Opioid Crisis Looming in the US

By Sandra Samuels, MD

Drug overdoses and deaths are climbing at an alarming rate. It is estimated that 2 million people in the US are drug dependent (addicted), mostly to narcotics. Accidental overdose caused 59-60,000 deaths in 2016, and it is the leading cause of death in populations between 15 and 50 years of age. An estimated 365,000 + emergency room visits are due to overdoses.

These tragedies are playing out in every corner of America, big cities, suburbs of wealthy areas, and small poor rural towns. They cross boundaries of race and socioeconomic class. The most affected states with vastly increased opioid deaths include Maryland, Florida, Pennsylvania, Maine and Ohio.

Prescription pain medication is often abused for recreation purposes, shared among friends, or bought on the street or dark web. Favorites include methadone, oxycodone and, most dangerously, heroin (injectable) and fentanyl derivatives (most potent/deadly). The recent spike in deaths is attributable to rising cost of opioid pills on the street associated with easier access to cheap heroin, and heroin spiked with Fentanyl derivatives to make it more potent. Drug cartels have been effective in providing cheap adulterated heroin to our population, and users do not appreciate the danger of the drugs they are injecting.

The reinforcing action on the reward centers of the brain makes opioids very addictive. Overdoses suppress respiration, leading to respiratory failure, cardiac arrhythmias and death. This can happen very quickly. Furthermore, injectable drugs can lead to HIV, Hepatitis B and C infections, most commonly due to sharing of dirty needles. Drug use is also associated with crime and imprisonment – these addictions are increasingly more expensive to nourish. They destroy individuals and their loved ones, break up relationships, and derail a person’s goals and life, leading to homelessness and poverty.                                                      

Immediate life-saving treatment, Narcan (Naloxone) is available in a nasal spray, or by injection. This treatment has saved many lives. Police, emergency medical technicians, and even school nurses and librarians and family members have been trained to provide this emergency treatment.

Chronic treatment with the use of Methadone or Buphrenorphine and individual and/or group psychotherapy under supervision of professional MD specialists and psychiatrists has been effective.

More than 259 million prescriptions were given for opioid painkillers in 2012, and most addictions result from prescribed opiates. Due to concerns about this crisis and strong public health efforts, less opioids are being prescribed by health care providers. Physicians and other prescribers of opiates must register in the the national Prescription Drug Monitoring Program (PDMP), follow the history of their patients’ prescription use, and may only give limited prescriptions.