It’s hard to go a single day without seeing new stories or information about the opioid epidemic. In the U.S., nearly 100 people die per day as a result of opioid overdose and if nothing changes over the next decade the number of dead from overdose will increase to more than half a million. Since the Great Recession the number of opiate abusers has greatly increased, with studies showing a correlation between increased rates of unemployment and a sharp increase in the opioid death rate. Drug overdoses are currently the leading cause of death for Americans under 50 years old.
Dr. Holiner appeared on The Therapy Hour with Rusty Lozano July 30, to discuss this important topic. Lozano, a licensed professional counselor and biofeedback therapist hosts his show weekly to discuss various medical and emotional issues and provides expert advice for those challenges. The episode was also livestreamed on Facebook. A synopsis of their discussion follows and you can watch the Facebook video here.
Defining the opioid epidemic
The opioid epidemic refers to the rapid increase in the use of prescription and non-prescription opioids in the United States and Canada in the 2010s. Although the U.S. accounts for only 4.2 percent of the overall world population, the country uses 80 percent of the world’s opiates. Ninety-nine percent of the world’s Hydrocodone is prescribed in America. More than two million Americans are addicted to prescription opiates. With numbers like this, it is easy to see why Dr. Holiner considers this a major public health emergency, and views it as the HIV/AIDS crisis of this generation.
And though many might believe the overdoses are a result of illegal substances, that is simply not the case. The deaths are equally attributed between prescriptions and street drugs like heroin. As it happens, four out of five heroin addicts started out on pain pills. With the relatively low price of street drugs and ease of acquisition, people transition from legal prescriptions to illegal substances to feed their addictions.
America also has synthetic opiates which only compounds the issue. These synthetic products, like Fentanyl, activate the opiate receptors in the brain, so the effects are similar. Synthetics are extremely potent, however. Police departments are even reporting addictions and deaths by officers who have simply come into contact with the drugs.
Who misuses opiates?
Addiction does not discriminate, all sorts of people are dealing with opiate addiction. Often, a person receives a prescription for a specific need, like recovering from a major surgery. Opiates are highly addictive and are to be prescribed for a brief time, but that doesn’t always happen. As a user becomes accustomed to the effects, and notices the difference when they do not take the medicines, they may want it to continue. This leads to the line between use and abuse being crossed.
There are some populations which are more prone to crossing that line. These include:
- Anyone who has used opiate prescriptions for more than a brief period of time
- People with a history of substance abuse
- People with mood disorders (depression, bipolar, anxiety, etc.)
- 51 percent of those who become addicted to pain pills have some sort of mood disorder
- Anyone with a history of taking psychiatric medications
How did America’s Opioid Epidemic Start?
As with any large-scale issue affecting the greater population, many factors came together as the foundation of the opioid crisis. Pharmaceutical companies, physicians and the government all had a role in the increase of opiate availability in the United States.
As previously stated, it’s well known that opiates are highly addictive substances, and this is true whether real or synthetic. However, in the 1980s when Hydrocodone and Oxycodone were being marketed by drug companies, the opposite was told to physicians and hospitals. While it’s true that both are incredibly effective pain relievers, both drugs were marketed as having low potential for addiction. As such, doctors began prescribing both drugs for patient pain.
Patients felt better because their pain was alleviated, but the side effect was many developed a dependence upon the drugs. Pharmaceutical companies want to create good and helpful products. No one wants to create something to hurt people, but these companies have to use their marketing responsibly so that others are not harmed.
Much like the pharmaceutical companies, most physicians seek to help people. They want what is best for their patients, especially when it comes to managing pain. There are more than 100 million Americans dealing with some kind of chronic pain. But the easy thing to do sometimes is to write a prescription without follow up and reevaluation. This can lead to patients having prescriptions, which should ideally have a two-week duration going on for two years or longer.
Dr. Holiner calls on his counterparts to prescribe the proper medications and to be vigilant against over prescribing. In 2014, a study showed there were more than 240 million opiate prescriptions in the United States, which is enough for every American adult to have a 30-day supply! Since 1999 opiate prescriptions and deaths by overdose have increased four fold, but pain has not decreased. Physicians have the responsibility of correct dosing, for the correct periods of time to help correct these issues.
The U.S. government is working hard to keep illegal substances from entering the country, however, that fight is continual. More than $64 billion in drugs are trafficked into the States annually and many are opiates. This makes the street price of drugs lower, making it easier for some people to have access to them, rather than a legal prescription.
The government also has the ability to fund research in alternative pain medications, but there have not been enough resources directed to this research. This includes research into medical marijuana. With so many states moving forward in legalizing it, instead of fighting marijuana, the government could fund its research for medicinal purposes, providing a larger body of work for physicians to be able to review.
The government has also limited physician access to certain medicines, which have been proven to help patients break out of addiction cycles. These include Buprenorphine and Naloxone, which can be used in medication assisted treatments (MAT) in outpatient situations. Because these drugs are powerful, and in an effort not to repeat the mistakes which led to the opioid epidemic, the Food and Drug Administration (FDA) has strict rules about use and distribution. But for the medicines to have their intended effect and help as many people as possible, current restrictions will need to be relaxed.
Solutions to the Opioid Epidemic
It took a long time for all of these factors to come together to create the opioid crisis America is currently facing. Accordingly, solutions will have to occur at personal and corporate levels, and will take time to correct. The issue itself is complex, but many baby steps can add up to move many people down the road to recovery.
Sometimes it’s hard to acknowledge the presence of a problem, or to think there’s no point in getting help, but that is not true. There are many options for treatment and Dr. Holiner suggests those struggling with addiction seek out an psychiatrist or physician who specializes in addiction.
These specialists know how to help and can prescribe a MAT regimen to help their patients break free with a holistic approach. Hospitals like Green Oaks on the Medical City campus in Dallas, where Dr. Holiner serves as the Executive Medical Director, have treatment programs designed to help people dealing with all manner of mental health conditions and addictions.
Outside of personal responsibility, there are a number of external factors which need to be addressed, according to Dr. Holiner. These include, but are not limited to:
- Shutting down pain mills. This refers to the rogue doctors who are prescribing drugs to people who don’t even need them. These negligent doctors do this for financial incentives from certain drug companies.
- Pharmaceutical companies changing. Someone in authority needs to step in and tell the companies to stop production on highly-addictive, high-potency narcotics, like Fentanyl and Oxymorphone. In the case of Oxymorphone ER, the FDA has halted production.
- Having a National Prescription Data Bank. In Texas, doctors are able to review patient prescriptions to ensure they are not visiting multiple locations to get the same drugs over and over. Expanding this to a national program could help reduce opiate abuse and illicit sales as well.
- Border surveillance. If fewer illegal drugs enter the country, it causes the street price to increase, making it more difficult to obtain than prescriptions, which would be monitored through the possible National Prescription Data Bank.
- Early intervention with children. It’s important to prepare parents with the necessary education materials to speak with their kids about drugs and how they are abused. Education on smoking has done a great deal to decrease the habit in students and adults.
- Focused government spending on pain research. This could include biofeedback, medical marijuana and further studies on Naloxone. If the FDA would focus on providing health care professionals with the proper education, they could relax restrictions on Naloxone. This could lead to its use to prevent deaths from overdose if placed into the hands of first responders and emergency room personnel.
Learn more about the Opioid Epidemic
Although this epidemic is currently a problem, if addressed head on, there are options to slow its deadly effects. The Centers for Disease Control and Prevention has more statistics and details about the crisis on its website as well as the U.S. Department of Health & Human Services.
To read more about Dr. Holiner’s thoughts on the opioid epidemic, review his entry “5 Things You Should Know About the Opioid Crisis” on the HCA Today blog. If you or a loved one struggles with addiction, Dr. Holiner is board certified in addiction psychiatry and has helped many patients in the Dallas area. Contact us in Dallas or McKinney to schedule an appointment.