The opioid crisis has captured the attention of policymakers and the public. It is becoming increasingly apparent that this is a multidimensional societal challenge that requires a new approach. Such an approach should include patient and community level intervention. Access to care for mental health conditions, private alcohol rehab and substance abuse treatment is also important if we are to curb overdose deaths.
The history and events that led to the opioid crisis are explored in this article.
History of Opioid Abuse
As early as 1980 Carter’s White House had identified prescription opioid medication to be responsible for “as many as seven out of ten drug-related injury or death”. Yet the issue of the opioid prescription medication crisis was not brought to the limelight until two decades later. More and more people were looking to join private alcohol rehab and addiction recovery centers or were struggling with health complications.
In the 80s, before policymakers and the public understood the full adverse effects of this medication, there were virtually no regulations to stop opioid prescriptions. Propoxyphene was one of the most prescribed drugs in the 80s.
Propoxyphene was initially considered to be a weak opioid that could be used as an analgesic. It was later pulled out of the market after it was discovered that it could cause irregular heartbeats. By 2011, it was banned in the US and Canada.
Despite the obvious dangers of opioid medication and the impact they have in the community, opioid-related deaths continue to rise. The CDC reports that opioid overdose deaths have increased fivefold since 1980.
Overdose deaths are caused by drug abuse and misuse of prescription medication. In recent years, the CDC report points out that overdose deaths caused by prescription medication outnumber those from illicit drugs. The factors behind overdose deaths from prescription medication include:
● Insurance and Pharmacy benefit Policies
● Lack of oversight in the prescription of opioids
● Problems with provider clinical practices
The impact of prescription medication dependency is significant and far-reaching. It has complicated chronic conditions further, leads to addiction and financial loss. The impact was slowly starting to become apparent. But many in the health industry felt that new policies shouldn’t be so restrictive that they prevent patients in pain from accessing care.
But what happened between the 90s when cases of opioid adverse effects were being highlighted and the present day when it has become an epidemic? A series of events paints a picture of medical practitioners who were unwittingly giving way to profiteering pharmaceuticals.
Profit over People
When Insurance companies started to withdraw cover for opioid medication, pharmaceutical companies came up with ways to go round it. This included extended-release formulas, transdermal patches, and pain modulating implants. Many non-opioid pain medications were being questioned for their potential cardiovascular risk. At this point, pharmaceutical companies would start pushing back opioid pain medication much more ruthlessly.
In 2016, seven employees of Insys Therapeutics, Inc, including its former CEO, were arrested for running a scheme to defraud medical practices and practitioners. The department of justice claims that the former executives conspired to push a fentanyl-based drug to health care providers.
The executives went ahead to develop a scheme that involved many conspiring practitioners. They would give kickbacks to professionals in the healthcare industry to push their fentanyl-based drugs to non-cancer patients. The report alleges that some practitioners were bribed to change the patient’s diagnosis.
Fentanyl is a powerful analgesic that can be used to help people cope with chronic pain. But it is 50 times more powerful than heroin. If not properly prescribed, it can lead to serious complications and often death. This drug alone handles "nearly half of all overdose deaths".
Disease of Despair
However, even as opioid pain prescriptions decreased by 13% between 2011 and 2016, overdose deaths continued to rise. This may be attributed to the entry of drugs such as fentanyl which are less bulky and easier to distribute.
However, some researchers feel that the focus on drug distribution and incarceration also contributes to overdose deaths. This single focus reduces response to prescription opioid overdose and complications. Understanding how addiction to opioid prescription medication starts is limited.
Another issue is access to treatment. Treatment requires an understanding of what addiction is and why it happens. Factors such as underlying mental conditions, physical health, lack of employment, are some of the factors that ought to be considered.
Access to mental health treatment, substance abuse, and private alcohol rehab is critical for addressing the issue conclusively. Patients require access to alternative pain medication that is effective. One of the nonopioid drugs that has been proposed is Buprenorphine.
Unfortunately, the drug can also cause dependency. It demands due to caution when prescribing to those with opioid addiction. Congress is yet to approve the drug for addiction to prescription medication.
Meanwhile, the opioid crisis continues to affect the poor disproportionately. Lack of access to professional care can increase the risk of opioid-related complications. The environment where many of the poor live, makes them more susceptible to mental health conditions.
The rate of death is the same in both urban and rural counties. But the report shows a clear difference in poor counties and counties with high rates of divorce and separation. Addiction is a social and psychological illness that needs more than tough laws to curb.
The opioid problem has grown exponentially over the last decade. Partly because of the lack of effective oversight on pharmaceutical companies, and partly because of an economy that puts profit over people. The main problem is that we have failed to acknowledge the multifaceted nature of the problem.
* Author Bio: Patrick Bailey is a professional writer mainly in the fields of mental health, addiction, and living in recovery. He attempts to stay on top of the latest news in the addiction and the mental health world and enjoys writing about these topics to break the stigma associated with them.
Patirck can be reached at the following address: baileypatrick780@gmail.com
