Americans all over the country are becoming addicted to opioids, a class of drug that is killing them in record numbers. In fact, there has been a 450 percent increase in the number of deaths among women since 1999, a statistic attributed to opioid use. How did this happen? Read on.
What Are Opiates?
If you take Oxycodone, Percocet, or Fentanyl—drugs all classified as opioid pain killers—the experience is “identical to taking heroin,” according to Andrew Kolodny, M.D., founder of Physicians for Responsible Opioid Prescribing, and a senior scientist at the Brandeis Heller School for Social Policy and Management. And that’s just what hundreds of thousands of Americans are doing every day—legally. They are taking a pain-killer that is addictive and that can potentially harm them if they find they can’t live without it.
“The U.S. is in the midst of a severe epidemic of opioid addiction,” Dr. Kolodny says. “Use of these drugs has increased very rapidly over the past 20 years—in fact, there’s been a 900 percent increase since 1997; that’s referring to both prescription opioids and heroin.”
There are 2.1 million people suffering substance use disorders related to opioid pain relievers, according to a report to Congress by Nora Volkow, M.D., director the National Institute on Drug Abuse. “There is an ongoing epidemic of prescription drug abuse and overdose deaths in this country,” she says.
Reasons for the Rise in Addiction
There are two prongs to this problem, Dr. Kolodny says: Younger Americans in their teens to early 30s encounter the drug when they have a sports injury or have their wisdom teeth removed. They wind up liking the effects of the pills, but can’t get more of them. Soon, they switch to heroin, which is much more available in places where it previously didn’t exist. They become addicted, and soon entire communities are mourning their death from drug overdoses.
But the other population suffering from addiction to these drugs is older Americans. “That group is almost entirely developing addiction through medical use,” Dr. Kolodny says. “When they get addicted, they don’t need to switch to heroin or look for drugs on the black market. They don’t have difficulty finding people who will keep them on a primary supply because they are complaining of pain and their doctors refer them to pain specialists, who keep on increasing the dose. The death rate is much higher in the older group than it is in the younger group.”
And the group that has seen the highest rise in death rates is middle aged women. “That is the group that is more likely to visit doctors and more likely to complain about a chronic pain problem,” Dr. Kolodny adds.
Middle-Age Women Are Most at Risk
According to Dr. Volkow, “Women are more likely to have chronic pain and be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men.” Evidence suggests, she adds, that for some reason, women may be more likely than men to take these drugs without a prescription to combat pain but also to treat other problems like anxiety or tension. “But there may be other factors (that make women more vulnerable to the pernicious effects of the drugs) having to do with [biological] differences between men and women. We know, for example, that women, in general, have a higher percent body fat and lower percent of body water. Body fat and water content can affect the volume distribution of certain drugs, such as opioids, and with chronic use, can lead to an increased load of drug in the fatty tissues, and potentially have a toxic effect.”
How Did This Happen?
Opioids can be an important and effective drug if used correctly, Dr. Volkow says. So how did we get to a place where doctors are the starting point for the worst addiction crisis in American history? Dr. Kolodny lays blame at the feet of a “multi-faceted campaign by pharmaceutical companies that caused (doctors) to prescribe these drugs.”
In the 1990s, he explains, a powerful marketing campaign got under way to urge doctors to prescribe opioids for pain relief. “The messaging was very compelling.”
The messaging said that people needn’t suffer pain, and that opioids did not cause addiction, except in very rare cases. The marketing material acknowledged that opioids would make patients feel sick if they suddenly stopped using the drug, calling it a “benign state” that shouldn't be confused with addiction. “They told us that opioids are a way to improve patients’ quality of life,” Dr. Kolodny says.
“But it’s not true that patients can be easily tapered off these drugs,” he adds. “It’s not true that it’s a benign state. It’s not true that addiction is rare. One of the reasons these drugs are so addictive is because of the physiological dependence. Patients feel real panic when they stop taking the drugs…it all led to the crisis that we’re dealing with today. It’s so severe that it’s having an impact on life expectancy in the United States, especially among women.”
Dr. Volkow also faults education among physicians who have been poorly trained in pain management. Some physicians, she says, “may find prescribing opioids to be the easiest and least expensive course for addressing pain.”
The Addiction Born of Pain and Societal Problems
Heather Healey, LCSW-C, Director of the Employee Assistance Program Association of Flight Attendants-CWA, AFL-CIO, says that aside from doctors pushing opioids, our society conspires to lead people—especially women—to addictive behavior by failing to provide the support they need. Employers expect them to get back to work quickly after an injury. Insurance companies pay for medications, but not for alternative treatments like yoga, meditation, or physical therapy. And we have come to believe in our doctors as infallible.
“Everyone is put on narcotics,” says Healey, an addiction expert. “There is a time and a place for narcotics…but we don’t challenge our doctors, we just follow orders,” she says. “We’ve gotten so desensitized to taking medication. We think it’s an easy solution. But we’ve become numb to the risks associated with it.”
How Opioids Can Hurt You
Opioids attach to receptors in the brain, spinal cord, GI tract and other organs and reduce the perception of pain in the body, Dr. Volkow says. One of the main dangers of opioids is the user’s quick progression to “tolerance” of the medication.
“With time, your body gets acclimated to the effects of the drugs. You override acclimation by taking more,” explains Healey. “That’s the vicious cycle, and depending on how long you use it, it is the exact same drug effect that’s used with anesthesia. It’s how you cannot feel pain from a knife slicing you open during surgery, but you keep breathing while the operation goes on. Opioids cause respiratory depression. We don’t think about breathing on a day-to-day basis, but the number one cause of death in opioid use is respiratory depression. It causes your breathing to stop. It puts the back of your brain to sleep and literally puts your breathing to sleep.”
Protect Yourself and Your Loved Ones
The first step to reducing this problem across the country is to reduce the availability of opioids and limit their use. But Dr. Volkow points out while efforts have begun to make that happen, the availability of heroin has been increasing, but experts are not sure whether increased supply or increased demand is to blame. Either way, people have reported choosing heroin because it is cheaper, more available, and provides an even better high, she adds. “In a recent survey of people in treatment for opioid addiction, almost all—94 percent—said they chose to use heroin because prescription opioids were ‘far more expensive and harder to obtain.’”
Still, if you or someone you know is battling these drugs, you can get help.
Recognize when you are addicted: “If you are in the cycle of taking medication and finding yourself needing to increase the dose because you’re managing chronic pain, that is a signal that you need to talk to someone who is an addiction expert to help you find ways to manage pain other than a pill,” Healey says. If you have been on your pills for more than two months, you’re moving into a dangerous situation, and should seek help from someone other than the doctor who prescribed them to you, she added.
Seek help through your workplace: If you’re employed, check out your Employee Assistance Program to get an evaluation and understand the options that are available to you. Or, you can contact the Substance Abuse Mental Health Service Administration to get started or call 1-800-622-HELP 24 hours a day.
Seek alternative treatments: Such drugs as Methadone, Buprenorphine and Naltrexone can be effective ways to wean heroin or opioid users away from the drug (when part of an addiction treatment program), according to Dr. Volkow.
Understand that addiction is a chronic disease: You don’t go for treatment once, but rather you must commit for a long haul and be ready to face a long road to recovery.
Avoid the Opioid Trap to Begin With
If you have chronic pain and your doctor prescribes opioids, ask about other options. “Many people don’t think of medication as a drug of abuse,” Healey says. “They think of it as a drug of use when they are following doctor’s orders.” But the Centers for Disease Control have recently issued new guidelines for treating pain, recommending that doctors start with the lowest pain relief possible.
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