America’s Legal Epidemic

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An opioid drug crisis has swept parts of the United States in 2017 as unprecedented numbers of people became addicted—and many died. An opioid is any synthetic or semi-synthetic drug that resembles an opiate (drug that contains opium) in its effects. People most often take opioids—which are legally available by prescription—for pain, but the drugs are highly addictive. The opioid crisis has devastated thousands of families and communities.

Opioid overdose incidents have been widespread and often shocking. For example, a mother collapsed in the stands at a Little League Baseball game in Ohio; an Indiana couple was found unconscious in a running car with two young children in the backseat; and a child called 911 after finding her mother and three adults passed out from overdoses in Massachusetts.

Public health officials have called the current epidemic of opioid overdoses the worst drug crisis in American history. In 2015, the most recent year for which complete data are available, more than 50,000 people died from drug abuse and overdose. Opioids played a role in 33,000 of those deaths. For the first time, deaths from opiate overdose surpassed deaths from homicide with a gun, and overdose deaths were nearly equal to the number of deaths from car crashes. Data from the U.S. Centers for Disease Control and Prevention show the current opioid epidemic has claimed an average of 142 lives each day in 2017.

In the United States, opioid-related visits to hospital emergency rooms have doubled since 2005, and admissions have increased 64 percent. According to a report from the Agency for Healthcare Research and Quality, unit of the U.S. Department of Health and Human Services, American hospitals experienced an average of 3,500 visits per day for opioid-related issues in 2014, compared with 1,800 per day in 2005. While emergency room visits rose for all age groups, the largest increase was seen in adults age 25 to 44. Men and women were equally likely to seek medical care for opioid-related issues over that time.

Although the epidemic is nationwide, certain areas have been harder hit than others. The Appalachian and nearby regions of Kentucky, Ohio, Pennsylvania, and West Virginia have seen the highest rate of opioid overdose deaths, and parts of New England and the Southwest are also far above the national average.

Opioids are any drugs made from or containing opium and other synthetic drugs that have a similar molecular structure. Opium is a dried milky substance obtained from the opium poppy. Opioids have medicinal value as powerful analgesics (painkillers). Morphine and codeine are familiar medications traditionally made from the opium poppy. Heroin was originally developed by the Bayer pharmaceutical company as a replacement for morphine. Today, opioid drugs are available legally only with a prescription from a doctor, and they are meant to treat severe pain.

Today, most prescription opioid painkillers are partly or totally synthetic. These opioids include hydromorphone (sold under the name Dilaudid); hydrocodone (combined with acetaminophen under the brand name Vicodin); and oxycodone (combined with aspirin under the brand name Percodan). Oxycodone is an opioid drug made from a chemical in the opium poppy called thebaine. A popular slow-release form of the drug is sold under the brand name OxyContin. Like their chemical cousin heroin, synthetic opioids can cause people to become physically dependent or addicted.

For many people, addiction to opioids often begins at the doctor’s office or after a visit to the emergency room. When administered under a doctor’s care, opioids are safe and effective. But should patients continue using these powerful drugs, as they increasingly do for conditions that result in chronic pain, the risk of addiction becomes very real. The same chemistry by which prescription opioids dull severe pain can also lead to crippling addiction and drug abuse—and often overdose and death.

After prescriptions run out or become too expensive, addicted people may resort to buying heroin on the street. Despite being illegal, heroin is widely available and cheaper than prescription pills. Heroin is often mixed with other ingredients or spiked with fentanyl, a synthetic opioid 50 times more potent than heroin.

Fentanyl overdoses have overtaken those caused by heroin in some regions of the United States, and the opioid has been increasingly found among drugs seized by law enforcement officers across the country. Fentanyl and other synthetics with a similar chemical structure, called fentanyl analogues, are so powerful that doses equal to the amount of a few grains of salt can be lethal.

A drug called naloxone, marketed under the brand name Narcan, is used to treat opioid overdose in emergency situations. The drug blocks or reverses the effects of opioids, which include extreme drowsiness, slowed breathing, and loss of consciousness. Naloxone is administered through an injection. However, emergency medical teams may be unable to revive people who overdose on fentanyl analogues even after multiple injections of naloxone.

As demand for naloxone has increased in response to the opioid epidemic, the price of the drug has followed suit. Many towns and counties burned through their annual budgets for the life-saving drug half way through 2017. Cash-strapped state and local emergency medical response teams are being pushed to the limit because of the crisis. This drain on resources prevents communities from dealing adequately with other medical care needs, further darkening the nation’s health care situation.

Opioid drugs remain an essential treatment for patients with severe pain, and the United States Food and Drug Administration (FDA) requires all manufacturers of such drugs to demonstrate that they are both safe and effective. However, medical experts recognize that more needs to be done to prevent opioid treatment from escalating to addiction.

Medical experts believe that solving the current opioid crisis is more than a matter of law enforcement cutting off the supply of illegally obtained opioid drugs. Treatment for addicts and education programs that emphasize prevention and the seeking of help are also vitally important. Medical experts at the FDA have proposed a policy of “opioid exceptionalism” for prescribing pain medications. Before prescribing opioids to treat pain, doctors would be instructed to consider the risks that a patient might develop an opioid use disorder or become addicted. Doctors would also consider the risk of addicted patients making a transition to other opioids or turning to illicit drugs such as heroin.

In March 2017, President Donald Trump appointed a commission to investigate the opioid crisis. On July 31, the commission recommended that the president declare a national emergency to deal with the epidemic. Public health experts agreed that such bold action is necessary to help Americans understand the severity of the opioid epidemic and to recognize that it is an unparalleled crisis requiring urgent attention.

The opioid commission’s report called for increasing access to naloxone and other medications used to treat overdose or addiction and requiring opioid drug prescribers to receive more education about the proper use of these drugs. The commission also proposed waiving a federal rule that limits addiction treatment for people who receive health care from government-funded Medicaid.

The federal report echoed similar reports from state and local counterparts across the United States. Medical experts emphasized that federal actions to complement state and local efforts help reduce rates of opioid dependence, overdose, and deaths, giving communities the greatest chance of success for ending the current crisis. President Trump, however, dismissed many of the findings detailed in the commission’s report. Instead, he focused on issues unrelated to the opioid crisis, such as stopping the influx of illicit drugs at the border with Mexico. Trump’s insistence on repealing the Affordable Care Act (commonly known as Obamacare) would risk making matters worse by stripping funding for Medicaid—so far the best source of government help for curbing the epidemic.

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Image 1: A pharmacist doles out a prescription of fentanyl, a powerful synthetic opioid that is sometimes combined with heroin. Fentanyl overdoses have killed thousands of people. Credit: Dennis Yip, Fentanyl Safety

Image 2: Naloxone is a temporary antidote for opioid overdoses, including those caused by Fentanyl. When properly administered it can restore normal breathing and consciousness to opioid overdose victims. Credit: Dennis Yip, Fentanyl Safety

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