Question #1: What is the history of the opioid epidemic in the United States?
“According to Professor Judith Feinberg, "Most insurance, especially for poor people, won't pay for anything but a pill."Prescription rates for opioids in the US are 40 percent higher than the rate in other developed countries such as Germany or Canada. While the rates of opioid prescriptions increased between 2001 and 2010, the prescription of non-opioid pain relievers (aspirin, ibuprofen, etc.) decreased from 38% to 29% of ambulatory visits in the same time period,and there has been no change in the amount of pain reported in the U.S. This has led to differing medical opinions, with some noting that there is little evidence that opioids are effective for chronic pain not caused by cancer.” (Para 5) (Wikipedia ,2019)
“In 1991 when deaths involving opioids began to rise following a sharp increase in the prescribing of opioid and opioid-combination medications for the treatment of pain. The increase in opioid prescriptions was influenced by reassurances given to prescribers by pharmaceutical companies and medical societies claiming that the risk of addiction to prescription opioids was very low. During this time, pharmaceutical companies also began to promote the use of opioids in patients with non-cancer related pain even though there was a lack of data regarding the risks and benefits in these patients. By 1999, 86% of patients using opioids were using them for non-cancer pain. Communities where opioids were readily available and prescribed liberally were the first places to experience increased opioid abuse and diversion (the transfer of opioids from the individual for whom they were prescribed, to others, which is illegal).” (Para 1) (Lindsay, 2019).
“The second wave of the opioid epidemic started around 2010 with a rapid increase in deaths from heroin abuse. As early efforts to decrease opioid prescribing began to take effect, making prescription opioids harder to obtain, the focus turned to heroin, a cheap, widely available, and potent illegal opioid. The use of heroin increased in both sexes, the majority of age brackets, and all socioeconomic groups. Deaths due to heroin-related overdose increased by 286% from 2002 to 2013, and approximately 80% of heroin users admitted to misusing prescription opioids before turning to heroin.” (Para 2) (Lindsay, 2019).
“The Opioid epidemic began in earnest in the 1990s when pharmaceutical corporations roundly assured the medical community of the safety of prescription Opioids as pain relievers. This period is described as the “first wave” of the Opioid epidemic. At the time, TV advertisements for medications increased to the point that patients could request prescriptions by name. Believing the threat of addiction to be low, doctors began prescribing painkillers in record numbers. By 2011, doctors were writing 238 million Opioid analgesic prescriptions annually. Yet, illegal street drugs and drug busts garnered more attention, leaving increasing numbers of Opioid overdose deaths underreported for a time.” Second Wave
“The second wave of the Opioid epidemic started in 2010 with a concurrent rise in Heroin deaths as prescription painkiller deaths continued to climb. That year, 16,651 people died from drug-induced overdose; Heroin was involved in 3,036 deaths. During this time, deaths from prescription Opioids overtook deaths from motor vehicle crashes, Cocaine, and Heroin combined. The rise in Heroin use, as an injection drug, also led to a rise in the spread of infectious diseases like HIV and Hepatitis C.”
“The third wave of the Opioid epidemic started only three years later with deaths involving highly potent synthetic Opioids (like Fentanyl and Carfentanil). In 2016, nearly a third of all drug overdose deaths and half of all Opioid deaths involved a synthetic Opioid, up 100% from the previous year. 19,413 individuals died as a result of synthetic Opioids in 2016, more than any other drug. What’s worse, illegally manufactured derivatives synthetic Opioids are now often added to counterfeit pills (like Benzodiazepines) and other street drugs (Heroin, Cocaine, Marijuana) for added side effects and to increase addictiveness. This has also contributed to a rise in overdose deaths for those substances.”
Question #2: How do opioids affect people biologically?
“When heroin, oxycodone, or any other opiate travels through the bloodstream to the brain, the chemicals attach to specialized proteins, called mu opioid receptors, on the surfaces of opiate-sensitive neurons (brain cells). The linkage of these chemicals with the receptors triggers the same biochemical brain processes that reward people with feelings of pleasure when they engage in activities that promote basic life functions, such as eating and sex. Opioids are prescribed therapeutically to relieve pain, but when opioids activate these reward processes in the absence of significant pain, they can motivate repeated use of the drug simply for pleasure.” (Para 6) (Thomas, 2002)
“One of the brain circuits that is activated by opioids is the mesolimbic (midbrain) reward system. This system generates signals in a part of the brain called the ventral tegmental area (VTA) that result in the release of the chemical dopamine (DA) in another part of the brain, the nucleus accumbens (NAc) This release of DA into the NAc causes feelings of pleasure. Other areas of the brain create a lasting record or memory that associates these good feelings with the circumstances and environment in which they occur. These memories, called conditioned associations, often lead to the craving for drugs when the abuser reen-counters those persons, places, or things, and they drive abusers to seek out more drugs in spite of many obstacles.” (Para 7) (Thomas, 2002)
“Particularly in the early stages of abuse, the opioids stimulation of the brain's reward system is the primary reason that some people take drugs repeatedly.” (Para 7) (Thomas, 2002)
Question #3: What is the role of pharmaceutical companies?
“It’s impossible to talk about the causes of America’s opioid epidemic without pointing to the manufacturers and distributors that marketed and proliferated dangerous opioid painkillers. Yet for much of the crisis, these multibillion dollar opioid companies have avoided much in the way of serious accountability. Until, perhaps, now.Last month, Purdue Pharma, the maker of OxyContin, tentatively agreed to pay as much as $12 billion to settle lawsuits it faces for its role in the opioid crisis. It would be the largest settlement related to the epidemic, which has contributed to the more than 700,000 drug overdose deaths in the US since 1999.” (Para 1 & 2) (Lopez, 2019)
“Starting in the mid-1990s, opioid manufacturers unleashed a misleading marketing push underplaying the risks of opioid painkillers and exaggerating the drugs’ benefits. This, the lawsuits argue, adds up to false advertising with deadly consequences by encouraging doctors to overprescribe the pills and getting patients to think the pills were safe and effective.” (Para 5) (Lopez, 2019).
Meanwhile, opioid distributors supplied a ton of these pills, even when they should have known they were going to people who were misusing the drugs. This is backed by data showing that, in some counties and states, there were more prescribed bottles of painkillers than there were people — a sign that something was going very wrong. Federal and some state laws require distributors to keep an eye on the supply chain to ensure their products aren’t falling into the wrong hands. Letting these drugs proliferate, the lawsuits say, violates those laws. Opioid manufacturers and distributors, of course, deny these allegations. While some lawsuits have been settled and some executives have even been criminally convicted for their involvement in the epidemic in the past, opioid companies vigorously reject the argument that they have carelessly fueled the current drug crisis. And so far, what the companies have paid by and large amounts to a fraction of the revenue they’ve taken in from the drugs.” (Para 6 & 7) (Lopez, 2019).
Question #4: What will the opioid crisis be in 10 years?
Although the number of opioid-related deaths may be decreasing in some states, overall, they continue to increase nationwide. The good news is that some research has shown that regulatory and legislative efforts introduced earlier this decade have succeeded in driving down prescription opioid dosage volume. And, in turn, some evidence indicates that these efforts have contributed to a decline in mortality rates from prescription opioid overdose. The bad news, however, is that overdose deaths involving heroin and synthetic opioids have spiked during the same period.
Specifically, the researchers estimated the annual and cumulative number of opioid overdose deaths from 2016 to 2025, and whether those deaths would be caused by illicit or prescription opioids, under each of the following scenarios:
no change in the annual incidence of prescription opioid misuse from 2015 onward;
a decrease in the incidence of prescription opioid misuse of 7.5 percent per year (the same rate of decline seen between 2008 and 2015) from 2016 to 2025;
a decrease in the incidence of prescription opioid misuse of 11.3 percent per year; and
no new incidence of prescription opioid misuse after 2015.
The research team repeated the analysis 1,000 times to ensure accuracy.
Devitt, Michael. “Research Shows Nation's Opioid Epidemic Is Far From Over.” AAFP Home, 20 Feb. 2019, www.aafp.org/news/health-of-the-public/20190220opioidprojections.html.
Kosten, Thomas R, and Tony P George. “The Neurobiology of Opioid Dependence: Implications for Treatment.” Science & Practice Perspectives, National Institute on Drug Abuse, July 2002, www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/.
“In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates.” This is how the American opioid epidemic started. When doctors increased the prescription of opioid medications it led to widespread misuse of both prescription and non-prescription opioids. Before it even became clear that the drugs were in fact very addictive, America was in a downward spiral. In 2017, the HHS (The purpose of HHS is to enhance the health and well-being of all Americans) declared a public health emergency.
The HHS stated, “Today, we have people dying from drug overdoses in the middle of funerals for loved ones who just days before died of an overdose. We have unimaginably lethal drugs, like fentanyl and carfentanil, pouring into our communities and instantly becoming best sellers because of their reputation for delivering a high so powerful that it can kill you with just one hit.” In 2015 alone, 52,000 Americans died of an opioid overdose, representing the highest number of opioid deaths ever recorded in our country. HHS came up with a 5 step strategy that could halt the crisis. Improving access to treatment and recovery services, promoting the use of overdose-reversing drugs, strengthening our understanding of the epidemic through better public health surveillance, providing support for cutting edge research on pain and addiction, and advancing better practices for pain management.
The pharmaceutical company, Purdue Pharma, is one of the biggest culprits for the current opioid epidemic. It invented oxycontin, a drug medically used for treating chronic pain. Purdue Pharma heavily promoted their products, even to the point that they claimed oxycontin was less addictive than other opioid painkillers, knowing that was not the case. In 2007, they were lawsuited $635 million dollars. That absolutely does not make up for the millions of people who are now addicted, the amount of deaths caused by opioid overdose, and the families who are affected.
In this situation, I believe there really isn't a perfect solution to all of our problems. There are always going to be broken families, broken homes. It’s hard to say what is going to be best for everyone. About 2.1 million Americans have an opioid use disorder. If we can’t tell people what to do, we can supply them with compassion and support. Many of the people addicted did not ask to be addicted, they were given narcotics to suppress their pain. The Dalai Lama states, “the only way to change a person's mind is with concern, not with anger or hatred.” I strongly feel this, I believe rehab should be free, since most of these people were started on prescription medication, but had to switch to heroin because it got to costly. A rehab that shows compassion and love. That could potentially help a lot of people.
Part 3: Approach
Colorado Addiction Services Inc is a program based in Durango, Colorado that treats patients who are addicted to all kinds of substances ranging from alcohol to opioids. Their mission is to empower patients in making informed choices in order to assist them in recovery, while still honoring individual dignity and respect. The strengths that this program has is that it provides a lot of different services including addiction treatments, integrative care, resources, and testimonials. They also treat hepatitis C in men, which is great, but why not women? The weaknesses of this program is that it doesn’t provide women's health as much as it does men. It seems like they have no sense of community, because in their treatment programs they don’t have anything about coming together. As a community, there might be potential for more love circulating and motivation. This treatment plan seems like it kind of singles out the patients, which doesn’t help. Something that has been proven to help patients steer off the drugs is mindfulness, which they don’t have either.
Part 4: Proposal
A proposal I would suggest to this company would be to include more services, services that are proven to help addicted patients. These services would include a spot in the facility designated just for mindfulness and meditation, treatments for women with hepatitis C, and to build a community. These 3 new resources could make this facility a lot better than it already is! This could impact the quality of the patients’ experience, and hopefully even help them with their addiction. My proposal is to be heard by the owners of this facility in Durango, and the patients who pay to be there. I think the patients would really enjoy having a place to do meditation, because it has been proven to help people struggling with addiction. The staff and patients could very much benefit from having a warm sense of community, and know everyone there. Women could very much benefit from a hepatitis C treatment, or any other type of disease treatment. Every patient should be treated for diseases that spread from sharing needles. Having a strong sense of community personally for me is very helpful when I'm struggling through something, so I think pitching this idea to this facility could be a great idea.
Part 5: Reflection
I do genuinely care about this subject, and I think something needs to be done about it, but I honestly got bored doing hours of research. It is just not a topic that blows my mind. It was interesting to get a better background on the topic, but I feel like I wasn’t really wanting to learn much more. I have always wanted to learn about this topic, and I was sure I would be interested, but I’m not and that’s useful to know going into Senior Project.
My proposal aligns with the caring strength I have, I feel like I care a lot about the things I try and fix. Especially with a sensitive topic like addiction, I feel like I care a lot about making things better for people, which is why I want to be a nurse. Going into my senior project, I feel like I want to do a serial killer topic, which is going to be hard to find an action project. I know if I want to be successful in my action project, I need to do something I’m really passionate about. So, for my senior project I need to find a topic that is so interesting that I don’t get bored after a week, but I get more passionate about it every week. Something that is going to make me WANT to do an action project.
I definitely gained some research skills. I hadn’t really ever done research like this before and it’s going to be useful for senior project, and in the long run in college. I gained insight on how to find a scholarly source, and good sources, which is also useful. I was effective in making an impact to, because I believe this facility would benefit greatly on what I proposed. Maybe they had never thought of what I have in mind.
The most interesting part of the project was finding that facility in Durango and learning a lot about it. I had no idea we had something like that here. I guess I don’t really see a lot of people on drugs in Durango, but I’ve heard there are a lot. It was fun to kind of find the flaws in their system and come up with new ideas for them.
I think one thing that could’ve been cool would be to actually email the facility and do something with that, as an exhibition or something. Overall I liked the project but I wish I could have changed my topic earlier on.