The Substance Abuse and Mental Health Services Administration released its annual National Survey on Drug Use and Health this past Friday, September 14, reporting that 2.1 million people over the age of twelve have an opioid-use disorder. According to the National Institute on Drug Abuse, between 8 and 12 percent of patients prescribed opioids develop a use disorder, and 80 percent of people addicted to heroin began by abusing prescription opioids. While opioid misuse has gone down in the past two years, the number of deaths related to opioids has significantly increased. Last year more people died from a drug overdose than ever before; according to the Centers for Disease Control and Prevention (CDC), over 72,000 people died from drug overdoses in 2017. At least two thirds of those deaths can be attributed to opioids.
Having an opioid addiction is more dangerous than ever before. Patients who lose access to prescription painkillers, or don’t have expansive financial means, turn to cheaper opioids: heroin and fentanyl. Fentanyl is similar to heroin and one of the most widely used synthetic opioids in the medical community due to its strength and effectiveness at managing pain. But because it can be produced cheaply in labs, it’s sold widely in the illicit drug trade as an alternative to heroin. Users are often sold fentanyl instead of heroin without their knowledge, which greatly increases the risk of overdose, as fentanyl is dramatically more potent.
A health crisis of this scale requires a multifaceted solution. A recent study published in the American Journal of Public Health explores in depth how America can combat the opioid epidemic. The answer? There isn’t one, but many.
“No single policy is likely to substantially reduce deaths over five to ten years,” write the Stanford researchers who conducted the study, “Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic.” While reduction treatments and medication-based treatments will have a positive effect across the board, committing to just a few limited solutions just isn’t enough.
The study found that the issue is more complicated than limiting access to prescription painkillers. In fact, reactionary solutions like reducing the overall number of prescriptions, rescheduling painkillers, and creating programs that monitor prescription drugs significantly increase opioid deaths. This is because when people are cut off from their supply of painkillers, they’re more likely to turn to more dangerous opioids like heroin and fentanyl.
Instead, researchers found that a series of targeted, proactive measures like reducing only acute and transitioning pain prescriptions, disposing of excess opioids more often, and reformulating the drugs to make them less addictive prevented more deaths.
Across the board, successful treatments include greater use of buprenorphine, methadone, and naloxone. Buprenorphine and methadone stop withdrawal symptoms without producing a euphoric high. Although opioids themselves, when utilized in a safe medical environment they can significantly reduce the chance of relapse and reduce the mortality rate by half. Greater distribution of naloxone, used as an antidote for overdoses, will save even more lives.
But beyond filling out more prescriptions, we also need comprehensive health care services that provide easy access to addiction treatment and harm reduction resources. Safe injection facilities (SIF) offer sterilized equipment, tests, and supervision to individuals suffering from addiction. Several US cities are working to establish safe injection facilities in their neighborhoods, but are facing hurdles due to negative public perception of individuals suffering from addiction and pushback from the federal government.
Ultimately, the Stanford researchers concluded that applying all of these approaches, rather than one or two, is the most effective way to combat the opioid crisis. One approach is not sufficient enough to make a dent in reducing the number of opioid related deaths, and it is crucial that we value opioid addiction treatment as much as prevention.
The US has a long way to go. In 2013, just under 11 percent of people needing addiction treatment received it. Congress has already allocated billions of dollars to the opioid epidemic, but it’s not enough to support the programs and initiatives needed to make change.
Yesterday, the Senate approved a bill that will enact several changes to the way we’ve tackled that opioid epidemic. The Opioid Crisis Response Act of 2018 is a bipartisan package that seeks to close legal loopholes and address regulations that have contributed to the epidemic. In short, the bill will make addiction treatment more accessible, make it harder to obtain illicit synthetic opioids, and promote research on alternatives for the treatment of pain.
The legislation includes a grant program for opioid recovery centers and care practitioners, expansion of the naloxone program, increase in federal research programs on addiction and pain, expanded access to addiction treatment for those with Medicare and Medicaid, increased penalties for drug manufacturers, and additional resources to stop illegal drug trafficking.
The bill now heads to the House, which passed similar legislation earlier this year. But large hurdles still remain. With all the good that this bill promises to provide, experts say it is still too little too late.
And while our legislators sort out the work they need to do to combat this crisis, part of the responsibility relies on you and me. We must challenge our own communities to rethink our response to addiction and promote treatments rooted in science, not stigmatization.