The U.S. is Facing a National Public Health Crisis Related to Prescription and Illicit Opioids
As reported by the Centers for Disease Control (CDC), the United States is in the midst of an opioid addiction and overdose epidemic with every American state, county, socio-economic and ethnic group impacted.
Drug overdose is the leading cause of accidental death in the United States. In fact, overdose is the leading cause of death for Americans under 50. In 2017, more than 70,200 Americans died from a drug overdose. This represents a 10% increase over the prior year. This is more deaths than from car crashes or guns, both homicides and suicides.
2017 CDC Death Rate Data: https://www.cdc.gov/drugoverdose/data/statedeaths.html
A brief history of opiates/opioids
You may have heard the term Opiate and Opioid. Is there a difference? Opiates are drugs derived from opium of the poppy plant. At one time “opioids” referred to synthetic opiates only (drugs created to emulate opium, however different chemically). Now the term Opioid is used for the entire family of opiates including natural, semi-synthetic and fully-synthetic. In the course, we will use the term Opioid.
Opioids have legitimate medical use; however they also have a high potential for addiction, misuse and overdose.
Sources: SAMSHA 2016 National Survey on Drug Use and Health and the World Drug Report 2017
The family of opioids
Opioids differ in how they are made, and in their potency. For example, morphine and codeine are natural opioids originating from the poppy plant. Heroin, oxycodone, Vicodin, Percocet and many others are semi-synthetic. Drugs such as fentanyl and methadone are fully synthetic. Another difference among the opioid family is the potency – or strength – of the opioids. For example, an opioid such as fentanyl is 50-100X more potent than morphine.
Morphine - Codeine - Opium
Vicodin - Percocet - Oxycodone - Heroin
Fentanyl - Methadone
Anyone who takes prescription opioids can become addicted to them.
Because prescription opioids are similar to, and act on the same brain systems affected by, heroin and morphine, they present an intrinsic misuse and addiction liability, particularly if they are used for non-medical purposes. They are most dangerous and addictive when taken via methods that increase their euphoric effects (the “high”), such as crushing pills and then snorting or injecting, or combining the pills with alcohol or other drugs.
Opioid prescribing rates key contributor to health crisis
Opioid prescribing practices are a PRIMARY contributor to opioid addiction and to the health crisis. Between 1991 and 2017 opioid prescriptions have more than tripled. Two out of three drug overdose deaths involve an opioid (68%). From 1999–2017, nearly 400,000 Americans have died from an opioid overdose. Of the 70,200 reported overdose deaths – Opioids killed 47,736 people in 2017 – representing a 13% increase over prior year.
Healthcare providers wrote 191 million prescriptions for pain medicine in 2017. Nearly enough for every American adult to have a prescription. For Overdose Lifeline’s home state of Indiana for every 100 people, 74 pain medicine prescriptions were written. States with the highest opioid prescribing rates were Alabama (107), Arkansas, (105), Tennessee (94), Mississippi (92), and Louisiana (89) per 100 people. States with the lowest opioid prescribing rates were Minnesota (40.0), California (39.5), New York (37.8), Hawaii (37), and District of Columbia (28.5).
Source: CDC Annual Surveillance Report of Drug-Related Risks and Outcomes, 2017 https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf
Heroin use is part of a larger substance use problem
People who are addicted to any one of the following substances, are much more likely to be addicted to heroin.
Source: National Survey on Drug Use and Health (NSDUH 2011-2013)
15 times more likely
2 times more likely
3 times more likely
Rx Opioid Pain Pills
40 times more likely
4 in 5 new heroin users started out misusing prescription pain pills
Heroin use has increased among most demographic groups
The use of heroin has been increasing in recent years among men and women, most age groups, and all income levels. In 2017, nearly 494,000 people in the United States (12-years old or older) reported using heroin in the past year.
Past misuse of prescription opioids is the strongest risk factor for starting heroin use, especially among people who became addicted to or misused prescription opioids in the past year. This indicates that widespread opioid exposure and increasing rates of opioid addiction have played a major role in the growth of heroin use.
Among new heroin users during 2000 to 2013, approximately three out of four report having misused prescription opioids prior to using heroin.