Opioid Use Disorder - A Growing Epidemic Threatening Public Health

Opioid Use Disorder

 

Opioid addiction and overdoses have reached epidemic proportions in the United States over the past two decades. Originally prescribed as treatment for pain, powerful prescription opioids have created millions of dependent users. As prescription opioids become harder to obtain, many users have turned to cheaper and more lethal street drugs such as heroin and synthetic opioids like fentanyl. The growing toll of addiction, overdoses and deaths from opioids has overwhelmed communities nationwide and shows no signs of slowing down without concerted action. This article explores the causes, consequences and potential solutions to the ongoing opioid crisis.

Defining Opioid Use Disorder

Opioid use disorder refers to problematic patterns of using opioids that cause significant impairment or distress. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), opioid use disorder is diagnosed based on experiencing at least two of eleven criteria within the past year including taking opioids in larger amounts or for longer than intended, cravings to use opioids, reduced participation in activities due to opioid use and continued use despite physical or psychological problems from opioids. Severity of the disorder is then categorized as mild, moderate or severe based on the number of criteria met.

Rise of Prescription Opioid Addiction

In the 1990s, pharmaceutical companies successfully marketed prescription opioid pain relievers to physicians as treatment for all types of pain, even though the drugs are strictly meant for severe acute pain. Over-prescription of potent opioids like oxycodone, hydrocodone and fentanyl rapidly created a generation of dependent users. By 2015, prescription opioid sales quadrupled while the death toll from these drugs tripled from 4 per 100,000 persons in 1999 to 12 per 100,000 persons. Over-prescription practices were facilitated by downplaying addiction risks and exaggerating benefits, with pharmaceutical representatives directly targeting physicians. Lax regulations and failure of medical groups and government to curb reckless prescribing fueled the increase in opioid addiction and overdoses.

Transition to Heroin and Illicit Synthetic Opioids

As opioid prescriptions declined due to tightened controls and monitoring, many addicted individuals were forced to turn to cheaper street drugs to avoid withdrawal. This transition from prescription opioids to heroin and synthetic opioids like illicit fentanyl has taken a massive toll. Heroin overdoses increased six-fold between 2010-2016. Simultaneously, fentanyl and other synthetic opioids have rapidly penetrated drug markets, further increasing overdose risk due to their potency levels that far exceed heroin. Accidental overdoses spiked as users were unaware they were ingesting fentanyl, not heroin or prescription pills. Fentanyl increasingly cut into cocaine and methamphetamine supplies has also broadened overdose risk beyond opioid users. The widespread accessibility of lethal substances has made safe use nearly impossible for many already struggling with opioid addiction.

Economic Costs and Social Impact

The economic costs related to the opioid crisis have stretched into the hundreds of billions due to healthcare costs, lost productivity and criminal justice impacts. In 2018 alone, the cost of the crisis was estimated at $631 billion. Overdosing on opioids has also shortened overall US life expectancy for the first time in decades, indicating the severity of the crisis. Beyond grim statistics, the scope of family dysfunction, child welfare issues and societal costs of the opioid epidemic cannot be quantified. Every community has been affected through loss of neighbors, coworkers, parents and loved ones to this preventable public health crisis that shows no signs of resolution without concerted actions. Homelessness, Hepatitis C, and HIV epidemics have also accelerated alongside increased substance use disorders and high-risk behaviors stemming from opioid addiction.

Public Health Emergency Response

In 2017, the federal government declared the opioid crisis a national public health emergency, directing increased funding towards prevention and treatment efforts. Naloxone distribution programs have succeeded in reducing overdose deaths by reversing opioid overdoses, saving thousands of lives. However, major gaps between treatment needs and capacity remain. Expanding treatment options including medications for Opioid Use Disorder  (MOUD) beyond just methadone are desperately needed along with reduced barriers to accessing life-saving treatments. Increased funding for harm reduction approaches including syringe access programs and overdose education could help to minimize overdose deaths. Additional efforts are required to monitor prescription practices, pharmaceutical industry marketing of opioids and illicit drug supply chains of heroin and synthetic opioids to help curb addictions rates. The most effective long-term solutions will require understanding and resolving root causes of opioid misuse as well as reducing stigma around addiction to facilitate earlier and more equitable access to treatment and recovery support services nationwide.

Conclusion

In summary, rapid acceleration and ubiquity of opioid addiction due to irresponsible prescription practices and unchecked spread of lethal illicit substances has created an overwhelming public health and social crisis throughout the US. While emergency response efforts have saved lives in the short-term through greater access to naloxone and expansion of treatment options, far more needs to be done to eliminate over-prescription, monitor illicit supply chains and reduce stigma to treatment. Holistic public health approaches considering root causes, prevention and long-term recovery are critical to truly combat this epidemic that shows no signs of abating if left unchecked. With sustained investment, compassion and multidimensional solutions, communities have hope of reversing opioid misuse and overdose trends to save lives and rebuild stability for those affected most by this ongoing crisis.

 

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