Thinking Citizen Blog — How Bad is the Opioid Epidemic? What Are the Causes? What Is to Be Done?
Thinking Citizen Blog — Thursday is Health, Health Care, Health Insurance and Global Health Policy Day
Today’s Topic: How Bad is the Opioid Epidemic? What Are the Causes? What Is to Be Done?
Today, three charts and a few notes. Pictures are worth a thousand words. Note that the number of opioid overdose deaths exceeded that of traffic fatalities in 2019 (49,860 versus 38.800). In 2020 both numbers spiked. Experts — please chime in. Correct, elaborate, elucidate.
THE FIRST WAVE: 1980–1999 — “THE FIFTH VITAL SIGN” — the change in professional opinion
1. “The first wave, which marked the start of the epidemic, began in the 1990s due to the push towards using opioid medications for chronic pain management and the increased promotion by pharmaceutical companies for medical professionals to use their opioid medications. During this time, around 100 million people in the United States were estimated to be affected by chronic pain; however, opioids were only reserved for acute pain experienced secondary to cancer or terminal illnesses. Physicians avoided prescribing opioids for other medical conditions because of the lack of evidence supporting their use, the concern of opioids having addictive properties, and the fear of being investigated or disciplined for liberal opioid practices.” (third link below)
2. “However, in 1980, a letter to the editor featured in the New England Journal of Medicine (NEJM) challenged these notions and advocated for more liberal use of opioids in pain management, which was eventually supported by the World Health Organization.”
3. “In addition to this, medical organizations began to push for more attentive physician response to pain, referring to pain as the “fifth vital sign. This was coupled with the promotion of opioids by pharmaceutical companies who insisted that patients could not become addicted. Opioids became an acceptable form of treatment for a wide variety of conditions, and this led to a consistent increase in opioid prescriptions.”
NB: “From 1990 to 1999, the total number of opioid prescriptions grew from 76 million to approximately 116 million, which led to them becoming the most prescribed class of medications in the United States.”
THE SECOND WAVE — HEROIN SUPPLIES INCREASE AND PRICES FALL, 2005 -2015
1. “The second wave of the opioid epidemic started around 2010 and is characterized by the rise in heroin use and overdose deaths.” Between 2005 and 2012, the number of people who used heroin almost doubled from 380,000 to 670,000, and in 2010, there were a total of 2,789 fatal heroin overdoses, an almost 50% increase from the years prior.”
3. “This spike is a reflection of the increase in heroin supplies in the United States and the decrease in prices, which encouraged a large proportion of individuals with an established dependency and tolerance on opioids to transition towards a more concentrated and cheaper alternative.”
THE THIRD WAVE — 2014 TO PRESENT: FENTANYL
1. “The third and most recent wave of the opioid epidemic began in 2013 and is ongoing. This wave coincides with the steep rise in overdose deaths that involved synthetic opioids, particularly illegally produced fentanyl.”
2. “The epidemic has been described as a “uniquely American problem”. The structure of the US healthcare system in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies. According to Professor Judith Feinberg, “Most insurance, especially for poor people, won’t pay for anything but a pill.” Prescription rates for opioids in the United States are 40 percent higher than the rate in other developed countries such as Germany or Canada.”
3. “The opioid epidemic is increasingly young, white, and female” with 1.2 million women being diagnosed with an opioid use disorder compared to 0.9 million men in 2015.”
FOOTNOTES (first link below)
1. “Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.”
2. “Between 8 and 12 percent of people using an opioid for chronic pain develop an opioid use disorder”
3. “An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.”
4. “About 80 percent of people who use heroin first misused prescription opioids.”
Opioid Overdose Crisis | National Institute on Drug Abuse
https://en.wikipedia.org/wiki/Opioid_epidemic
https://en.wikipedia.org/wiki/Opioid_epidemic_in_the_United_States
The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward
https://www.mass.gov/news/opioid-related-overdose-deaths-rose-by-5-percent-in-2020
For the last three years of posts organized by theme:
PDF with headlines — Google Drive
YOUR TURN
Please share the most interesting thing you learned in the last week related to health, health care or health care policy — the ethics, economics, politics, history…. Or the coolest, most important thing you learned in your life related to health are or health care policy that the rest of us may have missed. Or just some random health-related fact that blew you away.
This is your chance to make some one’s day. Or to cement in your mind something really important you might otherwise forget. Or to think more deeply than you otherwise would about something that matters.
