The opioid epidemic claimed nearly 450,000 lives from 1999 to 2018 due to opioid-related overdoses. This is an astonishing death toll, yet one that has not received significant attention from the general public. Prescription painkillers represent a significant portion of opioid-related deaths, yet a new study finds that 1 in 10 Americans still use these powerful drugs.
History of the Opioid Epidemic
People have used opioids for hundreds of years, but the current U.S. opioid epidemic began in the 1990s. The Centers for Disease Control and Prevention (CDC) now identifies three waves in the epidemic. The first wave began in the 1990s as doctors began prescribing opioid painkillers in huge quantities. Pharmaceutical companies recognized the potential for enormous profits related to marketing prescription opioids for chronic pain and related health conditions. They convinced doctors that prescription opioids were safe, effective, and a humane approach to pain management. Unfortunately, tens of thousands of people became addicted to painkillers during this time.
The second wave in the epidemic began in 2010. Deaths related to heroin began to spike. Many of the people affected had first started using prescription opioids. Once they became physically dependent on pain pills, they needed more and more powerful drugs to get the same effect. Heroin represents a more potent, and often cheaper, alternative to prescription painkillers.
The third wave in the epidemic began in 2013 as synthetic opioids like fentanyl became more widely available. Illicitly manufactured fentanyl from China was trafficked across the U.S. border with Mexico. Fentanyl is often added to heroin, cocaine, and counterfeit painkillers. In many cases, people do not realize the drugs they take contain fentanyl. Again, people abusing painkillers may be affected when they buy pills on the street.
Negative Side Effects of Opioid Painkillers
The widespread availability of prescription painkillers has a dark side. When your body metabolizes an opioid medication, the opioids spread through the bloodstream and cross the blood-brain barrier. Opioid molecules bind to special opioid receptors. Once there, they cause a series of chemical reactions that blunt the body’s pain response. Taking medication changes the receptors to become less sensitive in the future. That means that more of the drug is needed to achieve the same effect. This is known as tolerance. At the same time, the body becomes accustomed to having opioid molecules readily available. When the supply of opioids is cut, your body reacts with symptoms like nausea, chills, diarrhea, restlessness, sweating, watery eyes, and running nose. These withdrawal symptoms are the body’s attempt to compensate for the lack of available opioids. Together, tolerance and withdrawal symptoms are signs of opioid dependence. Dependence means that your body now depends on opioids to function normally.
In the brain, opioid activity also affects the brain’s reward circuits. Changes to the structure and functioning of these reward pathways alter how the brain responds to opioids. Over time, the reward circuits begin to crave more and more of the drugs. This results in addiction, which is a set of behavioral symptoms. Symptoms include cravings, spending excessive time using the drug, failure to recognize consequences of drug use, and an inability to stop using opioids despite negative effects.
Together, opioid dependence and addiction ruin lives. People struggling with chronic pain take prescription medications in an attempt to feel better. However, long-term use of these drugs affects psychological, physical, and emotional health.
CDC Efforts to Counteract Prescription Opioid Abuse
After prescriptions for opioids boomed in the 1990s, some chronic pain patients welcomed the shift. Advocates within chronic pain communities say that access to prescription opioids is essential for their ability to maintain everyday functioning. By the early 2010s, however, the CDC recognized that prescription opioid use was out of control in the United States. In 2012, doctors wrote more than 255 million prescriptions for opioid painkillers. That is a rate of 81.3 prescriptions per 100 persons, enough for every adult in the U.S. to have a bottle of painkillers.
In 2016, the CDC published new guidelines for opioid prescribing. The guidelines called for prescribers to use non-opioid or non-pharmacologic therapies as first-line treatments for chronic pain. Prescription painkillers for chronic pain are only to be used after other treatments have failed. Providers are also encouraged to develop a treatment plan with patients that includes a plan for tapering off opioids in a safe way.
New Study Shows 1 in 10 Americans Still Use Prescription Painkillers
Public health experts were eager to see whether the new CDC guidelines would have their intended effect. So far, the data look promising. In 2018, the prescribing rate fell from its high of 81.3 prescriptions per 100 people to 51.4 prescriptions (168 million total prescriptions).
However, the most recent study from the CDC shows that nearly 11% of adults in the U.S. used at least one prescription painkiller between 2015 and 2018. More than half of those used an opioid painkiller like oxycodone or morphine. Women (particularly older women) were more likely than men to use a prescription opioid. The study also found that Whites were most likely to use prescription opioids, followed by Blacks, Hispanics, and then Asians.
While the overall decline in prescription opioid use is encouraging, the fact that 11% of Americans continue to use prescription painkillers suggests that there is more work to be done. Painkillers cannot treat the underlying cause of the pain; they only mask the symptoms. Many chronic pain patients experience musculoskeletal pain such as lower back pain. Physical therapy, massage therapy, and acupuncture are effective treatments for these forms of pain. Furthermore, cognitive behavioral therapy can address psychological issues that perpetuate pain.
Toward a Solution for a Healthier, Opioid-Free Life
We must continue to develop solutions for the prescription opioid problem. One in 10 people is better than the peak of the epidemic, but it is not good enough. People with chronic pain are suffering, and they need real solutions.
Expanding access to medical detox programs can help patients go through withdrawal in a safe, compassionate, and humane environment. After detox, patients can get the treatment they need to address the issues that perpetuate opioid abuse. This includes non-opioid or non-pharmacologic treatments for chronic pain. Often, this will include psychotherapy to address depression, anxiety, and trauma. These psychological factors keep people trapped in a pain cycle. They also predispose a person to abuse prescription painkillers to numb their emotional pain. Addressing unmet mental health needs is a critical part of comprehensive treatment for opioid addiction.
At Waismann Method® Advanced Treatment for Opioid Dependence, we hope to continue to see a decline in prescription opioid levels. Restricting the number of unnecessary prescriptions is a good start. But only by addressing the medical and psychological issues that perpetuate prescription drug abuse will people be able to live healthy, opioid-free lives.