A study recently published by the University of Virginia found the number of deaths due to opioid overdoses is extremely underreported, with the actual number of deaths being around 24% higher. One of the most commonly used metrics is the 91 American deaths per day from opioid overdoses. The Centers for Disease Control (CDC) reports this number along with the fact that opioid overdoses involving prescription painkillers alone has quadrupled since 1999. Overdoses and deaths from opioid abuse are not new in the national spotlight. In fact, anti-drug abuse organizations have launched complex campaigns; research labs are evaluating the effects of opioids on the brain and life expectancy; doctors are being pressured to consider alternative pain treatments; and local, state, and national governments are changing policies to monitor opioid use. With all of the effort focused on this national epidemic, it is important to understand the origins of the epidemic, its effects on individuals and communities, and what’s being done about it.
The Origins of the Opioid Epidemic
Where did the epidemic begin?
Before the 1990s, overdoses and deaths from prescription opioids were extremely rare . . . making one wonder what happened before the turn of the century. In the late 90s, there was an increased focus on pain, especially chronic pain, and how doctors could address this problem in their patients’ lives. A national initiative known as Pain as the 5th Vital Sign (P5VS) was introduced to doctors as a way to subjectively assess the nearly 34 million individuals complaining of chronic pain. This movement incentivized both patients and doctors to attempt to achieve a rating of “0” on the subjective pain scale. And with the timely introduction of OxyContin by Purdue Pharma in 1996, doctors finally had the fuel to combat chronic pain. The pharmaceutical company had fairly aggressive marketing strategies for both the consumer and the physician, promoting OxyContin’s amazing relief for chronic pain sufferers and making sure to state the drug was “abuse resistant.”
Sitting here in 2017, it is hard to agree that the drug was truly abuse resistant. Back in 1996, the FDA had approved an 80 mg pill; however, four short year later, a double dosage (160 mg) was approved. The high-dosage, reasonably priced pill became a popular street drug, with users riding an Oxy high for over eight hours. As more doctors increased prescriptions and Purdue Pharma increased profits, the number of overdoses also increased. The CDC currently cites that since 1999, the number of overdoses has quadrupled but so has the selling of prescription drugs. This has left the consumer, who once believed the “abuse-resistant” label, questioning the drug.
In 2007, a lawsuit was filed by the state of Kentucky against Purdue Pharma, which was at this time known as Purdue Frederick Company, Inc., for the misbranding of OxyContin as “abuse resistant.” Purdue did plead guilty to charges for misleading doctors and patients about the addictive properties of the drug. This resulted in one of the largest settlements in US history for a pharmaceutical company, with Purdue paying over $600 million in fines. Kentucky isn’t the only state to sue Purdue for false marketing. Oklahoma, Missouri, and Ohio have also filed lawsuits against the pharmaceutical industry. In fact, 41 states are investigating the drug industry’s marketing practices.
“Our subpoenas and letters seek to uncover whether or not there was deception involved, if manufacturers misled doctors and patients about the efficacy and addictive power of these drugs,” New York Attorney General Eric Schneiderman said during his press conference announcing the investigation. “We will examine their marketing practices both to the medical community and the public.”
What are the effects of opioids?
An opioid is a naturally occurring or artificially manufactured substance that has similar biochemical actions to the active substance found in the opium poppy: morphine. Some naturally occurring opioids include morphine and codeine. Hydrocodone (Vicodin) and oxycodone (OxyContin and Percocet) are considered semi-synthetic, where the manufacturer starts with a natural substance and chemically adjusts it. Fully synthetic opioids are completely derived from chemicals, with the goal for them to act similar to morphine. This group includes methadone and fentanyl, which is 50 times more addictive than heroin.
The purpose of opioids is to provide a release from pain or produce a positive feeling in the body. The human body has naturally occurring opioids, such as endorphins, which supply the good mood after a hard workout. Unfortunately, taking, snorting, or injecting opioids, naturally occurring or chemically made, can have a significant impact on the body, mind, and brain. Here are some effects of opioids:
- Increased tolerance to the drug, resulting in the need to take more medication for the same pain relief
- Physical dependence, withdrawal symptoms when medication stops
- Sleepiness and dizziness
- Itching and sweating
- Increased sensitivity to pain
- Nausea, vomiting, and dry mouth
What’s being done about the epidemic?
Beyond the impact of opioid overdoses on the individual and family, there is a significant detriment to the local, state, and national economy, businesses, and governments. The CDC estimates the total economic burden of prescription opioid misuse alone is $78.5 billion a year. This includes the cost for health care, lost productivity, treatment, and police involvement.
Money and Grants to Address the Epidemic:
Earlier this year, the Department of Health and Human Services (HHS) announced a $70 million grant that will be used to address the opioid epidemic. HHS Secretary Tom Price said, “The purpose of these grants is to empower the heroes in this fight – the men and women on the forefront of supporting prevention, treatment, and recovery initiatives in their communities.” The money will go to first responders, organizations dedicated to addiction treatment, and overdose-reversing drugs, such as Nalaxone. This announcement followed a $485 million grant administered by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Research on Opioids:
Government and private labs are employing research initiatives to identify short- and long-term scientific strategies to combat the opioid crisis. These strategies evaluate overdose reversal interventions, addiction treatment, and how to address future chronic pain sufferers.
Recommendations for Physicians:
A number of people blame physicians for the current opioid crisis. In 2010, doctors wrote enough prescription for hydrocodone to give every American adult a one-month supply (CDC). Because of these staggering numbers, the government and local organizations have been working to change the way doctors look at pain. The CDC has proposed guidelines for prescribing opioids for chronic pain, based on previous research studies. Physicians have self-organized education and advocacy groups to encourage responsible prescribing practices.
Regulations and Laws to Limit Prescriptions:
In August, President Donald Trump declared the opioid crisis a national emergency. However, before this declaration, many states had already declared states of emergency and local governments and organizations had begun implementing new laws and regulations. All states now have a prescription drug monitoring program (PDMP) to control the amount of prescriptions given to each patient. Up until July of this year, Missouri was the only state without a PDMP. There has been much success in the implementation of these statewide programs, with decreases in number of prescriptions and overdoses.
Private companies are also stepping up to decrease the impact of the opioid epidemic. CVS, one the largest pharmacy chains in the U.S., recently announced that starting February 1, 2018, it will limit opioid prescriptions for certain conditions to seven days. CVS will also be limiting the daily dose based on strength. This will put CVS in agreeance with the CDC recommendations. Some states, such as Indiana and Maine, have also adopted the limitations on opioid prescriptions. With these new limits and regulations in place, the CDC reported that the number of opioid prescriptions has declined by 18% in just five years.
Initiatives to Change the Perspective on Opioids:
A number of initiatives have been started in hopes of changing the perspective on drugs. The US Department of Health and Human Services (HHS) is focusing its efforts on five major priorities, including improving access to treatment services, promoting the use of overdose-reversing drugs, strengthening the understanding of the epidemic, providing support for research on pain and addiction, and advancing better practices for managing pain. The Drug Enforcement Administration hosts a bi-annual National Prescription Take Back Day to encourage the safe disposal of extra prescription drugs.
You and Your Business:
Tom Ziglar once said “Change starts with you, but it doesn’t start until you do.” Whether you’re a business owner, an employee, a parent, or a friend, you can have an influence on the opioid epidemic. Change policies within your business or organization, educate your family and friends, and dispose of extra prescription drugs safely. Although we cannot change the origins of the epidemic, we can change the outcome.
We encourage you to stay ahead of the opioid epidemic by establishing a new or updating a current drug and alcohol policy in your workplace. If you’re looking to implement a drug-free workplace through drug and alcohol testing, contact Tomo Drug Testing. Based in Springfield (MO), St. Louis (MO), Kansas City (MO), Indianapolis (IN), and Evansville (IN), we offer customized solutions to make drug testing simple, and our nationwide network of clinics and providers allows Tomo to be available anytime, anywhere. For a free needs analysis, give us a call today at 1-888-379-7697 or contact us online. We would be happy to help!