In a polarized world, the Opioid Crisis is unifying. It’s one of the only issues to be mentioned in State of the Union addresses of both Donald Trump and Barack Obama. It has earned this attention for its devastating impact on the American workforce, and for its staggering annual overdose rate. In a seven year timeframe, America lost more people to overdose in every single year than it did in the entire Vietnam War. That’s more than 58000 lives lost every year!
Currently, the Opioid Crisis is on track to improve drastically for Generation Z and younger because of the legal reforms that have been put into place to reduce the number of opiates available to people. To understand why this is working, it helps to look back on where it went wrong.
How Did We Get Here?
In the early 1990’s, one of the most prolific prescription opioids hit the US market. When a drug becomes widely available, prescription drug companies offer information and training to medical providers on when and how to prescribe it, and when to be cautious. Oxycodone was described to providers as very low risk for addiction, yet very effective for pain. This was also well into the era of drug companies being able to market directly to consumers through advertising. Oxycodone had one of the most thorough and widespread marketing campaigns.
Around the same time, research was beginning to show the addiction potential for opiate pain medications, but by then these medications were already a patient and prescriber favorite. It remains unclear how much individual pharmaceutical company owners knew, or how much information may have been deliberately ignored. As of 2020, Purdue Pharma has begun the settlement process, paying families and communities between $10-$12 billion dollars. The overall cost to the country is estimated in the hundreds of billions, and the individual cost to families who have lost loved one’s is incalculable.
Wins: Policy That Changes the Future
The most effective changes have been through a range of laws passed to drastically alter the amount of opioid pain medications that are in communities. Most states have passed laws and developed systems that help connect prescribers and pharmacies, so that it’s flagged if a person attempts to fill more than one prescription. This makes “doctor shopping”, when people obtain multiple prescriptions from multiple doctors, a lot more difficult.
Limits have been placed on the quantity of pills that can be prescribed at a time, with additional short-term prescriptions only available after being seen again by a doctor. This is effective in keeping excess medications from being in medicine cabinets across America. For nearly a decade, many people had half full bottles of highly addictive medication in their medicine cabinets after having a basic medical or dental procedure done. There was a time when getting a cavity filled would get a person an automatic 50 pill bottle of opiates. Some communities had per capita prescription rates of up to 80% for several years in a row. Many teenagers began or continued their addiction from the supply in their own families’ houses. Recent legislation ends that.
Lastly, the information being given to prescribers is different than it was initially. Most importantly, the risk for addiction is clear, with information on addiction being labeled on every bottle and in the paperwork that most people get with their medication. Also, it is prescribed widely for acute pain, rather than chronic pain. Initially it was marketed as an easy, consequence-free solution for any pain. However, recent research shows that when opiates are prescribed for long periods of time, pain actually becomes worse. This is because the parts of the brain impacted by opiates become more sensitive to pain the longer that pain medication is taken. Not only has opioid pain medication back-fired in communities, but also in the brain itself.
To recap, Generation Z and future generations are not going to face the same opioid crisis that is affecting millions now. The information on risks and appropriate use is more effective, clear, and widespread. Prescribers and pharmacies have the ability to communicate with each other more effectively. Most importantly, it isn’t as easily and widely available in the form of legal prescriptions as it was before.
Losses: Challenges for the Present
The opioid crisis remains a widespread problem for three main reasons. First, the availability of illegal opiates in the form of fentanyl and heroin has increased. This means that it remains fairly easy for people who are already addicted to access a consistent supply. It’s harder to get it through legitimate medical sources, but it’s easier to get it on the streets. Overdose potential remains high, and fentanyl especially poses a very high risk.
Secondly, access to treatment is still a challenge. There are a wide range of disparities between who has easy access to treatment, and who doesn’t. While insurance companies are required to pay for substance abuse treatment due to recent parity laws, approval for longer term treatments remains low. Navigating the treatment process is more challenging than it should be. Many states have very low regulations for what passes as a treatment center, and unethical practices are widespread. Families access hotline numbers from an internet search, and end up connected to headhunters for sub-par rehabs. In the middle of a crisis, it’s hard to know how to find evidence-based, accredited treatment centers. Many clients compliment Harris House for treating them “like people”, or “with respect and dignity”. These things should be a given in the field of substance abuse treatment. A heroin addiction should not take away someone’s basic right to decency.
Lastly, people still need better ways of dealing with pain, both physically and emotionally. Some money has been directed towards researching safer pain management medications, but non-medicinal alternatives are less likely to get funding. Insurance companies are also less likely to pay for things like chiropractic care, acupuncture, or massage therapy even though the little research that exists supports these as effective pain management techniques.
Losses: A Final Word
Policy decisions tend to be motivated by quantifiable losses. It’s a bit easier to push for change to address the billions of dollars lost to the Opioid Crisis. The conversation is helped along when we discuss the number of industries that don’t have enough of a healthy workforce to thrive. Nearly every major business experiences loss of employee productivity, either because of addiction or because of family members helping loved one’s through addiction.
What we can’t quantify is the cost of lost futures. What is the dollar amount that matches the loss of a parent, as a young child? How do you categorize lost futures, teenagers who don’t pursue their dreams, or young people whose lives end before their potential is realized? The answer is that there is no dollar amount. You can’t quantify those losses, because they are bottomless. This type of bottomless, and needless suffering can end now. This decade can be the one when America turned the Opioid Crisis into history.
For More Information
If you are looking for support, please see the list below. Saint Louis has a solid and expanding network of support for families and loved one’s struggling with addiction. Nationwide, many resources also exist. The opiate crisis is far from over for our country, and many families. However, there is some light at the end of this devastating tunnel.
Resources for Continued Learning:
Al-anon.org Support for friends and family dealing with addiction.
Samhsa.gov Substance Abuse and Mental Health Services Administration.
NCADA-stl.org St. Louis based organization for education, and advocacy.
Access to Treatment:
SAMHSA’s National Helpline – 1-800-662-HELP (4357)
Harris House 24/7 Ask A Counselor Line – 314-631-4299
US Opioid Prescribing Rate Maps. https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html
Purdue Pharma Offers $10-12 Billion to Settle Opioid Claims. https://www.nbcnews.com/news/us-news/purdue-pharma-offers-10-12-billion-settle-opioid-claims-n1046526
The Promotion and Marketing of Oxycontin: Commercial Triumph, Public Health Tragedy. Am J Public Health. 2009 February; 99(2): 221–227.