The high incidence of opioid abuse, overdose, and even lethal outcomes has attracted substantial attention from the scientific community. Today, it is possible to determine the origins of the crisis and delineate how this public health concern has come to be. Jones et al. (2018) explain that before the 19th century, cocaine and opioid use in the West did not have to comply with any regulations. However, by 1914 when the Harrison Narcotic Control Act came into power, the public sentiment had changed the direction and became “opiophobic (Jones et al., 2018).” However, the rejection of opioids as an alternative to existing pain medication dominated health care only for the first half of the 20th century. In the second half, the World Health Organization, the American Pain Society, and the Veteran’s Health Administration started advocating for better pain management. Their pleas were strengthened by sporadic, small-sample studies proving the highly-effective therapeutic effects of opioid analgesics. The Federation of State Medical Boards and the Drug Enforcement Agency published two historically significant statements that ushered the United States into the era of opioid acceptance.
Today, the opioid crisis is not projected to come to a halt any time soon; in fact, it is only exacerbating. Saha et al. (2016) provide concerning data on opioid use in the United States. For instance, from 2002 through 2012, the number of opioid pain medications dispensed by US pharmacies doubled from 142 million to 248 million. Within the same period, the lethal overdose rate tripled (Saha et al., 2016). Saha et al. (2016) also point out a 153% surge in the number of opioid-related emergency visits between 2004 and 2011. The authors describe these concerning trends for several reasons such as increased acceptance and advocacy for opioid treatment and availability of long-acting medications. Aggressive marketing by pharmaceutical companies and a lack of understanding of opioid health effects also contribute to the problem.
Undoubtedly, an adequate response to the opioid crisis needs to include the identification of risk groups. First and foremost, individuals at risk of developing an opioid use disorder are those who experience chronic pain. Webster (2017) uses data from the most recent National Health Interview Survey to demonstrate that 126.1 million experienced some type of pain within the last three months. What is more, around 12 million suffer from pains daily, and 12 more report unmanageable pain levels? Webster (2017) provides his expert opinion on why opioid misuse persists and has yet to be fully harnessed. The scholar points out the misunderstanding between the patient and the provider as one of the causes. Another common motivation is to eliminate abstinence syndrome or put oneself in an altered psychological state.
To better understand the individual motivation behind opioid abuse, one should take a look at how social determinants of health fit into the picture. According to Webster (2017), healthcare providers should be wary of patients with inadequate social support, a history of substance abuse, and a criminal record. In addition, some factors contribute directly to overdose mortality (Webster, 2017). They include but are not limited to middle age, unemployment, comorbid mental and physical disorders, methadone use, and co-prescription of benzodiazepine and antidepressants. Indeed, research like this provides valuable implications for preventive strategies. Yet, the question stays as to whether the existing responses to the opioid crisis have yielded any positive results.
At present, research concerning the effectiveness of different drug monitoring programs remains limited. A study by Patrick et al. (2016) is one of the few rigorous papers that inquire the impact of particular characteristics of different programs on opioid-related overdose death rates. Their observational cohort research shows that by 2013, all but two US states had introduced a prescription drug monitoring program. Patrick et al. (2016) discovered that the implementation of such a program was associated with a decline in opioid-related mortality rates. After some statistical adjustment, it became apparent that the states with the most significant progress had programs that monitored four or more drug schedules. Data management played a big role in advancing those programs as weekly updates provided authorities with information to be considered in subsequent decisions.
Awareness and education are also seen as integral to addressing the opioid crisis. Mueller et al. (2015) explain that since 1996, the US has benefitted from community-based programs where vulnerable populations could educate themselves and receive naloxone. This strategy, known as overdose education and naloxone distribution (OEND), has gained traction for its potential to be adapted for conventional medical settings and patients who are prescribed pharmaceutical opioids. For their systematic review, Mueller et al. (2015) located 41 articles concerning the effects of OEND, its adaptability, and the willingness of patients to enroll. They concluded that depending on a state, OEND was able to reduce overdose deaths by 27-46%. Moreover, the strategy positively affected the attitude and knowledge of patients who were taking opioid analgesics. Only 0.3% of people experienced any adverse side effects from taking Naloxone, which suggests its safety and compatibility. To recapitulate, both state-level and community-based programs have promising prospects in combating the crisis.
References
Jones, M. R., Viswanath, O., Peck, J., Kaye, A. D., Gill, J. S., & Simopoulos, T. T. (2018). A brief history of the opioid epidemic and strategies for pain medicine. Pain and Therapy, 7(1), 13–21.
Mueller, S. R., Walley, A. Y., Calcaterra, S. L., Glanz, J. M., & Binswanger, I. A. (2015). A review of opioid overdose prevention and naloxone prescribing: Implications for translating community programming into clinical practice. Substance Abuse, 36(2), 240-253. Web.
Patrick, S. W., Fry, C. E., Jones, T. F., & Buntin, M. B. (2016). Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Affairs, 35(7), 1324-1332.
Saha, T. D., Kerridge, B. T., Goldstein, R. B., Chou, S. P., Zhang, H., Jung, J., … & Grant, B. F. (2016). Nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder in the United States. The Journal of Clinical Psychiatry, 77(06), 772-780.
Webster, L. R. (2017). Risk factors for opioid-use disorder and overdose. Anesthesia & Analgesia, 125(5), 1741-1748.