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 2020, nearly 92,000 Americans died from a drug overdose. This represents a 31% increase over the prior year. Opioids account for 75% of all overdose deaths. This is more deaths than from car crashes or guns, both homicides and suicides.
The overdose crisis that escalated sharply during the first year of the pandemic does not appear to be letting up. For the first time, overdose deaths exceeded 100,000 in 2021, increasing another 15%.
Illicit Fentanyl Continues to Drive the U.S. Health Crisis
Illicit Fentanyl (synthetic opioids produced by illegal drug trade) is currently the main driver of drug overdose deaths in the United State. 82.3% of opioid-involved overdose deaths involved synthetic opioids.
The practice of street drugs being laced with Fentanyl increased dramatically during the Pandemic resulting in a surge of overdose deaths across the nation.
Illicitly manufactured fentanyl is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
“It’s rare to find people who only overdose on cocaine or who only overdose on methamphetamines,” said Dr. Nora Volkow, head of the National Institute of Drug Abuse. “Fentanyl is being used to lace the illicit drug market because it’s very profitable.“
Illicitly manufactured powder fentanyl has been a known adulterant in drugs since 2013, but the extent that fentanyl is found in counterfeit pills has been largely unknown.
In a study released in 2022, the number of individual pills containing illicit fentanyl seized by law enforcement increased dramatically between January 2018 and December 2021. In 2021 alone, pills containing fentanyl increased 132%.
This practice of fentanyl laced counterfiet pills is a main contributor to youth/young adult aged 15-24 opioid overdose death increases. In 2020, opioid overdose deaths were responsible for 84% of all overdose deaths, increasing 61% over prior year, for this age group.
Source: JJ Palamar, et al. Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug and Alcohol Dependence. DOI: 10.1016/j.drugalcdep.2022.109398.
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.
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.
Prescription opioids play an active role in the health crisis.
Prescription opioids play an active role in the health crisis. Especially when we consider this as the entry point to opioid addiction, or opioid use disorder.
In 2020, 9.5 million people misused opioids; the overwhelming majority (9.3 million) of those individuals, specifically misused prescription opioids. 1.2 million initiated prescription opioid misuse in 2020.
Source: Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD