Today, Walgreens announced all of their stores will stock the drug Narcan, which is an over-the-counter opioid overdose-reversing drug. The vast availability of this medication speaks volumes about the opioid epidemic in America. Narcan is the nasal spray form of Naloxone normally used to combat the hazardous effects of opioids.
Opiate dependence is a behavioral health issue and chronic disease that no racial demographic is immune to. Since the year 2000, the availability and consumption of prescription pain medications, heroin and other illicit opiates in America has increased exponentially. A 2016 report by the National Institute of Health (HIH) revealed the use of non-medical prescription opioids has quadrupled since 1999. Furthermore, the increasing mortality rate has created a public health issue and has resulted in the Centers for Disease Control (CDC) implementing new guidelines for prescribers. The CDC recommends conducting appropriate risk assessments and frequent monitoring through ongoing drug screenings for long-term users. The new measures also require additional training for prescribing physicians. The rapid increase of non-prescription pain medication also led to the implementation of Prescription Drug Monitoring Programs (PDMPs) to track the dispensing of opioid medications.
The British Journal of Clinical Pharmacology estimates 15-21 million people are addicted to opiates worldwide today. According to the CDC, in the U.S. an average of 91 abusers die from an opiate overdose every day. Annually, more adults 50 years of age and younger die of opiate overdoses than cocaine. On average, opiate addiction costs Americans more than $484 billion annually.
Furthermore, opiate addiction is so extensive in the United States that President Obama allocated funds to implement Medical Assisted Treatment (MAT) programs to decrease the rate of recidivism and hopefully increase the abstinence rate. Little changed, and by March 2017, the Trump administration declared the opiate crisis a national emergency. This resulted in new medical programs to combat the problem of opiate overdoses and withdrawals.
A common approach to substance abuse treatment appears to focus on alleviating the patient’s withdrawal symptoms with little regard for relapse prevention. This approach may be counterproductive, since many users were initially prescribed opiates such as OxyContin, Fentanyl, Lorcet, Vicodin, Dilaudid, Morphine and Norco to manage pain after a debilitating illness ― like cancer or rheumatoid arthritis ― or after injuries and accidents. These patients require a continuous cycle of pain medication to control their pain levels.
Although researchers agree that opiates are effective for reducing pain, they are often overprescribed. This may occur because many consumers are unaware of the dangers and other physiological repercussions associated with prolonged opioid use. While some users experience minimal side effects while taking opiates, for some, this may be the starting point of their opiate addiction.
Some people assume painkillers are not harmful because they are prescribed by a licensed physician. However, the fact that a medication is prescribed does not decrease its lethality, nor does it guarantee it is the best course of treatment. Unbeknownst to many, painkillers and heroin are both opiates that have the same active ingredients. These drugs are effective in changing the way the brain responds to pain and may deliver a euphoric effect. According to the American Society of Addiction Medicine (ASAM), opiates are so addictive because the drugs works in the central nervous system to provide feelings of pleasure and to relieve pain.
The journey to alleviate opioid addiction is a long-term process for many. Within a short period of time, use of opioids may become a compulsion to prevent withdrawal symptoms. Those dependent on opiates often plan their activities to prevent the flu-like symptoms, cold sweats, diarrhea, nausea, vomiting, restless leg, fever and body aches associated with opiate dependency. Some withdrawal symptoms can have life-threatening consequences; however, the severity may depend on the person’s level of dependency. Before long, the intervals between use decrease and dependence develops. Those who can afford it may opt for medical detox or an anti-addiction medication regimen, such as Buprenorphine (Subutex) or Methadone, to help with withdrawals and Naltrexone to prevent relapse. Regrettably, the relapse-prevention treatments alone are not always effective, and they can also be addictive. Therefore, it is not uncommon for those in recovery to attempt treatment multiple times before ending the stint of habitual relapse.
At the community level, prevention is imperative. More community awareness campaigns must be implemented to educate consumers about the implications of opiate use. The national campaign should include literature and seminars freely disseminated to the public. Parents should also talk to their children about risk of opioid use and how to identify those substances. Prescribers must be required to inform patients about the negative consequences of prolonged opiate consumption. It may also be beneficial to provide patients with information about how and when to seek help.
In addition to implementing more MAT programs, eliminating the opioid epidemic will require legislative action. This includes reducing the number of unnecessary opiate prescriptions written. There is also a need for more affordable health care. At present, Medicaid and Medicare will not pay for some aspects of substance abuse treatment. This places many at a disadvantage ― especially the elderly, who are often prescribed pain medication to deal with common ailments related to aging. Lastly, rehabilitation programs must include a combination of mental health and substance abuse treatment to decrease the probability of relapse.
Dr. Arlether Wilson, PhD is a Master Addiction Counselor and Substance Abuse Professional working in the Houston, Texas area. She is also the author of Rewriting the Script and a contributor of the best-selling book 20 Beautiful Women (2nd Ed). To learn more about Dr. Wilson, visit her website at www.arletherwilson.com.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.