The Opioid Epidemic: What Is Your Role?

Written by BlackbirdGo May 20, 2018
The History

If illicit substances were akin to the revered celebrity on the cover of People, Vogue, or Seventeen magazines, then consider prescription painkillers to be the new “It Girl” of the drug world: Vicodin, Percocet, Fentanyl, Hydrocodone, OxyContin would all be walking the red carpets at every premiere. This once quiet epidemic starting from your doctor’s prescription pad and grandmother’s medicine cabinet has now changed the face of what addiction looks like; mothers, nurses, even Joe Football and Susie Cheerleader at high schools are checking into the nearest substance abuse treatment center. This once highly regarded, easy-to-use, miracle drug to alleviate your pain and suffering has done the exact opposite. To make a bad situation worse, prescription painkillers have become the new gateway drug to less forgiving illicit substances such as heroin, which has given fire to the spread of communicable diseases, such as HIV and viral hepatitis. It’s a perfect storm riddled with plenty of public health implications.

In general, opioids killed more than 42,000 people in 2016, and 40% of those were overdose deaths were due to prescription painkillers.(1) From 1999-2016, over 350,000 people died from an overdose involving an opioid, prescription or illicit.(2) By the numbers, that is 116 people dying every day, with 11.5 million people misusing prescription opioids.(3) Health care costs associated with opioid use have also skyrocketed, with more than $215 billion being spent on emergency room visits, ambulance costs, and the use of naloxone in recent years.(4)

This epidemic has also hit the U.S. where it counts: their pocket book. Since 2001, the opioid epidemic has cost the U.S. over a trillion dollars, with the greatest cost coming from lost earnings, productivity losses to employers, and lost tax revenue.(5) This might be why the current administration has added the opioid epidemic to their current platform. This administration has proposed adding a budget line item dedicated entirely to the opioid crisis. So, what does that mean? Summarized quickly, this means federal money to help support better addiction prevention/treatment and recovery services, better access to overdose reversing drugs, better data collection, better pain management, and better research.(3)

Fighting an epidemic of this proportion is a little like drinking water from a firehose. It’s hard to know what you can actually do to help. Here is a little knowledge to empower your plight.

Prevention

It starts with prevention! What’s the old adage, “Let’s nip this problem in the opium poppy bud?” The Centers for Disease Control and Prevention (CDC) recommends the following to prevent opioid overdose death:

How can you improve the opioid prescribing process?

If you’re a doctor, familiarize yourself with the Prescribing Guidelines for Chronic Pain so you can obtain recommendations for prescribing opioid pain medications for patients 18 and over in a primary care setting. However, most of us are not doctors. As patients, we can become informed consumers and talk to our doctors about alternate ways to manage our pain. Research actually suggests opioids do not work very well for long-term pain; however, an estimated 90% of people with chronic pain are prescribed opioids.(6,7,8)

What alternatives are there to opioid prescriptions?

Ask your doctor and insurance provider about options like cognitive behavioral therapy, exercise therapy, interventional therapies, exercise and weight loss, acupuncture, massage; there are even some medications for depression or for seizures that might help.(9) Additionally, there has been some evidence that cannabis-based medicines can help with pain management.(10) If your provider does choose a route of opioid therapy, establish your expectations: work with your provider to set pain management goals and develop a treatment plan, weigh your risks and benefits of using prescription opioids, follow-up if your pain is not resolving as quickly as expected, and ask about instructions to taper your opioids to minimize withdrawal symptoms once treatment is complete and you have taken opioids for an extended period of time.(11) Also recognize that your providers are under new laws and regulations to prevent opioid addiction. Your provider cares about you and wants to improve your quality of life but not at the risk on creating a lifelong addiction to opioids. Be patient and overcommunicate with your provider to find the best solution for pain management.

Support health policies and systematic ways to do business.

Prescription drug monitoring programs (PDMPs) are another prevention method that many states have implemented. PDMPs are electronic databases that track controlled substance prescriptions and help identify patients who might be misusing prescription opioids, which might put them at risk for overdose. Clinicians can assess prior prescribing history of all patients to ensure patient safety of opioid use. In addition to PDMPs, many states have implemented a “Good Samaritan Law,” which protects the victim and the person seeking medical help for a person experiencing a drug overdose from drug possession charges.^11 This has enabled many Americans to call 911 in the event of a drug overdose and not worry about punitive repercussions.

What is naloxone?

Be prepared, carry naloxone. Many states have increased access to overdose reversal drugs, such as naloxone. Naloxone is a non-addictive, unscheduled drug that can reverse the effects of an opioid overdose, if administered in time. Increasing access to this life-saving drug can be done through standing orders at pharmacies and distribution through local, community-based organizations in conjunction with syringe service programs, as well as to law enforcement officials and entry-level emergency medical service staff.(12)

How does naloxone work?

Naloxone can be administered through an injection or through a nasal spray, and it only works with opioids. This medication blocks the effects of opioids by binding to the opioid receptors in the brain. With supplemental rescue breathing, this can give a person 30-90 minutes of time to get further medical care.(13) From 1996-2014, at least 26,500 people were saved in the U.S. by laypersons using naloxone.(14) As an informed consumer, whenever you are prescribed prescription painkillers, ask for a supplemental prescription of naloxone. In addition, if you know somebody who might have an opioid use disorder, keep naloxone on hand and teach your loved one and their friends how to use it. Chances are, other drug users will be around when your loved one overdoses—NOT you, NOT medical emergency staff, and NOT law enforcement. Depending on where you live, you can buy naloxone over the counter at many pharmacies, such as CVS. You can have it prescribed by your doctor or you can contact your local outreach team or syringe service program.

Lock up your medications.

Ease of access has been said to be the culprit of this epidemic. Be an informed consumer of the prescription drugs you take, don’t share your prescriptions, and make sure you are storing them appropriately. An estimated 2.1 million Americans used prescription drugs nonmedically for the first time within the past year, and 30% of those were adolescents.(15)

From prevention to treatment

When your loved one is ready to take the steps to get off of opioids, consider Medication-assisted therapy (MAT). MAT is an evidence-based treatment that uses medications, such as methadone, buprenorphine, or naltrexone, in combination with counseling and behavioral therapies.(16) It is a whole-patient approach to care. MAT has been successful at improving a patient’s survival and retention in treatment services, has decreased opiate use, has increased a patient’s ability to gain and maintain employment, and has improved birth outcomes among women with substance use disorders while pregnant. Research also shows that MAT has lowered a person’s risk of contracting an infectious disease such as HIV and viral hepatitis.(17) Talk to your doctor if you would like to know more about MAT in your area.

Take a harm reduction approach: Harm reduction is an evidence-based approach that promotes practical strategies to reduce negative consequences as a result of drug use. You are preventing harm as opposed to preventing drug use.(18) It is important to understand that complete cessation of all drug use is not always feasible for everybody, and a harm reduction approach is about incremental life changes and treating people with dignity and compassion. Strategies can include MAT, access to syringe service programs, promoting condom use, and having access to naloxone.

You are the difference.

Do not dismiss the gravity of this epidemic and the reach it has, even on your own loved ones. Addiction is not a weakness or a lack of will power—it is a disorder of the brain. Stay educated, understand the signs of opioid addiction and symptoms of overdose, prevent opioid misuse, and support methods to reduce this opioid epidemic. Take the Smokey the Bear approach to the situation, “Even you can prevent opioid addiction.”

SAMHSA’s National Helpline: 1-800-662-HELP (4357)

SAMHSA’s Behavioral Health Treatment Services Locator: https://findtreatment.samhsa.gov/
Naloxone Locator: www.getnaloxonenow.org
In Nevada, you can find naloxone at CVS, your primary care provider can prescribe it, or you can find it at Join Together Northern Nevada (www.jtnn.org.).

** About The Author:** Melanie Flores has her Master of Social Work degree from the University of Nevada, Reno and has worked extensively for the last eight years in public health concentrating efforts in program development, program evaluation, quality improvement and policy in the fields of Chronic Disease and HIV/AIDS. Previous to public health, she spent 12 years working in commercial radio as a program director and on-air personality. Additionally, she teaches at a local university covering topics such as Health Communications, Personal Health and Well-being, and HIV/AIDS. Ms. Flores is a founding member of the Nevada Public Health Alliance for Safety Access (PHASA), which pushed forth two major pieces of health policy legislation in Nevada related to syringe services programs and naloxone access to prevent opioid overdose deaths. Ms. Flores was recognized for her work by the Northern Nevada HIV Prevention Planning Group through a HIV Prevention and Care Community Award for her policy work to increase access to syringe service programs in Nevada.

Sources

  1. CDC (2017). Opioid Overdose. Division of Unintended Injury Prevention. Retrieved from: https://www.cdc.gov/drugoverdose/index.html
  2. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017. Available at http://wonder.cdc.gov.
  3. HHS (2018). About the U.S. Opioid Epidemic. Retrieved from: https://www.hhs.gov/opioids/about-the-epidemic/
  4. Allen, G. (2018). Cost of U.S. Opioid Epidemic Since 2001 is $1 Trillion and Climbing. Retrieved from: https://www.npr.org/sections/health-shots/2018/02/13/585199746/cost-of-u-s-opioid-epidemic-since-2001-is-1-trillion-and-climbin
  5. Altarum, (2018). Economic Toll of Opioid Crisis in U.S> Exceeded $1 Trillion Since 2001. Retrieved from: https://altarum.org/about/news-and-events/economic-toll-of-opioid-crisis-in-u-s-exceeded-1-trillion-since-2001.
  6. CDC (2017). Overdose Prevention. Retrieved from: https://www.cdc.gov/drugoverdose/prevention/index.html.
  7. Juurlink, D.N. (2017) Rethinking “doing well” on chronic opioid therapy. Canadian Medical Association Journal, 39(189), E1222-E1223.
  8. Consumer Reports. (2014). 5 Surprising facts on prescription painkillers. Retrieved from: https://www.consumerreports.org/cro/2014/01/5-surprising-things-you-need-to-know-about-prescription-painkillers/index.htm.
  9. CDC. (2017). Opioid overdose: Know your options. Retrieved from: https://www.cdc.gov/drugoverdose/patients/options.html.
  10. Aviram, J., and Samuelly-Leichtag, G. (2017). Efficacy of cannabis-based medicines for pain management: A systematic review and meta-analysis of randomized control trials. Pain Physician, 20(6), E755-E796.
  11. CDC (2017). Opioid overdose: Expectations for opioid therapy. Retrieved from: https://www.cdc.gov/drugoverdose/patients/expectations.html.
  12. CDC (2017). Opioid overdose: Reverse overdose to prevent death. Retrieved from: https://www.cdc.gov/drugoverdose/prevention/reverse-od.html.
  13. National Institute on Drug Abuse. (2017). Naloxone for opioid overdose: Live-saving science. Retrieved from: https://www.drugabuse.gov/publications/naloxone-opioid-overdose-life-saving-science/naloxone-opioid-overdose-life-saving-science.
  14. MMWR (2015). Opioid overdose prevention programs providing naloxone to laypersons – United States, 2014. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm.
  15. SAMHSA. (2017). National survey on drug use and health, 2016.
  16. CDC (2017). Opioid overdose: Treat opioid use disorder. Retrieved from: https://www.cdc.gov/drugoverdose/prevention/treatment.html.
  17. SAMHSA. (2018). Medication-assisted treatment (MAT). Retrieved from: https://www.samhsa.gov/medication-assisted-treatment.
  18. Harm Reduction Coalition. (n.d.). Principles of harm reduction. Retrieved from: http://harmreduction.org/about-us/principles-of-harm-reduction/.

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