What Is The Opioid Crisis

In the United States, more than 90 people die every day from an opioid overdose. The Centers for Disease Control and Prevention estimates the economic burden of misusing prescription drugs is over $78.5 billion – that’s on the misuse of prescription drugs alone, not factoring in synthetic variants or illegal street drugs like heroin (Med Care. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013). The opioid crisis is having such a substantial fiscal impact on America due to healthcare, addiction treatment and criminal justice expenses that go along with it. So how did it get this bad?

What Are Opioids?

Opioids are pain killers that attach to the nervous system and cause people to quickly form a dependence (which is what results in withdrawal symptoms). They’re used in the medical industry for pain relief as the opioid bonds with the opioid receptors in your brain. This dulls the sensation of pain and can cause a euphoric (or high) sensation for many people. However, this rewires the brain’s “reward” system and causes a need for the instant gratification that comes with it. This is what results in many people becoming addicted.

Opioids come in many forms: liquid, tablet, pill, powder, etc. Some of the most common prescription drugs are fentanyl (a synthetic opioid), codeine, morphine, oxycodone, and hydrocodone; some are better known by their brand names like Vicodin, OxyContin, and Percocet. These are commonly prescribed by doctors and dentists to dull the pain following surgery.

Heroin is the most well known, illegal opioid. Heroin is usually injected, making it’s impact immediate as it floods the whole body. Prescription drugs differ in that they are condensed into a pill whose effects are more gradual as they slowly digest. Once addicted, many people turn to heroin as it doesn’t require a prescription and it’s much cheaper.

When Did The Opioid Crisis Start?

Roughly 20 years ago. In the 1990s, pharmaceutical companies assured the medical community that opioids were not addictive and as a result healthcare providers started prescribing pain relievers at a much higher rate.

Now, almost two decades later, the effects of misinformation are coming to the forefront. In 2015, two million Americans suffered from substance use disorders (limited to opioids and prescription drugs). Over a fourth of which (591,000) suffered from heroin use disorder, and 33,000 Americans died from an opioid overdose (CBHSQ. 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration).

In regards to how bad the opioid crisis is, 29% of patients prescribed pain killers misuse them (CBHSQ. Rates of opioid misuse, abuse, and addiction in chronic pain, 2015) and almost 80% of people with heroin use disorder started by misusing prescribed pain killers (Samhsa. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States, 2013).

Who Is To Blame?

This is a problem of infrastructure in that misinformation may have started it, but the healthcare system hasn’t improved it. While Doctors, healthcare providers and drugmakers have fallen under intense scrutiny of late, the crisis isn’t helped by the health insurance system either. Most insurers and pharmacy benefit managers make the more addictive opioids readily available because they’re cheaper than the safer alternatives.

For example, buprenorphine is an opioid with a lower risk of overdose than others. However, take the case of one patient, Alisa Erkes who lived with a chronic stabbing pain in her abdomen. She was prescribed Butrans (buphrenorphine) for two years, but when her insurance company (UnitedHealthcare) stopped covering the drug, she had to find an alternative.

Ms. Erkes doctor eventually found a substitute that was covered by her insurance, a long-acting morphine that’s known to be in a higher category of risk and dependence. Ms. Erkes tried to appeal her insurance company’s denial and failed (Butrans denial, 2017). The end result is Erkes is no longer able to get Butrans, the safer opioid at $342/month, but was approved for a more dangerous morphine alternative at $29/month.

What Is Being Done?

The department of Health and Human Services (HHS) are working on ways to solve the problem by improving access to treatment and recovery services, better health surveillance off the public (to help prevent further oversights and stay informed), changing best practices for pain management and promoting the use of overdose-reversing drugs. Meanwhile, the National Institutes of Health (NIH) have announced an opioid research initiative and are partnering with pharmaceutical companies and academics alike to dive deeper into this issue.