It’s no secret that the Opioid Crisis is here to stay. In the United States, over 115 people die from opioid overdose, including prescription opioids, heroin, and synthetic opiates like fentanyl. The Center for Disease Control and Prevention (CDC) estimates that the total cost of healthcare, loss of productivity, addiction treatment and criminal justice involvement totals to $78.5 billion a year in the US alone. Worldwide, it is estimated that 27 million people suffer from opioid use disorders but less than 10% of them who need treatment are receiving it. With opioid use and death from opiate use on the rise, how did we get here?
In later half of the 1990s, pharmaceutical companies had prescription opioid pain relievers on the market but there was concern for addiction. The companies reassured prescribers, pharmacists, and the medical community as a whole that patients would not become addicted to prescription opioid pain relievers. This led to an increase of opioid prescriptions, and widespread abuse of these medications before it was clear to the medical community that these were highly addictive. As addiction rose so did the rate of opioid overdose, by 2015 33,000 American had died from opioid overdose. In present day, doctors are more reluctant to prescribe opioids and their costs on the black market have increased. This drives abusers to street drugs such as heroin. In order to keep up with demand, dealers and suppliers cut their heroin with high potency opioids acquired from overseas like fentanyl. Fentanyl is a synthetic opioid used in patients with severe pain needing long term pain management, and it is 50 to 100 times more potent than morphine. Most fentanyl-related harm come from illegally made fentanyl mixed into heroin, sometimes without the user’s knowledge. The opioid epidemic has become a public health crisis with devastating consequences far beyond the users. There is a rising incidence of neonatal abstinence syndrome (infants born who suffer from opioid withdrawals), plus an increase in intravenous drug use increases the spread of HIV and hepatitis C. In order to combat this, some US states are offering safe needle programs and increasing overdose prevention intervention. One of these agents is known as naloxone. Naloxone is an inexpensive medication that can completely reverse the effects of opioid overdose and prevent death from opioid overdose. New opioid prescribing and dispensing programs have been started, along with continued education on safe opioid prescribing practices for prescribers. The World Health Organization (WHO) recommends tackling the opioid crisis with a variety of treatment options, including psychological support, opioid maintenance treatments such as methadone and buprenorphine and supported detoxification and treatment with reversal agents such as naloxone. The WHO also supports countries where these treatment programs don’t already exist. The United States, and the world has acknowledged the opioid crisis, but we are a long way from solving it.
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