and spinal cord receptors, thereby alleviating pain. They also release a hormone, called dopamine, which gives users a euphoric high. While opioids, such as codeine and morphine come from opium poppies, heroin is synthesized from the opioid morphine.
As noted, people who depend on pain medications, such as OxyContin, to get high easily switch to heroin when they cannot afford the prescription. While Purdue Pharma has reformulated OxyContin, it does not mean that the drug is preventing abuse.
Purdue Pharma’s Reformulation of OxyContin
The major formulation change, according to Pharmacy Times, is the size of the pill. The larger-sized 80-mg pill makes it more difficult for abusers to break down the pill for smoking, chewing, or snorting.
Many of the people who use OxyContin to get high seek an immediate response, thus the reason for the term “rush” among abusers. However, according to drug investigators, the abuse of OxyContin primarily extends to the street version of oxycodone IR (30 mg.). This high-demand opiate sells on the street for as much as $1 mg.
While it may be harder to break down the new formulation of the prescription medicine, OxyContin, its counterpart, oxycodone IR has plenty of users and abusers. Also, the reformulation of the OxyContin has led to a higher level of heroin abuse. In the interim, legislators are seeking ways to minimize the prescription problem as well the use of illegal opiates.
When you review the emergence of opiate abuse, you can see how misleading advertising, especially by the pharmacy company, Purdue Pharma, has sparked debate and controversy. Even when the FDA, in 2010, approved an abuse-deterrent version of OxyContin, people still found ways to misuse the drug.
One sting operation, dubbed “Operation Pilluted,” centered on health care professionals who dispensed large volumes of opioids. In 2015, the DEA arrested 22 physicians and pharmacists after a 15-month investigation. The FDA approval of the drug made it easy for health care providers to provide patients with this type of “pain relief.”
Opioid Commission Recommendations
One of the responses to the crisis was released by the Opioid Commission in the US. In its final report, the agency made 56 recommendations, including a proposal to establish drug courts across the nation. Instead of placing opioid addicts in prison, the mandates issued by the courts would direct addicts to treatment facilities.
An Advisory by the US Surgeon General
In fact, the crisis is so severe that the U.S. Surgeon general has contributed a recommendation as well. The highest surgeon of the land issued an advisory in April 2018, recommending that US residents carry the reversing drug naloxone. The last advisory issued, over ten years ago, concerned drinking while pregnant.
New Drug Legislation
Current drug legislation—as recent as October 2018—offers provisions that direct researchers to create and find non-addictive drugs for the management of pain. Laws are now in effect that also expand treatment for substance abuse to people on Medicaid.
State Lawsuits against Purdue Pharma
When you read the report concerning the OxyContin and opiate crisis, most experts blame false marketing for contributing to the development. In fact, Purdue Pharma still faces lawsuits from individual states. For instance, Kentucky officials claim that the pharmaceutical company contributed to its statewide medical expenses and opioid-associated deaths and addictions. Other states are making similar claims, with some seeking legal remedies.
Reformulating the Drug – How Abusers Are Getting around It
While the reformulation of OxyContin has been somewhat successful, some patients continue to abuse the drug by using microwaves, spice grinders, or acidic beverages to abuse the drug through nasal use or intravenous (IV) injection.
Review the Facts
When you review some of the factual data regarding the crisis, it puts everything in a clearer perspective. According to the National Institute on Drug Abuse, the following facts emphasize the need for legislators and health care providers to take action. Facts show the following:
- About 25% of prescription opioid patients abuse the drugs.
- Around 10% of patients develop an opioid use disorder or an addiction.
- A projected 5% of prescription opioid users end up using heroin.
- Around 80% who use heroin first abused a prescription opioid.
- Opioid overdoses increased approximately 30% between 2016 and 2017 in 45 states in the US.
- The Midwest saw the most overdoses from July 2016 through September 2017. During that time overdoses increased by 70%.
- Opioid overdoses increased in large cities in the past year by 54% in 16 of the US states.
A Public Health Crisis
When you review the findings, you can only describe opioid misuse as a public health crisis. A rising incidence of a health condition, neonatal abstinence syndrome, is also related to the crisis. The use of injection drugs has also increased the incidences of hepatitis C and HIV.
Steering the Country in a Better Direction
As a result, health care providers, physicians, and pharmacists must work diligently to reduce the number of opioid users. Limiting the prescribed amount of opioids or prescribing alternatives for minor and acute pain must be facilitated now and in the coming years. Careful monitoring of opioid medications is also advised. Overcoming the crisis will be slow-going. However, using different protocols in the use of pain substances will help steer the country in a better direction.