The Opioid Epidemic: the No. 1 Cause of Death for Americans Under Age 50

Opiate addiction has been called “America’s fastest-growing drug problem.” It’s now believed that the prescription opioid epidemic the leading cause of death among adults under 50 years old living in the U.S. In fact, the opioid epidemic is now responsible for more deaths of despair every year in the U.S than HIV was at the height of the AIDS epidemic.

Despite the stereotypical images that might come to mind when most people about “drug addicts,” opioid addiction definitely doesn’t discriminate. Due to their powerful and extremely addictive nature, people of all different ethnicities, age groups and economic backgrounds can become addicted to opioids. Whether someone is an older adult who’s suffering from chronic arthritis pain, or a teenager trying drugs for the first time to fit in, both are susceptible to the long-term damage caused by opioid drug use.

Most people understand that heroin — currently the most widely used illegal opiate— is a very dangerous drug. However, many don’t realize that legal prescription opiate painkillers are equally dangerous and an insidious problem. Findings from the 2015 National Survey on Drug Use and Health (NSUDH) show that roughly one in three adults living in the U.S. (an estimated 38 percent) report using some time of prescription opioid drug at least once within the previous 12 months. (1)

Whether it be hydrocodone, oxycodone, fentanyl, methadone or heroin, the use of opioid medications and/or illegal drugs is increasingly a serious global concern.

What Is the Opioid Epidemic?

The opioid epidemic refers to the growing struggle with addiction of opioid painkillers, as well as illegal opioid drugs such as heroin, in the U.S and Canada. (2) The NSUDH survey found that “The most common types of psychotherapeutic drugs abused (as of 2013) were pain relievers, tranquilizers, stimulants, and sedatives, in that order. Pain relievers are the most common cause of a substance use disorder among prescription drugs.” (3)

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According to a report published on the website of the New England Journal of Medicine, around 5 percent of adults who are not “institutionalized” (meaning not staying in the hospital or another facility for treatment) are currently misusing opioids, and another 1 percent have a very serious opioid use disorder. A whopping 63 percent of people who have been prescribed opioid drugs, usually for the treatment of chronic pain, report misusing them. In recent years, there have been over 52,000 deaths in the U.S. alone related to drug overdose, of which about 65 percent are due to opioid use.

One of the most troubling things about the opioid epidemic is that many people start to fall victim to addiction after receiving the drugs legally from their doctors, or from friends with prescriptions. Prescription opiate painkillers are responsible for 1.9 million Americans being addicted to drugs. This is more than the number of adults who are addicted to cocaine and heroin combined. Many people who abuse opioid drugs, whether types that are illegal or legal, report using multiple substances regularly, especially alcohol, cocaine and prescription opioid painkillers.

A major concern among health authorities is how often the use of prescription painkillers serve as a gateway to use of other addictive opioid drugs, especially heroin. According to the Centers for Disease Control and Prevention (CDC), “Heroin abuse and addiction have risen in all population and demographic groups in the United States over the past few years.” (4)

It’s estimated that over 700,000 Americans start using heroin each year, a high proportion of which will wind up struggling with addiction, depression and symptoms of withdrawal. Research shows that almost 25 percent (one quarter) of people who use heroin will become addicted to it. Hispanic and white males between the ages of 18 and 25 who live in large cities are at the greatest risk for dealing with heroin addiction.

In fact, overdoses in large cities increased by 54 percent in 16 states and Midwestern states in the U.S. experienced a 70 percent increase in opioid overdoses, according to the CDC’s Vital Signs March 2018 report. Opioid overdose-related emergency room visits rose by 30 percent in 52 areas of 45 reporting states from July 2016 through September 2017. Overall, overdoses increased at least 30 percent for all age groups and both sex groups (male and female). The report also highlighted that those who have had an opioid overdose are likely to experience another. Repeat overdoses can be avoided through medication-assisted treatment given during an emergency department visit and coordinated efforts between first responders, law enforcement, community members and mental health and substance abuse providers (to name a few). (5)

Opioids vs. Opiates: What’s the Difference?

Opiates are drugs derived from opium, the active narcotic components of the opium poppy. According to The National Alliance of Advocates for Buprenorphine Treatment (NAABT), “At one time ‘opioids’ referred to synthetic opiates only (drugs created to emulate opium, however different chemically). Now the term Opioid is used for the entire family of opiates including natural, synthetic and semi-synthetic drugs.” (6)

Today “opiates” and “opioids” are often used interchangeably. But you still may hear “opiates” referring only to drugs naturally derived from opium, compared to “opioids” which is used to refer to synthetic and semi-synthetic drugs that work in very similar ways in the brain.

• Opioids are either natural or synthetic chemicals that bind to receptors in the brain or body, changing thought processes, moods and motor control. An opioid drug get’s its name because it binds to opioid receptors (protein molecules located on the membranes of some nerve cells). These receptors are found in the central nervous system and gastrointestinal tract.
• What are some examples of legal opioid painkillers? Common types include prescription drugs such as oxycodone (such as brand name OxyContin®), methadone, hydrocodone (such as brand name Vicodin®), buprenorphine, and the extremely strong drug called fentanyl.
• OxyContin, the most popular and well-known formulation of oxycodone that was first released in 1996, is manufactured by the company Purdue Pharma. Oxycodone is an opiate derived from morphine and is legally prescribed for pain relief, especially chronic pain that requires treatment for many years. For example, it’s often prescribed to people dealing with chronic bone or neurological degeneration or end-stage cancer. OxyContin is known to be very addictive and is considered a Schedule II narcotic analgesic (it has high potential for abuse, so should be prescribed with precaution and restrictions.) (7)
• The most powerful prescription pain-killer available today is fentanyl, a synthetic opioid pain reliever that is significantly stronger than morphine. Fentanyl prescription names include Actiq®, Duragesic® and Sublimaze®. On the streets, heroin and cocaine may be laced with fentanyl, leading to a much greater risk of overdose and death. And then there’s carfentanil, a powerful synthetic opioid used legally as a large-animal tranquilizer, marketed as Wildnil®. It’s 100 times stronger than fentanyl, its relative, and 10,000 time stronger than morphine.
• When it comes to illegal “street drugs”, heroin is the most commonly used opioid drug in the world. Both OxyContin and heroin are very similar in that they affect the chemical pathway in the brain known as the dopamine pathway, which causes increases in pleasure, good feelings and temporary sense of well-being.

How Opioid Addiction Starts, Plus Risk Factors

Many people who wind up suffering from opioid addiction start by taking a prescription. Initially they may not abuse the drug, but their body becomes physically addicted, making it difficult to stop using the drug. Their need for more may increase with time, but they won’t have legal access to higher doses. Once addiction sets in many move on to other street drugs, whether fentanyl or other opioids such as heroin.Research shows that the total number of opiate prescriptions dispensed by retail pharmacies in the U.S. has increased significantly in the last 20 years. Prescriptions sales more than quadrupled from 1999 to 2010. Around 76 million prescriptions were filled in 1991, compared to over 300 million 20 years later. Every single day in the U.S. alone over 1,000 people are taken to the hospital to be treated for side effects due to misusing prescription opioids. Deaths due to overdose of prescription opioids has quadrupled since 1999. Overdose deaths affected those between 25–52 years old, especially men, more than any other age group. (8)

Drug addiction, whether to opioids or something like alcohol, is influenced by multiple factors including one’s upbringing, genetics and environment. According to a publication in the journal Clinical Pharmacology & Therapeutics, drug addiction is considered to be, on average, genetically influenced about 50 percent of the time.

Certain studies have found that “young age, back pain, multiple pain complaints, and substance abuse disorders identify patients at high risk for misuse.” A combination of four variables is believed to be tied to the opioid epidemic: age, depression, psychotropic medications and pain impairment. In studies, these have predicted increased risk for opioid dependence compared to those without these factors.

• Using prescription opioid drugs, especially if for many years. People who abuse opioids report dealing with more pain, multiple pain complaints and a greater degree of pain-related limitations.
• Family history of drug abuse
• Abuse of any other drugs, or alcohol
• Using drugs for the first time at an early age. It’s been found that abusing drugs or alcohol before the brain is fully developed, such as during the teenage years or early 20s,  increases the risk for addiction later in life. Drug use at an early changes how the brain develops and can lead to use of other substances. (9)
• Being a male between the ages of 18–55.  Men are more likely than women to obtain prescription opioids for free from family or friends, and are more likely to purchase them from a dealer.
• Suffering from mental illness or a mood disorder, such as depression or anxiety.
• Having a criminal record or having spent time in jail/prison.
• A history of forging prescriptions, stealing or borrowing drugs, frequently losing prescriptions, and resisting changes to medications despite experiencing side effects.

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Signs of Opioid Addiction

Addiction is defined as “A primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.” (10) Addiction to drugs does not happen overnight, it is a process that includes stages of: initial use, abuse, increased tolerance, dependence, addiction and often relapse. (11)

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Every person who uses drugs and experiences drug addiction has a different story to tell. Side effects due to drug use, risk for addiction and and symptoms tied to withdrawal differ from person to person, however some common symptoms tied to opioid drug addiction have been identified. These include:

• Severe constipation
• Mood swings and mood changes including anxiety, paranoia and depression, sometimes which are severe
• Lethargy, drowsiness and fatigue
• Nausea and vomiting
• Loss of appetite, reduced eating and weight loss
• Restlessness and insomnia
• Muscle spasms or cramps and pain
• Fertility problems and irregular menstrual cycles in women
• Decreased libido and testosterone depletion in men
• Depleted immune system and frequent illness
• Intestinal damage
• Liver damage
• Obsessive thoughts with procuring more drugs, leading to an inability to concentrate or focus on other tasks

Physical indicators of heroin use include: the presence of pipes, aluminum foil, baggies, and syringes. Other signs include lying and secretiveness, missing valuables in the home, and legal issues.

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Steps to Take to End Opioid Addiction

Finding someone’s way out of opioid addiction is known to be extremely difficult, likely the hardest thing that someone will ever have to go through in their life. However, it is possible, and with proper treatment many people have been able to do it. Many addicts will say that they had to “hit rock bottom” in order to know that enough is enough, and that recovery and change are necessary.

The CDC states that the U.S. should take the following steps in order to help reverse the opioid epidemic and treat people dealing with opioid addiction:

• Starting with the biggest risk factor: address the high amount of prescriptions for opioid painkillers. Physicians should prescribe these medications very carefully, being very restrictive and using precaution.
• Increase access to substance abuse treatment services and prevention services. These include Medication-Assisted Treatments (MAT) that are often recommended for those dealing with opioid addiction.
• Professionally train therapists and healthcare providers to deal with addiction and withdrawal.
• Expand access to and training for administering naloxone to reduce opioid overdose deaths. This is most needed in areas where drug addiction is common.

What can an addicted individual do to help themselves?

• First and foremost, to get clean you need to stop using and cut ties with anyone that enables your addictive behavior.
• Seek out help from a therapist, doctor or a treatment center to taper off drug use and cope with withdrawal symptoms. The controversial botanical substance kratom is also sometimes used to fight opioid addiction and help with withdrawal.
• Strongly consider joining a program for recovery, which most experts believe should be priority No. 1.  Programs typically start with detox and are followed by a treatment program with a therapist, supplemented by participation in a recovery support group. Some programs emphasis “the 12 steps to recovery.”
• Focus on improving mental and emotional health by practicing goal setting, establishing a plan for the future and training for a job that interests you.
• Find other ways to deal with stress and physical pain.
• If physical pain is a serious issue for you, discuss other medication options with your doctor and take steps to manage pain naturally any way you can.
• To lower symptoms like discomfort and depression, you can benefit from: improving your diet, exercising, getting more sleep, reducing emotional stress, trying alternative medicines like acupuncture, massage or osteopathic manipulative therapy, and using supplements or essential oils for enhanced relief.

What can family members and friends of an addict do to help?

At this point a number of states in the U.S have passed laws allowing for involuntary addiction treatment. This means that with a physician’s backing, family members can petition a judge to force someone who is addicted into treatment. This might not always be the best idea given the situation, which is why it’s always encouraged for concerned family/friends to seek help from a professional.

Having an intervention may also be helpful in getting the person to see the negative effects that drugs have had on their lives and those around them. A drug intervention is a planned process that involves a professional guide along with family and friends of the addicted person. Together, the group confronts the addicted person to offer help, support and a plan for treatment.

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Opioid Withdrawal Precautions

Opiate withdrawal symptoms affect many recovering addicts and be extremely uncomfortable for some people, sometimes lasting for weeks. Withdrawal symptoms may include:

• Abdominal pain, nausea, diarrhea and vomiting
• Insomnia
• Sweating
• Muscle aches
• Anxiety and agitation

To deal with these effects, it’s recommended to find a physician who is familiar with treating withdrawal symptoms, or to join a structured detox program that provides a level of support, comfort and security.

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Final Thoughts on the Opioid Epidemic

• The opioid epidemic refers to the growing struggle with addiction of opioid painkillers, as well as illegal opioid drugs such as heroin.
• Signs that someone may be dealing with addiction include: mood changes like anxiety and depression; sneaky, paranoid or aggressive behavior; insomnia and restlessness; changes in appetite, weight and digestion; complaints of pain and discomfort.
• Ways to help combat the opioid epidemic include: cutting ties with enabling friends or family, joining a support group, seeing  a therapist, enrolling in a detox program, getting support from family and friends, managing pain naturally, and working on improving mental/emotional health.

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