A daunting medical crisis is sweeping across the United States: the rapid acceleration of addiction and death rates associated with opioid medications. Often prescribed to treat moderate to severe pain, opioids are highly addictive. In 2016 alone, doctors prescribed more than 214 million opioid medications, treating nearly one in five people on long-term courses of these drugs. More than eleven million people abuse these medications, and 40 percent of all opioid overdose deaths in the United States are from legally obtained, physician-prescribed drugs.
In order to undertake the daunting task of finding solutions to such a large problem, it is necessary to understand the historical background behind how the use of opioids became so widespread. The opioid crisis began to intensify in the mid-1990s, as prescription of addictive painkillers began to rise. During this time, narcotic stigma in the medical community was low, as the result of a 1980 journal article entitled “Addiction Rare in Patients Treated with Narcotics,” published in the New England Journal of Medicine. Doctors prescribed opioids mainly for management of chronic non-cancer pain. This is primarily because the structure of the American healthcare and insurance systems makes expensive—but more effective—long-term therapies or treatments harder to access than a simple prescription for a pill. But though it is initially easier and less expensive, the over-prescription of opioids causes patients to develop dependencies. Once these patients are dependent on their prescriptions, when those prescriptions expire or become too expensive, patients seek out cheaper alternatives, like heroin: 80 percent of today’s adult heroin addicts began by abusing prescription opioids.
Prescribed opioids include hydrocodone (i.e., Vicodin), oxycodone (i.e., Percocet or Oxycontin), and morphine. With international black market smuggling, drugs like codeine, heroin, or fentanyl circulate in the black market, providing illicit opioid access to already dependent patients. Fentanyl is the most potent out of the synthetic opioids, and deaths in Illinois due to this drug have increased tenfold in the past five years. This is usually due to “spiking,” when stocks of heroin or other drugs are mixed with fentanyl to lower their market prices, without the drug user knowing. Millions of people across the United States are addicted to these drugs, putting them at risk of death due to overdose and serious long-term health complications.
Given that so many people are dying or turning to deadly alternatives because of dependencies on commonly prescribed medications, it begs the questions: what exactly about the American healthcare system makes it so susceptible to a crisis of painkiller addiction? How did advocacy for pain management lead to unprecedented acceleration in opioid prescription and production, with the United States at the forefront of consumption.
As detailed above, high prescription rates led to higher rates of use among patients, and the highly addictive nature of the drugs led many people down the road of dependence. However, two other key players outside of the doctor’s office are pharmaceutical and insurance companies. “Big Pharma,” often condemned for its aggressive pro-opioid marketing strategy at the beginning of the crisis, marketed the drugs as safe and effective for long-term use. The FDA only recently has begun to improve warning labels and push companies to put abuse deterrent formulas in place.
As millions of Americans die from opioid related overdoses, insurance companies create barriers to treatment that lock some patients into the prescription route. Long-term, non-prescription pain therapies are expensive, with non-guaranteed results and even-less-guaranteed patient compliance. These therapies are nearly inaccessible in rural areas with no large hospitals nearby, and blocked to those without comprehensive insurance plans. Patients also have their own schedules, and some of the more rigorous treatments for patients with severe pain require a large time commitment, not to mention more medical knowledge to understand the subtleties of treatment. The easy alternative to chronic pain management for all parties—doctor, patient, and insurance—is a pill. However, this approach has backfired for the American healthcare system.
Across the United States, communities, families, and lives have been and continue to be decimated by opioid addiction. But the opioid crisis has yet to be solved on any meaningful level. Across the board, stigma and funding complications make this emergency a Goliath threat to the public health system. Though solutions are in sight, reaching them may prove to be troublesome. The next article in this series on the opioid crisis will review these solutions and their feasibility across different levels of government.
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