19 Things You Didn't Know About the Opioid Epidemic
Prescription painkillers and illicit drugs have killed hundreds of thousands of Americans in the last decade.
It’s difficult to escape headlines about the opioid epidemic. The crisis has taken the lives of hundreds of thousands of Americans and has cost the United States more than $1 trillion since 2001. Currently, more than 115 people die every day after overdosing on opioids, including prescription painkillers (like OxyContin or Percocet) and illicit drugs like heroin and fentanyl.
According to a recent government survey, one in five Americans knows someone personally who has been addicted to opioids or prescription painkillers. But if you’re not part of that 20%—or even if you are—the true toll of the opioid epidemic, and what it’s really like to experience it, may still come as a shock. Here are some of the most eye-opening facts and surprising statistics.
More than one-third of American adults have used opioids
In fact, more than a third of American adults (about 38%) used at least one prescription opioid in 2015 alone. That’s the finding of a 2017 survey in the Annals of Internal Medicine, which also found that about 13% of those who took opioids actually misused them—either taking them without a prescription or not as directed.
Yet, despite the drugs’ widespread prevalence, there’s still a lot of stigma around them, says Laura Veach, PhD, professor and director of specialized counseling, intervention, and training at Wake Forest Baptist Medical Center.
“Patients think it could never happen to them or their loved ones, and doctors think it could never happen to their patients,” she says. That stigma prevents people struggling with addiction from coming forward to seek help, she adds—and it prevents health care professionals from bringing up the issue with their patients, as well.
Opioid-related deaths have nearly doubled in the last decade
According to a 2017 study in the Annals of the American Thoracic Society, opioid-related hospital deaths nearly doubled from 2009 to 2015. Over the same time period, the number of overdose-related admissions to hospital intensive care units also increased by 34%.
The death rate from opioid overdoses saw its biggest bump around 2012 in this study. The authors say this increase could be the result of more opioid prescriptions being written by doctors in the preceding years, which may have eventually led to more addiction.
Opioid overdoses among children have doubled, too
Mirroring adult trends, childhood hospitalizations due to opioid overdoses have also nearly doubled—from 797 between 2004 and 2006 to 1,504 between 2013 and 2015, according to a recent Pediatrics study. Those numbers don’t just reflect older kids using drugs intentionally, either: One-third of the hospitalizations reported in the study were for children younger than 6.
About 20% of those children under 6 had overdosed on methadone, an opioid that’s prescribed to help people recover from addiction to heroin or other narcotics. The study is a stark reminder that opioids in the home can put young children at risk, its authors say, even if adults are currently seeking treatment for themselves.
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We don't really know how many people have died—but it's probably more than we realize
Recent estimates suggest that more than 42,000 people died of an opioid overdose in 2016 alone, and that these drugs accounted for about 20% of all deaths among young adults that year. As if that weren't enough, however, a study published this week in Public Health Reports reports that those numbers only make up part of the total death toll.
According to the new study, as many as 70,000 opioid overdose deaths went unreported or misclassified between 1999 and 2015 because of the way they were coded on death certificates. More than 97,000 unintentional overdose deaths during that period were coded as "unspecified" rather than opioid-related, and researchers believe that many of them belong in the opioid category.
All age groups and regions have been affected
“Addiction is such a non-discriminatory disease,” says Veach. “It doesn’t matter if you’re at the top level of your job with CEO status or if you’re in school as an eighth-grader; the brain can still become hijacked.”
Recent research by the nonprofit organization FAIR Health backs up that claim with numbers: From 2007 to 2016, private insurance claims pertaining to opioid abuse and dependence were found in every age group from teens to seniors in their 70s and 80s.
The wide range of age groups was noted in claims from both rural and urban parts of the country, as well. “It’s not just an inner-city crisis and it’s not just a Middle-America crisis,” says Jonah Stulberg, MD, assistant professor of surgery at Northwestern University Feinberg School of Medicine. “It’s happening everywhere, and no one is immune to it because they’re rich or poor or white or black.”
A recent report from the Centers for Disease Control and Prevention (CDC) confirmed this nationwide trend, finding deaths involving synthetic opioids increased in 21 states.
At first, addiction is hard to recognize
Because opioids are often first prescribed for legitimate medical purposes, addiction can develop slowly and sneakily. “I wish people would break out in purple spots when addiction starts, because at first it’s invisible; very few people recognize it in the early stages,” says Veach. Of course, she adds, later stages of addiction are much more easily recognized.
There are things people can do to reduce their risk of becoming addicted to prescription painkillers, though. If you’re at all concerned about taking an opioid for pain, talk with your doctor about alternatives. If you decide together that an opioid is your best choice, take them only for as long as you really need them—usually just a couple of days.
Recovery is harder than you think
“Hollywood has not done us any favors in terms of portraying recovery from addiction,” says Veach. “People think it’s okay to still hang with their friends who are using, or to go to the bar and have a few drinks, but those habits can be extremely dangerous and triggering.”
People recovering from an opioid addiction often have to change their lifestyle and their daily patterns to avoid these types of triggers, Veach adds. Even reading or watching the news can be difficult, if drug busts or opioid overdoses are mentioned.
Veach also wants friends and family of addiction victims to know that treatment is a slow process, and it can take months or even years before a loved one is out of danger. “It’s a chronic illness, and it has nothing to do with them being a bad person or not loving you or not trying hard enough to get better,” she says.
That being said, she adds, treatment does work for people who are receptive and who receive proper care—especially when they have a strong support network of people who have their best interests at heart.
Health care professionals face barriers to treatment
As much as doctors and therapists want to help patients addicted to opioids, they are often hindered by a lack of resources or outdated policies, says Veach. “If this were any horrible virus, we’d be treating it much more aggressively,” she says. “Look at the flu this year: If we did for addiction half as much as we do for the flu—with vaccines and antiviral medication and all of the awareness efforts—I think we’d be in a different place right now.”
One problem, Veach says, is that it’s much easier for doctors to prescribe opioids than it is to prescribe the drugs that treat opioid withdrawal. Physicians have to receive a special license to prescribe one of those drugs, buprenorphine, while methadone can only be administered in highly structured clinics.
Many hospitals are also just learning how to counsel patients about opioid- and addiction-related issues. “The medical and insurance industries have always separated behavioral health treatment from any type of medical treatment,” she says. “But this opioid epidemic has shown the fallacy of that approach, and how we’re missing way too many people if we don’t combine them.”
In October 2017, the Trump administration declared the opioid epidemic a public-health emergency, opening up new resources for cities and states to combat the problem. But many health experts believe the President should declare a national emergency, which would provide even more funding and assistance to physicians struggling to keep up.
Some doctors think marijuana could help
More medical marijuana could mean fewer opioid overdoses, according to studies published earlier this year in JAMA Internal Medicine. Two separate teams of scientists both came to the same conclusion in their recent research: States that have legalized marijuana—either for medical or recreational purposes—have seen a drop in the number of opioid prescriptions written.
Other research has suggested that a drop in opioid prescriptions could also lead to a drop in abuse rates and overdoses, as well. Some patients say they need fewer opioids when they use marijuana for pain relief, although experts caution that there’s not enough evidence yet to use the cannabis-based drug as a first-line treatment.
Many people get opioids from friends and family
“If we look at the crisis as a whole, we know that the number of prescriptions given per population is linked to overdose deaths and also to something called diversion, meaning the non-medical use of prescription medication,” says Dr. Stulberg. “That’s the in-between step, and it’s important to know where and how non-medical users obtain the drugs.”
It turns out that many people get them from their loved ones. According to that 2017 Annals of Internal Medicine survey, about 60% of adults who misused opioids did not have a prescription, and about 41% recently obtained drugs for free from friends or relatives.
“When there’s so much access, it becomes a community problem,” says Dr. Stulberg. “Addiction is a crisis of loneliness and about filling a void—and the more readily people can get it, the more they’re going to misuse.”
Prescription drug addiction often leads to heroin use
The opioid epidemic isn’t just about prescription medications, but also the illicit drugs heroin and fentanyl. And while the two categories may have different connotations, addiction to both prescription and non-prescription drugs tend to start the same way.
“We think that about 80% of those who are addicted to heroin started by abusing prescription medication,” says Dr. Stulberg. “That’s one of the things that makes this particular crisis unique: It comes directly from the health care community, and there’s this very close association with prescribing habits.”
According to the CDC, people who are addicted to prescription painkillers are 40 times more likely to use or be addicted to heroin—which is cheaper and sometimes easier to get, since it doesn’t require a prescription.
Cities and states are now suing drug companies
Experts now know that the current opioid epidemic is largely a result of the huge boost in doctors prescribing the drugs over the last two decades. Pharmaceutical companies marketed opioids as effective and “relatively benign” remedies for managing chronic pain, according to a 2017 editorial in JAMA Psychiatry, and doctors were pressured to treat all types of conditions with the drugs.
Now, many cities and states are fighting back. In May, six states sued the makers of OxyContin, alleging false advertising and dangerous practices in which doctors were urged to increase patients’ doses if they weren’t getting relief. That adds to hundreds of other lawsuits around the country against other pharmaceutical brands that engaged in similar tactics.
Some patients are now scared to take opioids for pain
“We do have some patients who are very worried about being prescribed an opioid after surgery, because they’re terrified they’re going to become addicted,” says Dr. Stulberg. Part of his job is now assuring patients that there are still safe ways to manage pain with opioid medications.
Veach thinks this type of questioning is a good thing. “I want every patient to be an advocate for themselves, and if they’re experiencing emotions like fear or worry, those are very important,” she says. “We talk with patients about how that danger is more likely to occur after continuous use for several weeks, and not with one short-term prescription for just a few days.”
Others are worried doctors won't treat them at all
“At the same time, we have patients who are terrified that their physician won’t treat their pain adequately because they think we no longer give opioids at all,” says Dr. Stulberg.
It’s true that the medical community is exploring safer alternatives to opioids for things like chronic pain and post-surgical recovery, and that doctors are now prescribing lower doses and shorter courses of opioids than they once did.
“But that doesn’t mean we don’t still feel strongly about controlling pain appropriately, and there’s a big difference between taking a medication for a short time and becoming addicted,” says Dr. Stulberg. “One of the things that’s been linked to addiction, actually, is chronic pain—so we have to treat the pain so that people can move on with their lives.”
Opioid deaths aren't just from overdoses
“Overdosing is not the only way people are dying from opioid addiction,” says Veach. “The other way we’re seeing so much of is endocarditis, an infection of the heart lining you can get from IV needle use.” Pneumonia and osteomyelitis, a potentially deadly infection of the bone, can also occur.
These conditions bring up ethical issues for doctors and hospitals, Veach adds. “How many heart surgeries to replace a heart valve should somebody with an opioid addiction get?” she says. “We’re finding that we have to use much more intensive interventions with patients, to ensure that they’re not going to go right back out and return to IV drug use.”
On top of infection and accidental overdose, another contributor to the opioid mortality rate is suicide. According to a recent analysis in the New England Journal of Medicine, experts don’t know exactly how many opioid overdoses have been intentional—but it’s estimated to be a significant number that’s also grown over the last decade.
You can now buy naloxone at the drug store
Naloxone (sold under brand names Narcan and Evzio) is a drug that can reverse the effects of an opioid overdose. Many emergency medical technicians, police officers, and other first responders now carry the drug, which is administered via an injection or a nasal spray. Naloxone can restore normal breathing and save lives, but it must be used at the first sign of an overdose.
In October 2017, Walgreens announced that it would begin selling Narcan at all of its 8,000 stores nationwide, without a prescription. CVS also sells the drug over the counter in 43 states. Narcan can cost around $130 to $140 for two doses, and is often covered (minus a copay) by insurance. Some community organizations may also provide the drug free of charge.
There's now a non-opioid medication to treat withdrawal
Until very recently, the two medication options for treating opioid withdrawal (methadone and buprenorphine) were also both opioids themselves. Although they’re less dangerous than drugs like heroin and fentanyl, they still have addictive properties and patients must be tapered off of them gradually.
Now, there’s an alternative: In late May, the FDA approved the non-opioid drug Lucemyra to treat the physical symptoms of opioid withdrawal, such as anxiety, nausea, sleep problems, and drug cravings. Scientists say the drug, which will be available this summer, may help more people stop using opioids cold turkey and prevent relapses.
Overdose victims' organs are being used to save lives
Because many of the Americans who have died from drug overdoses in recent years have been organ donors, the opioid epidemic has had a surprising side effect: More organs have become available for much-needed transplants. A recent study in the New England Journal of Medicine noted a more than 10-fold increase in the proportion of donors who died from drug intoxication between 2000 and 2016 in the United States.
Doctors may be hesitant to use organs from an overdose victim—and patients may be hesitant to accept them, the study authors noted. But when the researchers compared one-year survival rates for heart and lung recipients who received organs from overdose victims versus people who died from other causes (such as gunshot wound, blunt head injury, or stroke), they found no significant differences.
"In the unfortunate circumstances where opioid deaths happen, organ donation can extend life of many patients in need of transplant," said senior author Josef Stehlik, MD, medical director of the heart transplant program at the University of Utah, in a statement. "I feel hopeful that doctors across the country will read this and feel confident that organs that pass the required tests are safe for transplant.”
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Returning unused drugs can help
Any time people have leftover painkillers from a surgery, an injury, or even from childbirth, that’s an opportunity for them to wind up in the wrong hands, says Dr. Stulberg—either intentionally (if you give or sell them to another person) or unintentionally (if you misplace them or have them stolen from you). Even throwing them away in the trash is a bad idea, unless you take proper precautions first.
“There are just so many unused medications per person in our society, and it’s a readily available source for individuals who struggle with addiction,” says Dr. Stulberg. “But that’s something everybody can do something about: You can start participating in Drug Take Back Days, or returning medications to pharmacies or hospitals that will take them.”
It’s also important for everyone to realize that it’s not okay to share opioid drugs or any other prescription medications with others, he adds. “The health care community is well aware that these drugs have addictive properties and carry a high risk of respiratory problems,” he says. “Now we need the rest of the country to realize that too—that sharing these drugs without expert supervision can lead to serious harm.”