By Bethany Erb
Adam Moser was one of those guys who had everything going for him. He was a World War II history buff, international explorer, and a top fisherman who could discuss his recent catch as fluently as he spoke French. In 2015, Adam died after overdosing on fentanyl—a powerful synthetic opioid. He was 27.
Adam’s family was devastated. Opioid addiction was something that didn’t happen to them. They were an affluent New England family and he was an intelligent, well-rounded young man. How could addiction strike? It would take them time to recognize that opioid addiction is, superficially, exceedingly arbitrary. It is democratic in its impact, favoring no social strata or structure. Anyone, regardless of IQ or education can succumb to its draw. “Opioids are not recreational. Anything can become addictive, but the opiates grab you right away,” told Adam’s father, Jim, to the Seacoast Online. Yet, as Adam’s family knows, opiates do not like to let go.
The Opioid Epidemic: Origins
Across the United States, Adam’s fate is becoming an archetype. Beginning in the late 1990s-2000s, the United States experienced a rapid increase in the use of prescription and non-prescription opioid drugs. Aggressive pharmaceutical marketing, along with doctor-prescribed painkiller prescriptions created a perfect set-up for patients to become opioid-dependent.
In 2007, according to a Pulitzer Prize-winning Charleston Gazette-Mail investigation, three drug companies distributed an inordinate amount of opioid painkillers to West Virginia pharmacies, making $17 billion. The opioids distributed by the drug companies were relatively strong painkillers, including oxycodone, hydrocodone, and fentanyl. Fentanyl, incidentally, can be synthesized to resemble opium-derived morphine and heroin.
With assurance from pharmaceutical companies, the medical community initially believed that these prescription opioids would not be addictive, leading to the abuse and widespread prescription of them before evidence emerged of their addictive behavior. With comparatively little awareness of opioid addiction, West Virginian doctors liberally prescribed these painkillers, acting as a catalyst for America’s opioid epidemic. By the time prescribing physicians realized what was happening on a large scale, it was too late.
By 2009, just over a decade from when opioid crisis began, the United States was the sole user of 99% percent of all hydrocodone and 81% of all oxycodone. A health care accrediting body, the Joint Commission also removed a doctor’s duty to evaluate all patients for pain, making it easier for doctors to legally prescribe opiates and making it easier for addicts to access prescription drugs. By 2010, the levels of addiction in the US were increasing dramatically, and the statistics started to creep into public consciousness.
The Opioid Epidemic: How They Work
What makes opioids so addictive? Opioids are opium-like compounds that attach to receptors in the brain, spinal cord, and other parts of the body. Once attached, they send signals to the brain, creating an “opioid effect.” The opioid effect can be diverse. If they attach to the Limbic System of the brain the opioids influence emotions, such as contentment, pleasure, and relaxation. If they attach to the brain stem, they affect autonomic behaviors, such as the pain response, coughing, and respiration. Overdoses often result from an excessive reduction in respiration. If the opioids attach to the spinal cord, they decrease pain awareness, which is their main medical value.
On a functional level, because an opioid’s chemical structure mimics that of a neurotransmitter, opioids hijack the brain’s reward system. Flooding the reward circuit with dopamine, opioids cause an upswing in personal contentment, pleasure, and euphoria. Because the human brain is wired to repeat life-giving activities, it remembers the source of the pleasure—an opioid—and reminds the body to seek out the reward again. Thus, the continual use of opioids creates a powerful addiction.
The Opioid Epidemic: Today
Since the 1990s, the opioid crisis has truly reached epic proportions, creating a national crisis that impacts social, economic, and public health for thousands of people. Every day, more than 115 Americans will die from overconsumption of opioids. Former Mississippi Attorney General Mike Moore emphasizes, the death toll from drug overdoses is killing all the passengers onboard a 737 every single day. “If plane crashes like that happened a few days in a row, we’d shut the skies down until we figured out the problem,” Moore states, urging responsible solutions promising statistical improvements.
The crisis is more prevalent in America’s “heartland” states—West Virginia, Pennsylvania, Ohio, Kentucky, and others are particularly impacted. People aged 45-64 experience over 40% of all drug overdose deaths, and emergency room visits, where over-prescription of opioids can occur, are a very common way for people to become addicted. As Brennan Hobings, from the Brookings Institution, points out, “uneducated, middle-aged whites in rural areas have both the highest levels of reported stress, worry, and desperation, and also have, not coincidentally […] the starkest increase in premature mortality due to opioid addiction, other drug overdoses, etc.”
The present predicament is stark. The U.S. Federal Government is trying to intervene. On October 6, 2017, President Trump declared America’s opioid epidemic a national public health emergency, which enables funding and resources to be directed to help opioid addicts and start prevention programs. On February 9, 2018, President Trump’s budget agreement included a $6 billion funding boost to prevent and crackdown on opioid abuse and unlawful distribution. Attorney General Jeff Sessions is also stepping up the fight, creating the PIL Task Force on February 27 to focus on addressing the distributors and manufacturers of opioids. The opioid crisis is starting to get the attention that it deserves.
The Opioid Epidemic: Solutions
In conclusion, there are a few smart, educated answers to this opioid epidemic:
- Make accessing treatment easier than accessing opioid painkillers, fentanyl, and heroin
- Fund resources to emergency rooms, including a stringent protocol for prescribing limiting opioids and addressing addicted patients in an ethical manner
- Address the emotional, social, and cultural factors that lead to addiction
- Prevent America’s posterity from being hooked on opioid pain-killers
All of these will take time, initiative, and funding to shift the tide in America’s favor. But the good news is, the fight is not lost. With federal funding, increasing media coverage, and public awareness of the dangers, instead of just the superficial benefits of opioid pain-killers, the prospects of lowering drug overdoses and reversing the consequent decrease in America’s average life-expectancy is good.
A major problem is, what do we do about those who genuinely need opiates to maintain a minimal quality of life? Especially in the presence of excruciating, debilitating pain? As Michael Bihovsky states, “We have a genuine and devastating epidemic of opiate abuse in this country […] but we must address this in a way that doesn’t cut off an effective (and often the only) treatment for the chronically ill, many of whom are able to function in this world at all only because of the small respite that responsible opiate use provides.” The problem is not simple. Yet, with relentless curiosity, intellectual thought, and devotion to results, America’s public and government should be able to find an equilibrium that helps more than it hurts.
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