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Magnitude of the problem - MessAge Media: Health

The Opioid Crisis

Magnitude of the problem

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Posted: Thursday, April 11, 2019 3:08 pm

Editor’s note: This is the first of three parts in a series by Adams Publishing Group newspapers about the nation’s ongoing and evolving opioid crisis.

Today: Part 1 addresses the magnitude of the problem across the country as well as its causes and impacts.

Upcoming: Part 2 looks at treatment options for people addicted to opioids and the availability of those services.

Upcoming: Part 3 assesses policies state and local governments are pursuing to stem the epidemic.

In North Carolina’s Surry County, emergency crews responded to 371 drug overdose calls in 2018.

That’s a little more than one a day in the county that’s home to Mount Airy, the city where actor Andy Griffith grew up that is widely known as the inspiration for the idyllic, fictional town of Mayberry in the iconic 1960s sitcom “The Andy Griffith Show.”

Drug overdoses killed 32 people, or about one every 11 days, last year in Surry County. Those overdose deaths were down 42 percent from 55 in 2017 — not because overdoses dropped, but because first-responders saved more people through widespread use of the opioid overdose reversal medication, naloxone. Hundreds of other county residents bypassed 911 calls and were taken directly to the hospital.

“Just because we’ve reduced the number of overdose deaths doesn’t mean we’ve solved the original problem of why we have so many people who are using opioids,” said Mark Willis, who was hired last year as the county’s opioid response director. “The first thing I’m trying to do is plug the hole in the bucket. But right now we’re just buying more mops.”

If the U.S. opioid epidemic can reach Mount Airy, which the local tourism bureau proudly proclaims is often referred to as “Small-town USA,” it can strike anywhere. And it does.

A total of 399,230 U.S. residents died from opioid-related causes from 1999 through 2017, according to the U.S. Centers for Disease Control and Prevention.

That’s the equivalent of the entire city of New Orleans or Tampa or Cleveland, or 70 percent of the population of the state of Wyoming, being wiped off the map. Gone in less than two decades.

“In terms of the overall number of overdose deaths, the epidemic is unprecedented and has wide-ranging negative effects, not only on individuals, but on their families and communities,” said Nora Volkow, director of the National Institute on Drug Abuse.

Opioid overdoses, which kill 130 people a day in the U.S., are a driving force behind the United States enduring its longest sustained life expectancy decline since World War I. Americans now have a greater chance of dying from an accidental opioid overdose than from a vehicle crash, according to the National Safety Council.

Though much progress has been made in the fight against opioid addiction, the number of overdose deaths from the drugs continues to rise – climbing 13 percent from 42,249 in 2016 to 47,600 in 2017. And the CDC estimates this ever-evolving national crisis has an annual economic burden to the nation of $78.5 billion, including the costs of health care, lost productivity, addiction treatment and criminal justice involvement.

Opioids are a class of drugs that includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain medications available legally by prescription such as oxycodone, hydrocodone, codeine and morphine.

Evolving epidemic

The opioid crisis originated around the turn of the millennium, driven mainly by the overprescribing and diverting of opioid pain medications in the first decade, Volkow said.

As prescriptions ran out and doctors began to cut back on prescribing opioids, many users sparked the second phase of the crisis by turning to cheaper illicit opioids, such as heroin.

In the past few years, powerful synthetic opioids, such as fentanyl, have started taking over the market and now are blamed for more overdose deaths than either heroin or prescription painkillers. Their potency makes synthetics, which are being substituted for heroin or used to lace counterfeit pain pills, easier to smuggle into the U.S. and more profitable for dealers, Volkow said. 

With the CDC reporting that fentanyl is 50 times more potent than heroin and 100 times stronger than morphine, this third wave of the opioid crisis threatens to be the deadliest of all.

“Had it not been for the introduction of fentanyl in our state, we may have started to turn this thing around by now,” said Alisha Nelson, director of RecoveryOhio, the agency Ohio Gov. Mike DeWine created shortly after taking office in January to address the opioid challenge.

In 2017, Ohio ranked number two behind only Pennsylvania among all states for the most drug overdose deaths with 5,111, and also had the second highest overdose death rate, at 46.3 deaths per 100,000 residents, trailing only West Virginia’s 57.8.

“But now fentanyl is being mixed and cut with a number of other drugs, and the end users with substance abuse disorder have no idea what they’re accessing when they get those drugs,” Nelson said. “That has led to a rise in our overdoses and our overdose deaths.

What drugs are opioids?

ILLEGAL OPIOIDS:

Heroin

Heroin laced with Fentanyl

PRESCRIPTION OPIOIDS:

Oxycodone (OxyContin; Roxicodone; Oxecta; Oxaydo; Xtampza ER; Percodan; Targiniq; Xartemis XR; Oxycet; Roxicet; Tylox; Percocet)

Hydrocodone-Acetaminophen (Vicodin, Norco, Lorcet, Zamicet, Verdrocet, Lortab, Anexsia, Co-Gesic, Hycet, Liquicet, Maxidone, Norco, Xodol 10/300, Zolvit, Zydone)

Hydrocodone bitartrate (Sysingla, Zohydro ER)

Hydrocodone-Homatropine (Hycodan, Hydromet)

Hyrdocodone-Ibuprofen (Ibudone, Xylon 10, Reprexain, Vicoprofen)

Pseudoephedrine-Hydrocodone (Rezira)

Hydrocodone-Clorpheniramine (Vituz)

Hydrocodone- Cpm-Pseudoephed (Zutripro)

Morphine (Duramorph, Infumorph P/F, MS Contin, Oramorph SR, Avinza, Arymo ER, Kadian, Morphabond, Roxanol-T)

Morphine-Naltrexone (Embeda)

Hydromorphone (Dilaudid, Exalgo, Palladone)

Fentanyl Cirtrate (Actiq, Fentora, Abstral, Lazanda, Onsolis, Sublimaze)

Fentanyl (Duragesic, Subsys)

Codeine Poli-Chlorphenir Poli (Tuzistra XR)

Acetaminophen with codeine phosphate/Acetaminophen-Codeine

Methadone (Dolophine, Methadose)

Methadone Hydrochloride (Methadose)

Morphine Sulfate (Morphabond)

Oxymorphone Hydrochloride (Opana)

Meperidine (Demerol)

Tramadol

Carfentanil

Buprenorphine (Subatex, Buprenex, Butrans, Probuphine)

SOURCE: Johns Hopkins University, National Institute on Drug Abuse

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