Three Waves Of Opioid Overdose Deaths
From 19992019, nearly 500,000 people died from an overdose involving any opioid, including prescription and illicit opioids1.
This rise in opioid overdose deaths can be outlined in three distinct waves.
Many opioid-involved overdose deaths also include other drugs9.10.
Opioid Support And Aftercare
Support and aftercare following treatment for opioid use disorder are important. This often includes long-term maintenance medications to support sobriety, such as methadone, buprenorphine, or naltrexone.24 Each of these medications works differently, but they all achieve the same goal of treating OUD by helping a person to maintain sobriety by increasing the likelihood of a person staying in treatment and improving recovery outcomes.24
Methadone can be used long-term to reduce opioid cravings and block the effects of any opioids that are taken. It activates the same areas of the brain as other opioids but does not cause euphoria or a high.24 Since methadone is long-acting, it needs to be taken only once a day, allowing people to function normally while on this medication.16
Suboxone is a combination of buprenorphine, a weak opioid, and naloxone, an opioid blocker.16 When Suboxone is taken as prescribed, only the buprenorphine has an effect. If taken differently than prescribed, such as injected, the naloxone will dominate, and it will induce severe withdrawal symptoms.16 Suboxone functions similarly to methadone in that it lessens cravings and works effectively when taken properly.24
Many people find that attending mutual-help groups is a great way to develop a sober support group and maintain sobriety after completing treatment.
What Is The Scale Of The Epidemic
Overdose deaths involving opioids have increased more than sixfold since 1999. In 2019the most recent year for which full data is availableopioid overdoses killed nearly fifty thousand people, or more than seven times the number of U.S. military service members killed in the post-9/11 wars in Iraq and Afghanistan. And the CDC estimates that in 2020, the number of opioid-related overdose deaths shot up to 69,710. The opioid mortality rate contributed to a historic, three-year decline in life expectancy in the United States between 2015 and 2017 after a short reprieve, life expectancy dropped again in 2020.
Many health experts attribute the high death toll to what they say has been years of overprescribing by physicians. Doctors began prescribing more opioids amid a growing concern that pain was going undertreated, and also because pharmaceutical companies began marketing the drugs more aggressively while claiming they posed little risk. Health-care providers have reported feeling pressure to prescribe opioid medications rather than alternatives, such as physical therapy or acupuncture, because patients request them and other treatments are often more costly or less accessible.
The pandemic of a new coronavirus disease, COVID-19, has worsened the opioid epidemic. Disruptions to supply chains have forced people to turn to drugs they are less familiar with, and social-distancing measures have meant more people taking drugs alone, analysts say.
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What Precautions Are Needed When Giving Naloxone
Naloxone works to reverse opioid overdose in the body for only 30 to 90 minutes. But many opioids remain in the body longer than that. Because of this, it is possible for a person to still experience the effects of an overdose after a dose of naloxone wears off. Also, some opioids are stronger and might require multiple doses of naloxone. Therefore, one of the most important steps to take is to call 911 so the individual can receive immediate medical attention. NIDA is supporting research for stronger formulations for use with potent opioids like fentanyl.
People who are given naloxone should be observed constantly until emergency care arrives. They should be monitored for another 2 hours after the last dose of naloxone is given to make sure breathing does not slow or stop.
Americans Have Been Addicted To Prescription Opiates Forever
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Opiates are amazing. They make dentistry not a horror movie, make a broken bone something you can tolerate while waiting in the ER, and kept your great-grandpop from going into shock after being shelled in the trenches of Ypres. Opiates are also amazingly addictive. The government estimates that roughly 1.9 million Americans were hooked on opiates in 2013. Use and abuse in America has reached epidemic levels, prompting the Centers for Disease Control and Prevention to issue a new set of recommendations from the CDC to control how doctors are distributing the drugs.
The recommendations came out yesterday, but this problem isn’t new: Opiates have always oscillated between medicine and drug. Their regulatory history reflects the precarious balancing act between help and harm—one that the CDCs new recommendations will address, but never solve.
So in 1914, the US passed the Harrison Act. The new rules required everyone in the opium and cocaine supply chains to pay taxes and register with the government. When the Supreme Court ratified the rule in 1919, it banned doctors from giving opiates to addicts except to wean them off.
Now, Campbell says, people are realizing that expansion has gone too far. Between 1999 and 2014, 165,000 people died from prescription opiates.
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What Are The Demographics Of The Opioid Crisis
The vast majority of those who overdose on opioids are non-Hispanic white Americans, who made up more than 75 percent of the annual total in 2018. Black Americans and Hispanic Americans accounted for about 13 and 9 percent of cases, respectively. Economists Anne Case and Angus Deaton have argued that the rise in what they call deaths of despairwhich include drug overdoses, particularly among white Americans without college degreesis primarily the result of wages stagnating over the last four decades and a decline in available jobs.
U.S. military veterans, many of whom suffer from chronic pain as a result of their service, account for a disproportionately high number of opioid-related deaths. Veterans are twice as likely as the general population to die from an opioid overdose, according to a study commissioned by the National Institutes of Health.
Nearly One In Three People Know Someone Addicted To Opioids
The opioid crisis continues to weigh heavily on the minds of Americans, according to a new national poll released today by the American Psychiatric Association, . Nearly a third of Americans say they know someone who is or has been addicted to opioids or prescription painkillers. Nearly half feel it is extremely or somewhat easy to access opioids for illicit use. Americans strongly favor improving access to treatment over imposing stricter punishments to address the problem.
An estimated 2 million people in the United States have a substance use disorder related to prescription opioid pain medication and the number of overdose deaths from prescription and illicit opioids doubled from just over 21,000 in 2010 to more than 42,000 in 2016.
More Americans say they know someone who is or has been addicted to opioids or prescription painkillers compared to this time last year . Nearly half say the opioid crisis is impacting people like them, up from 37 percent in 2017. And nearly one in 10 say they have taken an opioid or prescription painkiller without a prescription. Five percent of U.S. adults say they have abused or been addicted to opioids or prescription painkillers, up from 1 percent in 2017, possibly reflecting a greater awareness and willingness to talk about the problem.
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Need For True ‘public Health Response’
“It’s inner city communities that have been most affected by addiction, where the problem was neglected for four decades,” says Dr. Andrew Kolodny, the medical director for opioid policy research at Brandeis University’s Heller School for Social Policy and Management. “It wasn’t really until we saw a drug crisis affecting white communities that we started to see the resources from Congress.”
He says it’s important that addiction resources be directed to the communities that need them the most.
“One of the problems here is that we have terrible surveillance of the opioid crisis,” Kolodny says. He notes that nationally, data tracking of drug addiction has been patchwork, with some federal agencies focusing on overdose deaths exclusively, others on treatment and others on research. “Surveillance fell through the cracks here,” he says.
For COVID-19, the U.S. tracks cases, deaths and hospitalizations at the county level and generally on a daily basis, says Kolodny. “But for the opioid crisis, we don’t have a good estimate of how many Americans are opioid-addicted or the communities that are most impacted or incidence rates. We don’t know how many people are becoming newly addicted to opioids,” says Kolodny. “We are still in the dark ages.”
“Opiate addiction is a disease that’s preventable and treatable, and you need a public health response that would be similar to even a communicable disease outbreak like COVID.”
What Are Some Efforts To Restrict Domestic Supply
Federal agencies, state governments, insurance providers, and physicians all influence the supply of opioid medications.
Federal regulators have introduced new limits on opioid prescriptions, reducing the total nationwide in 2019 by nearly 40 percent from the peak in 2012, according to the CDC. Current CDC guidelines advise physicians not to prescribe opioids as a first-line therapy. Meanwhile, the DEA has required pharmaceutical companies to reduce their production of certain opioids, including oxycodone, fentanyl, and morphine, by at least 25 percent. Amid the COVID-19 pandemic, however, the agency allowed production boosts for substances including codeine, fentanyl, and morphine.
The Justice Department has ramped up efforts to prosecute those involved in overprescribing and trafficking. In 2018, it partnered with nearly all state attorneys general to share opioid prescription information in order to investigate drug crimes and soon after brought charges against more than 150 doctors, nurses, pharmacists, and others for their alleged roles in distributing opioids. Two years later, the department filed a civil suit against Walmart for allegedly failing to stop hundreds of thousands of improper prescriptions.
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Drug Abuse Among Demographics
Statistics indicate that some demographics and communities face elevated risks of drug abuse and drug disorders.
- Persons previously abusing drugs and recently released from prison are at the highest risk for overdose as their tolerance to the drug has dropped while being incarcerated.
- Club drugs such as ecstasy, meth, cocaine, ketamine, LSD, and GHB are primarily used in higher-income settings by young people.
- Among lower-income users, the most commonly used drugs are inhalants such as paint thinner, gasoline, paint, correction fluid and glue.
- 6.3 million LGBT+ adults had a substance or mental abuse disorder or both.
- 7% of LGBT+ adults struggled with illegal drugs.
- 2% of LGBT+ adults struggled with alcohol abuse.
- 8% struggled with both illegal drugs and alcohol abuse.
- 3% indicated a serious mental illness.
Drug Abuse Among Age Groups
While younger people are more likely to use drugs, the rate of drug use among people over 40 is increasing faster than it is among younger age grups.
- The drug-related death rate for users over 50 increases 3% annually.
- 75% of deaths from drug use disorders among users aged 50 years and older are caused by opioids.
- 6% of drug deaths among 50-plus users are from cocaine and amphetamines, and 13% are from other drugs.
- 35% of college students indicated they use illegal drugs instead of prescription drugs.
- 93% of college students who use illegal drugs use marijuana.
- 37% use cocaine and 36% use hallucinogens.
Drug Abuse Among States
How Should You Respond To An Opioid Overdose
If you think someone may be experiencing an opioid overdose, take the following actions immediately:
If You Get Little or No Response
If lightly tapping, shaking, and shouting at the person or rubbing your knuckles on the personâs breastbone do not elicit a response , take the following actions:
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Many Opioid Addictions Surface After Surgery
Some patients face much higher risk of becoming dependent on powerful painkillers
WEDNESDAY, April 12, 2017 — Some surgery patients prescribed opioids for post-operative pain relief may face a high risk for developing a long-term opioid addiction, new research warns.
The analysis tracked a half-year of opioid use among more than 36,000 surgery patients. None had taken opioids before their surgical procedure.
“We found that 5 to 6 percent of patients not using opioids prior to surgery continued to fill prescriptions for opioids long after what would be considered normal surgical recovery,” said study author Dr. Chad Brummett. He is director of the division of pain research at the University of Michigan Medical School.
“Moreover, the rates of new chronic use did not differ between patients having major and minor surgeries, suggesting that patients continue to use these pain medications for something other than simply pain from surgery,” he added.
The risk was highest among smokers patients who had struggled with alcohol and/or drugs in the past those previously diagnosed with depression or anxiety and those with a history of chronic pain, the findings showed.
Patients who smoked and those who had a history of alcohol and/or drug abuse faced about a 30 percent higher risk. And that increased risk rose to roughly 50 percent among patients with a history of arthritis, the researcher said.
The findings were published online April 12 in JAMA Surgery.
What Are The Signs Of An Addiction
People addicted to drugs may change their behavior. Possible signs include:
- Mixing with different groups of people or changing friends
- Spending time alone and avoiding time with family and friends
- Losing interest in activities
- Getting into trouble with the law
- Attending work or school on an erratic schedule
- Experiencing financial hardship
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Developing More Effective Means For Preventing Overdose Deaths
The opioid overdose antidote naloxone has reversed more than 10,000 overdose cases between 1996 and 2010, according to CDC. For many years, naloxone was available only in an injectable formulation and was generally only carried by medical emergency personnel. However, FDA has recently approved a new hand-held auto-injector of naloxone to reverse opioid overdose that is specifically designed to be given by family members or caregivers. In order to expand the options for effectively and rapidly counteracting the effects of an overdose, NIDA is also supporting the development of a naloxone nasal spraya needle-free, unit-dose, ready-to-use opioid overdose antidote that can easily be used by an overdose victim, a companion, or a wider range of first responders in the event of an emergency.
Overdose Deaths Reached Record High As The Pandemic Spread
More than 100,000 Americans died from drug overdoses in the yearlong period ending in April, government researchers said.
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Americans died of drug overdoses in record numbers as the pandemic spread across the country, federal researchers reported on Wednesday, the result of lost access to treatment, rising mental health problems and wider availability of dangerously potent street drugs.
In the 12-month period that ended in April, more than 100,000 Americans died of overdoses, up almost 30 percent from the 78,000 deaths in the prior year, according to provisional figures from the National Center for Health Statistics. The figure marks the first time the number of overdose deaths in the United States has exceeded 100,000 a year, more than the toll of car crashes and gun fatalities combined. Overdose deaths have more than doubled since 2015.
Administration officials said on Wednesday that they will expand access to medications like naloxone, which can reverse an opioid overdose, by encouraging states to pass laws that will make it more widely available and promoting its use by Americans.
They leave behind friends, family and children, if they have children, so there are a lot of downstream consequences, Dr. Volkow said. This is a major challenge to our society.
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Where Do We Get Figures On The Number Of Addicted
Every year, the Substance Abuse and Mental Health Administration completes a new National Survey on Drug Use and Health . Nearly 70,000 Americans aged 12 or older are asked about smoking, drinking, drug use and mental health symptoms. Survey administrators try to distribute these surveys proportionally across ages, ethnic background and other criteria so theres a reasonably accurate representation of the American public. This is the survey used to calculate the number of opioid-dependent Americans, or the number addicted to marijuana, alcohol or other drugs.
The survey doesnt ask survey respondents if they are alcoholics or drug addicts but it asks questions like these:
- Did you continue to drink alcohol even though you thought drinking was causing you to have problems with your emotions, nerves, or mental health?
- During the past 12 months, did you need to use more or hashish than you used to in order to get the effect you wanted?
- During the past 12 months, did you have any problems with family or friends that were probably caused by your use of cocaine?
- During the past 12 months, was there a month or more when you spent a lot of your time getting or using heroin?
These questions allow the surveyors to gauge whether or not the person filling in the survey is dependent or addicted to these substances, whether that individual knows they are or not.