Combating opioid epidemic requires numerous efforts

Friday, May 25, 2018 9:31 PM

There is an epidemic of opioid misuse in the United States. While the causes are multifactorial, the results have been devastating to individuals, families and communities throughout the country.

Nearly two out of every 100 adults reported a history of heroin use in 2015. During that same year, nearly 4 million adolescents and adults reported misuse of a prescription painkiller. Overdose deaths have reached epidemic proportions, with more than 100 estimated deaths per day in the U.S. As of 2016, the opioid epidemic has cost the nation more than $1 trillion, with a projected additional cost of $500 billion by 2020.

Opioids, derived from the opium poppy, have been used for pain relief for millennia. The medical use of opioids in the U.S. dates back to the late 19th century. These medications work by stimulating receptors in the brain and peripheral nervous system that block pain signals. However, opioid receptors are responsible for a variety of other effects in the body.

Because of effects such as sedation and euphoria resulting from the use of opioids, there is significant potential for misuse.

Common prescription opioids include medications such as codeine, morphine, hydrocodone, oxycodone and fentanyl. Heroin, a semi-synthetic opioid, has been banned from legal use in the U.S. since the early 20th century. The current opioid epidemic began with a rise in the use of prescription painkillers in the early 2000s.

While prescription drug abuse continues to be a significant problem, there has been a substantial rise in heroin use in the last seven to eight years. For many, prescription drug misuse is the gateway to opioid addiction and nearly two-thirds of heroin users report prescription painkiller abuse.

Physical opioid dependence can develop in as little as three weeks of daily use. As a result of dependence, users may experience withdrawal symptoms with discontinuation of opioids. Symptoms of withdrawal may include irritability, insomnia, rapid heart rate, tremor, fever and gastrointestinal distress.

Frequent use of opioids also results in tolerance to the effects of the drug. The result is frequently the use of increasing amounts of the drug to achieve the same desirable effects. However, opioids have other dose-dependent side effects, such as depression of the drive to breathe. With increasing dose, overdose can result in death.

Public health efforts are currently underway to address the opioid epidemic, but there is still significant progress to be made. Reducing opioid misuse requires a combination of efforts, including educating the public about the potential harms of both legal and illegal opiates.

For those already addicted who desire help, medically supervised withdrawal and medication assisted treatment are an option.

Meanwhile, harm reduction strategies include the availability and use of prescription Naloxone to prevent overdose deaths. This medication reverses the immediate effects of opioid intoxication and has long been available to hospitals and emergency medical services. Now, it is commonly being provided to law enforcement and even families of those addicted to opioids in an effort to save lives.

Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.