There is a crisis in America – widespread opioid abuse and addiction – and it has been taking its toll. Multitudes have died as a result. More people have been cleared at a go than the numbers that died from the Vietnam war. In November 2017, President Donald Trump declared this crisis as a national public health emergency.
It hit the headlines. This opioid epidemic actually killed more people that year than road accidents or gun violence did. It had been predicted that in 2018, more than two million people would suffer from addiction to opioids, whether illicit opioids like heroin or prescription opioids like oxycodone. Research has it that this commonly stated figure is way too low. There has been an average daily opioid death toll of about ninety Americans per day. The death rate has been reported to be highest among males under fifty years of age. This means that the US is losing its youth. This epidemic did not just spring up suddenly.
How It All Began
Generations of Americans have battled with opioid addiction and many have died from it. As the year’s progress, the crisis is deepening and experts agree with this. It has caught the government’s attention and is gaining rapid recognition, not only in America but across the globe.
It all began in the late 1990s when pharmaceutical companies convinced the medical community that prescribing opioid drugs as painkillers would not result in addictions. Opioids are very effective in helping to manage pain in the short-term, hence their attractiveness. However, continued use can easily lead to dependence and this is exactly what happened.
The availability of these prescribed opioids resulted in opioid overdoses, with the abusers ending up either with Opioid Use Disorders (OUD) or dead. Around 2010, as efforts were being made to restrict access to these prescription opioids many of the abusers turned to heroin, which was both cheaper and easily available. There have also been cases of diversion. This is where the drug is passed on to persons for whom it was not intended.
Over and above affecting physical health, opioid addiction carries with it some socio-economic effects. Just to give some examples, they may include wastage of resources to service one’s addiction, decreased productivity due to the effect of the drugs which could lead to unemployment, children being affected by the dependency of their parents on the drugs, and so on.
Dealing With The Crisis
Interventions have been made but a comprehensively effective solution is yet to be found. Measures have been taken to both prevent and treat addictions and addicts. The focus, however, has been on the preventive measures.
Formulation of Guidelines
Stakeholders are making more sophisticated guidelines for prescribing opioids which state, for one, that non-opioid drugs should be the first resort before opioid drugs are prescribed. These restrictions nevertheless only result in addicts turning to illicit opioids such as heroin as earlier mentioned, which just happens to be more affordable than the prescription opioids. Recent findings have shown that illicit drugs are now being laced with fentanyl. This has led to a much more potent opioid than heroin and has been behind the most recent increase in deaths.
Another challenge with such guidelines is that they are not consistent across various states and communities, leading to huge variations in the desired impact. There is a need for standardization. Prescription monitoring programs should also be initiated.
Disposal Of The Drugs
Unused opioids need to be safely disposed of so that they do not land in the wrong hands. Stashing them away in a cabinet for later use in order to save money the next time they might be needed or just throwing them away in the trash are not proper ways of disposing of such drugs. There are drug-take back programs through which people can return the drugs or one can just flush them down the toilet. Nobody will follow them in there.
Both physicians and patients need to be extensively educated on the use of opioids and their inherent risks. They also need to be made aware of the various interventions available for both prevention and treatment.
These measures may not be totally full proof because follow up studies of patients with OUD stemming from heroin have later on indicated a high rate of premature mortality from overdosing or from complications arising from withdrawal.
Some curative measures include:-
Making Naloxone More Available
Naloxone is a drug used to treat opioid overdoses. Though the drug was initially only available by prescription, new laws and policies are emerging which allow access to the drugs by at-risk groups at a low cost or no cost at all. Educating the masses about the use of Naloxone is also an important step.
Medication Assisted Treatment (MAT)
Use of MAT and Opioid Treatment Programs (which are coupled with psycho-social assistance, counseling and behavioral therapy) can be used to treat OUD. These should be encouraged and capacity for offering these services increased.
Detox helps curb unpleasant withdrawal symptoms and other dangerous consequences of instant cessation of drug use. The Waismann method is one safe way to do this. It was founded by addiction specialist Clare Waismann. When a patient has successfully undergone detox, care should be taken to avoid a relapse. This involves using counseling and substance abuse therapy to determine and deal with the root causes of the person’s abuse of the drug.
Having glimpsed at some of the best practices, the best direction to take may be to scale them up while innovating strategies that challenge the core of the problem. There are more drugs being developed to deal with the issue. For instance, in 2017 the Food and Drug Administration (FDA) approved several new drugs for treating opiate addiction. Various stakeholders should come together to jointly deal with this crisis: from the government to the criminal justice departments, to the health sector, to the church, to the community, right down to the family level. Together, we can.