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The Evolution of the Opioid Crisis
With President Trump declaring the opioid crisis a public health emergency in October 2017, Americans may be wondering how in the world we got here. Opioid related drug overdoses and deaths are increasing at an alarming rate in recent years, killing more than 60,000 people in 2016. Considering the following facts published by the White House in the study The Underestimated Cost of the Opioid Crisis, Nov, 2017:
- The majority of these deaths fall between the ages of 25-55.
- About two-thirds of opioid drug overdoses are from prescription medications.
- The crisis is costing Americans over $500 billion per year.
In addition to the deaths between the ages of 25-55, an increasing number of children are being found unconscious or dead after accessing their parent’s drugs or coming in contact with these very dangerous drugs, and there is a surge of babies being born who are opioid dependent. In this article we examine the evolution of the opioid crisis to see how we ended up in this position as a nation.
Opioid History
Opioid addiction has been a problem for much of the history of the United States, but never at this level. Beginning in the 1990’s something began to change. There was a push by patients in the US to more effectively treat pain and pharmaceutical companies began to promote the benefits of opioid pain relievers. Pharmaceutical companies dramatically increased the size of their sales staff and gave out generous bonuses to sales reps. Doctors began writing prescriptions more liberally for all sorts of pain ailments from back pain to arthritis pain to chronic pain. Thus, began an epidemic use of prescription opioids in the United States.
An enlightening fact that has emerged in the evolution of the opioid crisis is that there has been a demographic shift among opioid users from the 1960s to the 2000s. In the 60s more than 80% of opioid users began by using heroin. In the 2000s, 75% report beginning with a prescription opioid pain reliever.
Opioid Crisis Statistics
According the Centers for Disease Control the rate of drug overdose deaths in the United States was 2.5 times higher in 2015 than in 1999. Examine these statistics per 100,000 people:
| 1999 | 2015 | |
| Overall Deaths | 6.1 | 16.3 |
| Male Deaths | 8.2 | 20.8 |
| Female Deaths | 3.9 | 11.8 |
| Deaths Ages 55-64 | 4.2 | 21.8 |
The largest percentage of increases have occurred since 2013 and by 2015 deaths in the age range of 45-54 had increased to 30 per 100,000.
States with the statistically significant increases in death rates from 2013 to 2015 include an overwhelming majority from the eastern half of the United States including:
- Connecticut
- Florida
- Illinois
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- New Hampshire
- New Jersey
- New York
- North Carolina
- Ohio
- Pennsylvania
- Tennessee
- West Virginia
When comparing statistics from the Annual Surveillance Report Of Drug-related Risks And Outcomes, 2006 to 2016 data shows that current levels of prescriptions are trending downward overall, yet some states still have very high prescription rates:
| Location | 2006 | 2016 |
| Overall | 72.4 | 66.5 |
| Oklahoma | 108.7 | 97.9 |
| Alabama | 115.6 | 121 |
| Arkansas | 98.3 | 114.6 |
| Tennessee | 124.8 | 107.5 |
| West Virginia | 129.9 | 96 |
| Kentucky | 122.6 | 97.2 |
What is Being Done Now?
The CDC published a report titled CDC Guideline for Prescribing Opioids for Chronic Pain in 2016 which “provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.” This includes recommendations on when to use an opioid for pain relief, which opioid to choose, dosage and duration recommendations, and assessing risks and potential harm to patients.
In addition, in a 2015 address titled What is the Federal Government Doing to Combat the Opioid Abuse Epidemic?, Nora D. Volkow, Director, National Institute on Drug Abuse, stressed that the recent initiative by the U.S. Secretary of Health and Human Services would implement better prescription practices as well as reversal drugs, research, and promotion of findings to the public as well as healthcare facilities and practitioners. In addition, measures would be taken to develop treatment plans with “reduced potential for misuse and diversion.” Types of intervention shown to be successful are:
- Delivering addiction/overdose education and prevention in schools and communities
- Supporting drug monitoring programs
- Distribution of reversal drugs such as naloxone to opioid users
- Investigation and prosecution of inappropriate use of opioids by doctors and pharmacies
For more information on this topic contact Taylor Martino Rowan at 1-800-256-7728 or locally at 251-433-3131.
