I have written several articles on the coronavirus and on masks and healthcare issues. A series of links have been provided at the bottom of this article for your convenience. This article will, however address a different aspect of the virus or on healthcare issues in general.
Only in America can we destroy ourselves. We seem to be out own worse enemy. We kill more of ourselves than any outside enemy ever has, through either drug overdoses or suicide or Americans shooting other Americans. Who needs radical Muslims to kill us? The lives lost in 9/11 is chicken feed to what we do to ourselves.
Prescription drugs: The epidemic of addiction in the U.S.
Pharmacy retail sales of opioid painkillers, obtained through doctors’ prescriptions, quadrupled between 1999 and 2010, and deaths from accidental opioid overdose now comprise the leading cause of injury death in the U.S. — exceeding deaths due to motor vehicle accidents. This scourge is affecting people of all races, places and walks of life. Alarmingly, and despite warnings by many (including the Centers for Disease Control and Prevention), this tragedy shows no signs of diminishing. To explain more of what’s going on, and why we should all be concerned and, in fact, prepared, BeWell spoke with Anna Lembke, MD, Assistant Professor and Chief of Addiction Medicine, Stanford University School of Medicine. Dr. Lembke recently published the book, Drug Dealer, M.D.: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.
Most of us are at least somewhat familiar with alcoholism and “street drug” addiction, but addiction to prescribed drugs, and opioids in particular, seems a much newer “epidemic.” When and why did this problem suddenly become so much larger in scope?
The current prescription drug epidemic is first and foremost an epidemic of overprescribing, not just of opioid painkillers, but of other controlled medications such as sedatives (Xanax) and stimulants (Ritalin).
Doctors began prescribing more opioids in the 1980s out of compassion for those people living with intolerable pain. But what began as an act of compassion quickly turned into inadvertent harm, and eventually a blatant disregard of patients’ well-being, as doctors got caught up in a system gone awry. My book looks at the unseen forces driving the epidemic as a way to get at the root of the problem and find ways to solve it. I am particularly interested in the average compassionate doctor (rather than the willfully nefarious one) who went into medicine to save lives and ease suffering, then found himself/herself acting against intuition and better judgement when prescribing potentially dangerous drugs.
What factors caused this rapid and relatively recent rise in the number of opioid pills prescribed by doctors?
The factors driving overprescribing are many and complex; here are some of the most important:
- Cultural narratives that promote pills as quick fixes for pain.
- Corporations that are in cahoots with organized medicine, misrepresenting medical science to promote pill-taking.
- Medical disability scenarios that hinge on patients taking pills and staying sick as a way to secure an income.
- A new medical bureaucracy that is focused on the bottom line — favoring pills, procedures, and patient satisfaction over patients getting well.
- Disjointed medical care and antiquated privacy laws that make it impossible for the right hand to know what the left hand is prescribing.
Interwoven through all of this is the complex interpersonal dynamic between doctors and patients — riddled with mutual deception, wishful thinking, wounded pride, and desperate attempts on both sides to pretend that a doctor’s only mission is to heal and a patient’s only mission to recover from illness.
Even when addiction is recognized by doctors and their patients, doctors don’t know how to treat it; no infrastructure exists to provide that treatment, and insurance companies won’t pay for it.
What has changed in medicine that is driving physicians to prescribe so much more than was once the case?
The biggest change in medicine, which has contributed significantly to the prescription drug epidemic, has been the mass exodus of physicians out of physician-owned practices and into integrated health care institutions. Prior to 2000, the majority of doctors worked in physician-owned practices. Today, the majority of doctors are salaried employees in large health-care conglomerates, with billing quotas, patient satisfactions surveys, and hospital “quality measures” driving them to provide a certain kind of care — even when that care is against their better judgement and/or the health of the patient. To be sure, top-down medicine has the potential to improve many aspects of medical care, and probably allows more people access to medical care; but when it comes to prescribing pills as a short-term quick fix for complex problems, top-down medicine has been a disaster.
In addition, pain has “become it’s own disease” — a relatively recent change in medical perspective. While this phenomenon has resulted in better treatment for some, another outcome has been a startling rise in the prescribing of opioids.
Can you explain further how this “disease-ification of pain” may have contributed to overprescribing of opioids?
Prior to 1900, pain was viewed as an immediate and short-lived response to an injury or illness — the body’s emergency warning system that burned bright and then burned out. Once the injury healed or the illness was cured, (or the body just got used to it, whichever came first), the pain — so the thinking went — disappeared. There was no framework or lexicon for chronic pain, especially in the absence of injury or objectively verifiable disease.
Today, hospitals and clinics are overrun with patients struggling with a growing variety of chronic pain conditions. Indeed, the number one cause of Social Security Insurance (SSI) disability today is chronic pain. Compare this with the 1980s, when the leading causes of disability were heart disease and cancer. Furthermore, pain today need not be caused by an injury or illness. Pain can be its own disease. A growing list of chronic pain conditions has emerged for which there is limited understanding and no obvious medical antecedent: fibromyalgia, complex regional pain syndrome, pelvic pain syndrome, etc.
Another aspect of pain management that has changed in the last 150 years is the approach to peri-operative pain. As recently as the mid to late 1800s, pain during surgery was considered salutary by boosting cardiovascular and immune function and thereby expediting healing. By the 1950s, with advances in anesthesia (methods of rendering patients unconscious) and analgesia (methods of eliminating acute pain) — especially the growing availability of synthetic and semisynthetic opioids — pain during surgery was no longer associated with any beneficial medical effects. (Of interest, recent reports have shown that patients who receive opioid painkillers during surgery have slowed rates of tissue healing compared to those undergoing the same surgery without opioids, which may be attributable to opioid suppression of the immune system.)
A third way medicine’s conception of pain has changed over time: today, pain is “bad” — not merely because it is painful, but also because it is believed to engender future pain by leaving a neurological scar, so to speak. Such conditions are of late referred to as “centralized pain syndromes,” and localize the source of the pain in the brain, rather than out in the body. As a psychiatrist, I can’t help but note the parallels between centralized pain syndromes and post-traumatic stress disorder, both of which link the acute experience of pain as a potential source of long-lasting pain.
Over the course of the past century, these changes in the way medicine and society view pain have allowed for a lessening of the burden of suffering for many people with pain; however, this altered perspective has also inadvertently contributed to the opioid epidemic by encouraging doctors to overprescribe opioids for chronic pain as a way to make the elimination of all pain the goal of medical treatment. Emerging evidence suggests that opioids are noteffective when used long-term for pain (they are very effective for short-term, i.e., 1-3-day, pain). Opioids may even cause serious adverse health consequences, including making pain worse when used for more than a month and impeding the healing process.
What role has “Big Pharma” played in the rising prescription levels?
Big Pharma (a nickname for the multi-billion-dollar pharmaceutical industry) has always been in the business of getting doctors to prescribe more drugs, and they have used every tactic at their disposal to do that. What changed in the last 30 years was that Big Pharma infiltrated Big Medicine (The Joint Commission, The Federation of State Medical Boards, the Food and Drug Administration) in an unprecedented way, to convince doctors that prescribing more opioids was not what Big Pharma wanted, but rather what Science supported. Turns out none of it was true. There is no evidence that opioids are effective in the treatment of chronic pain when used long term. (Opioids are very effective when used short-term for acute pain.) Doctors, increasingly pressured to practice so-called “evidence-based medicine,” prescribed more opioids for chronic pain because they were misled to believe medical science supported it. It also happened to be a convenient solution to the increasing industrialization of medicine, in which some doctors are forced to see upwards of 40 patients a day.
What can stop the overprescribing of drugs in the U.S.?
Unfortunately, the prescription drug epidemic is likely to continue for the foreseeable future — unless we do more to target the unseen forces driving the epidemic. (However, even public discussion of these unseen forces verges on political incorrectness.)
What it will take to stop the overprescribing of opioids, and other pills, is a restructuring of medicine to a system which reimburses doctors to provide the kind of treatment that actually helps pain in the long term. Beneficial treatments include behavioral and psychological interventions ranging from psychotherapy to physical therapy and everything in between — not pills.
Can we hope that clinical research studies will indicate or prove how detrimental chronic opioid use is for so many, even relative to the pain management benefits they may provide for some?
There are already many studies showing the damage that exposure to chronic opioids can cause — including increased risk of fractures, disordered breathing, and delayed tissue healing, to name a few. Ironically, chronic opioids can also cause increased pain over time, a condition called opioid-induced hyperalgesia. And let’s not forget of course the risk of addiction, as well as the risk of accidental overdose.
Are there other drugs physicians are starting to prescribe too much… and that may prove more addicting than first thought? In other words, is there another Rx epidemic in the offing?
Prescriptions for stimulants to treat attention deficit disorders, especially among ever-younger children, some as young as 2 years old, have sky-rocketed in the last few decades, along with prescriptions for sedatives and anti-anxiety medications. Because these medications are less likely to cause overdose and accidental death, we hear less about them, but my clinical practice is full of people addicted to these prescription drugs, most of whom got started on those drugs by a doctor.
Can you explain why some individuals may be “dependent” on a substance, including opioids, whereas others are more than just dependent, but rather are “addicted”?
The great and enduring mystery in the field of addiction is why some people can use addictive substances in moderation and never get hooked, while others eventually progress to addictive behavior. The risk is some combination of nature, nurture, and neighborhood. The risk of developing addiction increases 4-fold if the individual has a biological parent or grandparent with addiction. Mental illness and early trauma increase the risk of addiction. Growing up in an environment in which maladaptive substance use is modeled and condoned is also a risk factor. Perhaps the greatest risk factor of all is simple access: if alcohol and drugs are readily available, the individual is at greater risk to use them and become addicted to them.
How can a family member or friend tell if a loved one might be addicted to opioids or other drugs… and if it becomes evident that there is a problem, what’s the best approach for dealing with it and getting help?
Signs of addiction include lying, blaming, erratic behavior, and poor function at work, school, home. I always tell parents that if your kid is not doing well, and spends a lot of time unaccounted for, or has had an abrupt change in personality, think drugs. This is one instance in which being a helicopter parent is a good thing: search their back-packs, their rooms, their phones. Find out where they’re going, what they’re doing, who they’re with. Respecting autonomy is well and good, but if you’ve got a teenager in trouble, dive in and try to find out what is going on. If you find out alcohol and/or drugs are involved, find the resources in your area that help people with drug and alcohol problems.
Tell us what one can expect about addiction recovery success rates. Is the forecast rosy or dim? Improving?
It’s a myth that addicts don’t get better. About 50% of people who get addiction treatment get into recovery, response rates that are on par with those who get depression treatment. Many recover without any professional treatment at all. Those who actively participate in AA and other 12-step groups have outcomes on par with those who get professionally mediated treatment, like cognitive behavioral therapy. AA may even be better than CBT long-term, for those who have a goal of abstinence.
… any final thoughts?
Above all, be a wary consumer of prescription drugs. Even your doctor may not realize a drug he/she is prescribing has the potential for addiction.
Drug addiction is a serious epidemic, why don’t we treat it like one?
We are in this surreal moment in time when creating a social media challenge to raise money for a cause, for example the ALS Ice Bucket Challenge, has become the main source of funding for some of our most successful scientific research endeavors. Gene editing can be done in your garage on a layman’s budget. And, suddenly, the people responsible for our health care future are wondering, “Is curing patients a sustainable business model?”
Unfortunately, this kind of insecurity is exactly what experts in the substance use disorder field have felt for decades as insurance and public support wobble. Despite becoming one of the most serious epidemics of our time, drug addiction is still wildly misunderstand by the public, the victims are still wrongfully criminalized by the court of public opinion, and public policies are doing little to treat or even soften the spread of this disease.
Drug addiction is an intergenerational disease, just as prevalent in the family tree as cancer or diabetes. In fact, studies found that animals exposed to prenatal stress tend to exhibit the same signs as seen in addiction and are more likely to self-medicate when given access. Addiction is a serious brain disease that targets the “opioid attachment-reward system, the dopamine-based incentive-motivation apparatus and the self-regulation areas of the prefrontal cortex.” Essentially it hijacks the very parts of our brain responsible for goal-setting and motivation. It’s a disease that is commonly comorbid with, or puts people at risk of, other mental and physical health concerns, like Post-Traumatic Stress Disorder (PTSD) or HIV, which means those suffering with addiction are also often combating other physical or mental health disease at the same time. PTSD prevalence alone was found to be five times higher in patients with Substance Use Disorders (SUDs). The comorbidity of the two diseases makes it difficult to overcome one or the other.
Meanwhile those suffering with addiction are unfairly persecuted by the stigma against the disease, a stigma that is sewn heavily with misinformation. To this day, it is still treated as a personal failure despite overwhelming evidence to the contrary. The typical victim of an SUD began using drugs or alcohol by the age of 17, when the brain is still not fully developed, especially in terms of stress management, emotion and higher executive functions. Over a tenth of people admitted to treatment for an SUD began use by the age of 11. We are talking about middle and high school children who first develop this disease, so the stigma behind addiction is shockingly damaging.
Because of these (and other) factors, addiction-related deaths have been skyrocketing. The total number of deaths from substance use overdose in 2017 was over 70,000 and has been growing year over year. Compare that to the roughly 35,000 deaths from drug overdoses in 2007; it’s deeply disturbing that the number has doubled in just 10 years.
We have an epidemic on our hands, but instead of doing everything in our power to fight this disease, we are instead working with research that is often a decade old. Many of the more current articles can’t even agree on the most effective methods of treatment for comorbid disorders, such as PTSD and addiction, which makes it hard for providers to make the most effective calls in treatment.
Addiction experts agree that we need to know the best and most practical options for treating our patients effectively. Our field needs new research and more support from our local communities, because the data on the matter is clear: It isn’t some stranger at risk of addiction, it’s the children in our own towns.
The Drug Overdose Epidemic Affects All Communities
In the last few decades, the drug overdose epidemic has worsened dramatically. The number of deaths from drug overdoses has skyrocketed, particularly among White people and people who live in rural areas. This aspect of the epidemic has gotten a lot of attention, because the rate has been increasing so quickly. However, it is not the whole story of the drug overdose epidemic.
A new NIH analysis of drug overdose deaths shows that the epidemic is huge and national, affecting people of all racial and ethnic groups, in cities, suburbs, small towns, and rural areas, and rates of drug overdose are rising among almost all groups.1 Most U.S. overdose deaths involve opioids, a group of drugs that includes illegal drugs like heroin and prescription pain medicines like oxycodone (OxyContin) and hydrocodone (Vicodin). In 2017, the U.S. Department of Health and Human Services declared the opioid crisis a national public health emergency. Recently, the Centers for Disease Control and Prevention (CDC) published a report on preliminary data showing a significant decline in prescription use-related deaths for the first time since 1990. However, deaths from other opioid use continue to rise.
“News of the declining death rate for prescription drug use is encouraging, yet we are greatly concerned about the rising number of deaths that continue for other segments of opioid and other drug users and recognize these drug overdoses cross racial, ethnic, geographic location and socioeconomic status lines,” said NIMHD Director Eliseo J. Pérez-Stable, M.D., one of the authors of the new study. “There is an urgent need for multifaceted approaches to reduce and even eliminate mortality due to fatal drug poisoning.”
Shape of an Epidemic
Opioids bind to receptors on nerve cells in your body. The drugs block pain but can also slow your breathing and digestion. In an opioid overdose, your breathing and heartbeat can slow to a dangerously low rate. An overdose of a stimulant like cocaine or methamphetamines, on the other hand, speeds your heart rate and raises your blood pressure to dangerous levels.
Drug overdoses were increasing very slowly through the 1980s but took off in the late 1990s as prescriptions for opioid pain medicines increased. A second wave of the epidemic began in 2010, when overdose deaths related to heroin started to increase among younger people, predominantly those ages 20 to 40.2 Meanwhile, several factors contributed to a reduction in overdose deaths related to opioid prescriptions; one study suggests that physicians were cutting back on opioid prescriptions because of worries about overdoses, and people who were already addicted to prescription opioids were switching to heroin.2
In 2013, a third wave of overdose deaths began, with a sharp increase in deaths involving fentanyl. Fentanyl is a prescription opioid, but it can also be synthesized illegally and is often added to heroin and cocaine. In 2017, more than two-thirds of drug overdose deaths in the United States involved an opioid, and more than half of those deaths involved fentanyl.1 Overdose deaths involving cocaine and other stimulants have also started increasing; according to the CDC report, the death toll involving this drug category rose significantly in 2018. Many people who died of overdoses were using multiple drugs; cocaine overdose deaths often also involved an opioid.3
A Closer Look
The new analysis focused on premature deaths—that is, deaths of people ages 25 to 64.1 The researchers combined the death certificate information that the CDC collects with U.S. Census data on the counties where people lived, including the median household income, how rural the county was, and what percentage of its population was unemployed.
Of the groups studied—African Americans, Latinos, and Whites—Whites generally had the highest overdose rates, and those rates also increased sharply: From 2000 to 2015, drug overdose death rates went up by more than 10% per year among White men and women. But rates also rose quickly in other groups: For example, overdoses went up almost 10% a year for African Americans aged 50 to 64. Young Latinas’ overdose rates also increased quickly.
Looking at where overdose deaths occurred, the researchers found that rural areas had the highest rates of drug overdose deaths. However, these still represented a relatively small number of overdoses nationwide. The researchers found that 75% of drug overdose deaths from 2012 to 2015 were in large metropolitan counties, while only 1% occurred in the most rural areas.4
“I was surprised to learn that drug overdose death rates are increasing in all types of communities—rich, poor, rural, and metropolitan,” said Meredith S. Shiels, Ph.D., a National Cancer Institute (NCI) investigator and lead study author. “The epidemic impacts people everywhere in the U.S., regardless of the socioeconomic situation of the counties where they live.”
The researchers did not consider which drugs were in a person’s system when they died. Other research has shown that African American men and women who overdosed were more often taking cocaine.3,5 However, many of those deaths may have actually been caused by opioids, since cocaine and opioids are often taken in combination. According to NIH-supported studies, these deaths indicate an important, long-term public health problem that is often overlooked.5 Strategies to combat the U.S. prescription opioid and heroin epidemics remain critical for all race and ethnic groups, but additional efforts focused on the prevention of cocaine-related deaths, which disproportionately affect African Americans, are needed.5
Drug overdose deaths from 2012 to 2015 were generally highest in counties with the most unemployment, lower levels of education, and a low median income. But this trend was not generally true for African Americans and Latinos. “These socioeconomic factors have a stronger impact on Whites,” says Erik J. Rodriquez, Ph.D., M.P.H., study co-author and staff scientist in the Minority Health and Health Disparities Population Laboratory at the National Heart, Lung, and Blood Institute. This was a surprise, he said: “It may be that socioeconomic changes are affecting Whites at a faster pace, which may affect their perception and make them think that things are worse despite data to show that the general socioeconomic conditions of African Americans and Latinos are objectively poorer than that of Whites.”
“If someone asks, ‘What is the cause of the opioid crisis?’ most people who work on opioids say it is a failure to take care of pain and a failure to care for mental health,” said Benyam Hailu, M.D., M.P.H., a medical officer for NIMHD. Prescription and illegal opioids soothe both mental and physical pain. Many people with opioid use disorder also have depression, bipolar disorder, or schizophrenia. The opioid crisis may be part of a larger, longer-term process. Economic, sociological, and psychological factors, such as despair, loss of purpose, and dissolution of communities, may be at work to accelerate the crisis.2
Dr. Hailu also noted that the new study was only able to look at Whites, African Americans, and Latinos, but American Indians and Alaska Natives have also been severely affected by the overdose epidemic. Overdose rates for American Indians and Alaska Natives have increased dramatically in recent years; opioid overdose rates are almost as high for American Indians and Alaska Natives as for Whites.1
What NIH Is Doing
NIH’s Helping to End Addiction Long-term℠ (HEAL) Initiative is taking on the national opioid public health crisis via two prongs: looking for better treatments for pain and improving treatments for addiction. NIMHD is working with 10 other NIH Institutes and Centers on research that will have components related to health disparity populations, such as African Americans, American Indians and Alaska Natives, and people who live in rural areas.
Separately from HEAL, NIMHD is also working with other Institutes and Centers to fund research related to health disparities and the opioid epidemic. The funding opportunity announcement (FOA) calls for research on opioid use in health disparity populations, including understanding how opioid prescribing relates to race and ethnicity and how to reduce gaps in treatment. The first project funded under this FOA received funding from the National Institute on Drug Abuse (NIDA) to study differences in access to treatment for opioid use disorder for men and women.
In addition, NIH is supporting projects addressing addiction and substance abuse in general across the United States. For example, within Collaborative Research on Addiction at NIH (CRAN), NIDA is focusing on advancing research on addiction and drug abuse. The CRAN plan involves determining risk factors and signs of addiction, as well as identifying the connections among substances of abuse. CRAN hopes to use this additional insight to help prevent the onset or increase of substance use, particularly in vulnerable populations.
There are multiple aspects to the issue of drug abuse, including genetic, environmental, social, and socioeconomic factors that contribute to this crisis. By funding research on the opioid crisis, NIMHD hopes to find out more about what is causing the drug overdose epidemic—and how to address it.
Kashmir sees rise in heroin epidemic, 95% addicts consume drugs
70% addicts suffer from Hepatitis C, females too falling prey to heroin, say Medicos
SRINAGAR: Kashmir is witnessing a steep rise in drug addiction cases as cases are rising in hospitals for treatment.
Officials told that Kashmir is suffering a heroin epidemic as most of the drug addicts who are brought to the hospital for treatment are heroin abusers.
Dr Yasir Hussain Rather, a psychiatrist at the Institute of Mental Health and Mental Health (IMHANS) told that the drug addiction in Kashmir is increasing at an alarming rate as every day 10-15 new drug abusers, mostly heroin abusers, are being brought to the hospital.
He said that on an average hospital receives over 50 drug addiction cases every day which includes old cases which are coming for follow up treatment. Rather said that the hospital received just around 100 drug addicts in 2012, “but we are now receiving 100 cases in two days and in the last two over 8000 drug addicts were received at the hospital.”
“There is a heroin epidemic as 95 percent cases are of drug abusers. The cases of death due to drug overdose are also because of overdose of heroin,” he said.
He said that due to needle sharing while injecting heroin, around 70 percent drug abusers received at the hospital are suffering from hepatitis C and there remain chances of HIV AIDS as well.
“We are witnessing drug abusers suffering from severe hepatitis C which affects their liver and adding to their health burden as the medicines to treat hepatitis C is very expensive,” he said.
He said that heroin addiction is a chronic disease and if they treat 50 patients, over 30 patients relapse and using heroin for a period of five years will definitely lead to destruction, devastation and untimely death.
“Now even female drug addicts are being received at the hospital, though their number is low yet now the trend has also started,” Rather said.
“There is no recreational alternative available for the children in Kashmir as drug addiction isn’t a choice but in absence of any sports and recreational alternative, children are becoming addicts as we are witnessing mostly 15-30 year age group involved in it,” he said.
Rather said there is need to develop a healthy behavior by promoting sports and recreational culture besides that parents must supervise their children as well as lack of supervision, communication, parental discord often leads to depression and later turns to become a drug addict—(KNO)
How the pandemic helped spread fentanyl, drive opioid overdose deaths to a new high
For the past 20 years, I have been engaged in efforts to end the opioid epidemic, as a public health official, researcher and clinician. And for every one of those years I have looked on as the number of deaths from drug overdoses has set a new record high.
Yet even knowing that trend I was surprised by the latest tally from the CDC showing that for the first time ever, the number of Americans who fatally overdosed over the course of a year surpassed 100,000. In a 12-month period ending at the end of April 2021, some 100,306 died in the U.S., up 28.5% over the same period a year earlier.
The soaring death toll has been fueled by a much more dangerous black market opioid supply. Illicitly synthesized fentanyl – a potent and inexpensive opioid that has driven the rise in overdoses since it emerged in 2014 – is increasingly replacing heroin. Fentanyl and fentanyl analogs were responsible for almost two-thirds of the overdose deaths recorded in the 12 months period ending in April 2021.
It is especially tragic that these deaths are mainly occurring in people with a disease – opioid addiction – that is both preventable and treatable. Most heroin users want to avoid fentanyl. But increasingly, the heroin they seek is mixed with fentanyl or what they purchase is just fentanyl without any heroin in the mix.
While the spread of fentanyl is the primary cause of the spike in overdose deaths, the coronavirus pandemic also made the crisis worse.
The geographical distribution of opioid deaths makes it clear that there has been a change during the pandemic months.
Before the COVID-19 health crisis, the skyrocketing increase in fentanyl-related overdose deaths in America was mainly affecting the eastern half of the U.S., and hit especially hard in urban areas like Washington, D.C., Baltimore, Philadelphia and New York City. A possible reason behind this was that in the eastern half of the U.S., heroin has mainly been available in powder form rather than the black tar heroin more common in the West. It is easier to mix fentanyl with powdered heroin.
COVID-19 resulted in less cross-national traffic, which made it harder to smuggle illegal drugs across borders. Border restrictions make it harder to move bulkier drugs, resulting in smugglers’ increased reliance on fentanyl – which is more potent and easier to transport in small quantities and as pills, making it easier to traffic by mail. This may have helped fentanyl spread to areas that escaped the earlier surge in fentanyl deaths.
Opioid-addicted individuals seeking prescription opioids instead of heroin have also been affected, because counterfeit pills made with fentanyl have become more common. This may explain why public health officials in Seattle and elsewhere are reporting many fatalities resulting from use of counterfeit pills.
Another factor that may have contributed to the soaring death toll is that the pandemic made it harder for those dependent on opioids to get in-person treatment.
More than anything else, what drives opioid-addicted individuals to continue using is that without opioids they will experience severe symptoms of withdrawal. Treatment, especially with buprenorphine and methadone, has to be easy to access or addicted individuals will continue using heroin, prescription opioids or illict fentanyl to stave off withdrawal. Some treatment centers innovated in the face of lockdowns, for example, by allowing more patients to take methadone unsupervised at home, but this may not have been enough to offset the disruption to treatment services.
And maintaining access to treatment is crucial to avoid relapse, especially during the pandemic. Research has shown that social isolation and stress – which became more common during the pandemic – increase the chances of a relapse in someone in recovery.
In the past, one slip might not be the end of the world for someone in recovery. But given the extraordinarily dangerous black market opioid supply, any slip can result in death.
Americans are overdosing on a drug they don’t know they’re taking
Fueled by the coronavirus pandemic and an increase in fentanyl use, the US drug epidemic exploded while Americans were locked down.From May 2020 through April 2021, more than 100,000 people died from drug overdoses in the US, according to provisional data released Wednesday by the US Centers for Disease Control and Prevention.That’s a horrible new record for drug overdose deaths — a near-30% rise from the same period a year earlier and a near-doubling over the past five years.
The drug epidemic grew in tandem with the Covid-19 pandemic, which claimed about 509,000 deaths in the same period.
Synthetic opioids like fentanyl — a painkiller 50-100 times more potent than morphine — accounted for the bulk of those drug overdose deaths: around 64,000.
The pandemic played a role. “In a crisis of this magnitude, those already taking drugs may take higher amounts and those in recovery may relapse. It’s a phenomenon we’ve seen and perhaps could have predicted,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, told CNN. Enter your email or view the Vault By CNN webpage to own a piece of CNN History with blockchain technology.
Enough fentanyl to kill 333 million people. Read this line from CNN’s report: The US government has seized enough fentanyl this year to give every American a lethal dose, Drug Enforcement Administration Administrator Anne Milgram said Wednesday at a White House press briefing, calling the overdose epidemic in the US “a national crisis” that “knows no geographical boundaries, and it continues to get worse.”
Deadly fakes that look like prescription pills. Illegal drugs are often made to look like prescription pills, available online and sold through social media, according to a US Drug Enforcement Administration warning in September. That same month the DEA announced more than 800 arrests and the seizure of more than 1.8 million pills as part of a two-month sweep. The agency noted fentanyl has been seized in every state and it issued an urgent warning in September about fake prescription pills laced with the drug. A scant 2 milligrams can be deadly, and they’re often cut in with counterfeit Oxycontin, Percocet or other drugs.
30mg authentic, left, and counterfeit Oxycodone
Who abuses drugs? A lot of people. An estimated 10.1 million Americans ages 12 and above misused opioids in 2019, including 9.7 million prescription pain reliever abusers and 745,000 heroin users, according to CNN’s reporting. Who is dying? A Google search yields scores of stories like these:
- There’s the 28-year-old man in Northern California who died after taking a fake pain pill that contained fentanyl.
- There’s the 11-month-old baby left unsupervised in North Carolina who died from a fentanyl overdose. Her mother and grandmother are facing charges. (While searching on Google for specific cases of fentanyl deaths, I saw reports on a lot of toddlers eating their parents’ pills: A 15-month old’s father charged in his overdose death in Southern California. A mother of a 1-year-old in Alabama arrested after the child overdosed.)
- There’s the family of a prisoner in Alabama who died of a fentanyl overdose but didn’t find out until months later.
- There’s the teenager outside Los Angeles who bought what he thought were prescription painkillers from a friend of a friend and died from fentanyl poisoning.
- There’s the 25-year-old woman in Las Vegas who thought she was buying Percocet but died after taking fake pills with fentanyl.
The stories are everywhere.Where are they getting the drugs? Look at these two stories from Las Vegas: A 27-year-old man is accused of selling fentanyl-laced pills over Snapchat to a 32-year-old man who died of fentanyl toxicity.A 21-year-old woman who went by the Snapchat username “yungdrugaddict” was charged with second-degree murder for selling fentanyl-laced pills that killed a woman of the same age.What does Snapchat say? In an October 7 statement on its website, Snapchat argues it is improving its work with law enforcement and using artificial intelligence and reports from the community to identify and remove drug dealers from the platform.How does fentanyl get to the US? Chemicals used to make the drug are often shipped from China to the US or Mexico for production by drug cartels in Mexico and then smuggled to the US.The drug can come in small mailed shipments of less than a kilogram.A Chinese government crackdown on fentanyl has slowed this method. India is another source of fentanyl in the US.Here’s a passage from the DEA’s fentanyl report:Fentanyl is being mixed in with other illicit drugs to increase the potency of the drug, sold as powders and nasal sprays, and increasingly pressed into pills made to look like legitimate prescription opioids. Because there is no official oversight or quality control, these counterfeit pills often contain lethal doses of fentanyl, with none of the promised drug.
What is President Joe Biden doing? The administration notes it put $4 billion in funding from the Covid-19 relief package, known as the American Rescue Plan, toward combating overdose deaths, including expanding services for substance use disorder and mental health.Biden told reporters Wednesday his administration is also “working to make health coverage more accessible and affordable for all Americans, so that more people who need care can get it.”
DEA seizes 300 kilos of Fentanyl, say Mexican Drug Cartels fueling record high overdose deaths
EL PASO, Texas (KTSM) – Drug overdose deaths have hit an all time high in the United States with more than 100,000 people dead in one year’s time.
The DEA is pointing to Fentanyl as a major factor in the spike in deaths saying the drug is being made in Mexico, turned into fake prescription pills by the Mexican Cartels and then smuggled across the border.
KTSM 9 News Anchor Christina Aguayo was taken inside the drug testing room at the DEA and was shown about 11,000 counterfeit prescription pills laced with Fentanyl, equaling about a kilogram with a street value, according to Acting Special Agent In Charge Greg Millard, of more than $100,000.
The Fentanyl laced fake prescription pills are made to look exactly like prescription pills. They are so potent a special agent must be fully protected before handling them. While in the drug testing room, a special agent put on three layers of glove, an air purifying respirator and a special suit before handling the drugs inside a special hood.
Special Agent Millard said that profit and greed are driving the Mexican Drug Cartels to push the fake prescription pills laced with Fentanyl saying,
“It’s easy to produce it’s easy to get the chemicals. With the other drugs you have to grow a plant. With Heroin you have to grow a plant, Marijuana you have to grow a plant, Cocaine you have to grow a plant. But Fentanyl is produced in a laboratory, it’s produced clandestinely. It’s just chemicals mixed together.”Acting Special Agent In Charge Greg Millard
Which makes it extremely dangerous. According to Special Agent Millard the Cartels are making Fentanyl in powder and pill form,
“And the pill form is very scary because they’re made to look like legitimate pharmaceutical like Oxycontin, Oxycodone, Valium, and Xanax. So, they’re mimicking these so when people buy the pill on the street, they think they’re getting what maybe was a pill bought from a pharmacy prescribed by a doctor but sold on the black market. However they’re not. They’re getting a pill made somewhere south of the border containing fentanyl.”Acting Special Agent In Charge Greg Millard
A drug that is 50 times more powerful than Heroin and 100 times more powerful than Morphine. In fact, Millard said a very small amount can be deadly,
“Fentanyl is so powerful, only two milligrams could be potentially lethal. Two milligrams is like a few grains of salt. Picture a few grains of salt on the end of a pencil. That’s two milligrams. 40% of the pills have a potentially fatal dose”Acting Special Agent In Charge Greg Millard
In 2021 the DEA El Paso Division seized nearly 300 kilos of Fentanyl – marking a 600% increase from 2020 – where they seized about 42 kilos. Millard said that the drugs are shipped through out the country by way of El Paso, but recently they’re seeing more staying in the city.
And a new method being used by the Mexican Drug Cartels is recruiting young adults to smuggle ‘people’ across the border. Special Agent Millard said the same method is being used to traffic drugs into El Paso.
“We are [seeing] younger smugglers being recruited on social media platforms bringing, being recruited by the drug cartels to bring the drugs across. Often they don’t know what there are smuggling they are just paid to bring something to the united states.”
But Agent Millard has a warning about accepting cash to bring drugs across the border, .
“I would tell them to be careful. If they are recruited on social media to be paid $50 or $100 or $200 to bring something into the united states. Stay away it’s not safe. It’s probably narcotics and you’re risking your freedom you will be arrested if you’re caught with it.”Acting Special Agent In Charge Greg Millard
Millard says that the DEA is attacking the Opioid crisis from every angle including using a response vehicle to help bust drug labs, and showing Aguayo one of those response vehicles,
“This is our new Clandestine Laboratory Response Vehicle. Traditionally these were used to respond to clan labs for Meth where it was being produced in Texas, more recently these are used to respond to Fentanyl.”
Everything the agents need to process a Fentanyl lab is inside the truck, it also contains sophisticated equipment to test for the deadly drug.
In addition to taking down Fentanyl drug labs, the DEA has launched Operation Engage – a program that takes a deeper dive into community outreach engaging everyone from local law enforcement to schools, faith based organizations and even medical professionals – and they are encouraging parents to talk to their kids about the dangers of drugs.
“We’ve destigmatized drug use,” Millard said, “I’ve always said, a kid, a young kid and adult that maybe wouldn’t inject themselves with heroin, they wouldn’t do cocaine, but they’ll take a pill and its really scary”
Special Agent Millard said that other drugs like Marijuana, Cocaine and even Meth are being laced with Fentanyl so the deadly drug is not just found in the fake pills being smuggled across the border.
He also said that pills – prescribed by your doctor – are safe. But if it’s not straight from the pharmacy don’t take it. One pill, he said, can kill.
Take Action Against Addiction
Drug abuse affects all of us, and we must act to prevent more unnecessary deaths.
In recent weeks, a spate of media attention has once again alerted Americans to our epidemic of narcotic drug abuse – and its destructive and fatal consequences. My recent piece in this publication spoke to the political promise for a response in this country because an epidemic is indifferent to whether a person is Republican, Democrat or independent. We are all besieged by this problem; an epidemic makes no distinctions between white, black, Hispanic or Asian, rich or poor, urban or rural, or young or old.
For the doers among us, we need to decide and act on what can be done to contain this epidemic. Unnecessary deaths can be averted, and we can do far better to protect against the personal, community and economic devastation that addiction wreaks on a society. At the risk of missing a few things, I offer below 10 actions individuals, families and communities (including our policymakers and insurers) can do. These are not meant to be taken in rank order; rather, the more taken, the greater our chances of success.
1. Reduce overdose deaths by providing easy access to naloxone. Naloxone, now available as a nasal spray, immediately blocks the deadly respiratory suppression caused by heroin, methadone and narcotic pain pills (like OxyContin, Percodan and Vicodin), and it should be made easily available to first responders, families and those dependent on narcotics and their friends. In 2014, overdose deaths from prescription pain pills reached nearly 19,000, a more than threefold increase from 2001. Over 47,000 people total overdosed that same year.
2. Identify and crack down on prescribers who are providing large quantities of narcotics in so-called pill mills. Use state prescription databases to identify these prescirbers, and distinguish them from doctors legitimately practicing with populations of pain and cancer patients.
3. Employ TV, radio and social media to educate families about drug-abuse prevention. This has been repeatedly shown to reduce the non-medical use of narcotic pain pills.
4. Establish and implement medical guidelines for the treatment of chronic pain. This can be done through quality improvement techniques and performance improvement strategies.
5. Make problem drug and alcohol use screening a standard of care. Screening for this abuse should be a universal practice, used with adult patients seen in primary care settings to identify and intervene early before addiction sets in and overtakes an individual. Screening, brief intervention and referral for treatment, or SBIRT, is a proven intervention that is generally covered by insurers, including Medicaid and Medicare. This intervention has also been adapted for teenage detection and intervention of drug and alcohol problems.
6. Increase the availability, affordability and access to drug treatment programs. An estimated 80 to 90 percent of individuals who could benefit from treatment are not getting it. Celebrities who can pay vast sums for private treatment programs should not be the only ones able to enter them. The Affordable Care Act requires as an essential service element coverage and parity for mental health and substance use disorders, meaning that insurance benefits for addiction must be equivalent to any other covered general medical condition. The opportunity for proper reimbursement for substance disorder treatment has never been better.
7. Educate doctors, patients and families about what good addiction treatment must include. Medical providers, not just addiction specialists, need to appreciate the underlying neuroscience of addiction and fashion their treatment accordingly. Patients and families need to be far more informed consumers in order to advocate for effective treatments.
8. Expose treatment centers not providing comprehensive treatment for substance abuse as falling below standards of quality of care. 12-Step recovery programs (like Alcoholics Anonymous and Narcotics Anonymous) are important as a part of a comprehensive treatment program, but have low rates of effectiveness alone. Treatment options must include motivational enhancement, cognitive-behavioral treatments, relapse prevention, family education and support, wellness efforts and medication to help prevent relapse and maintain sobriety.
9. Promote and pay for the use of medication-assisted treatment. This means that recovery efforts can include medication.The use of medicationshould not be exhorted as a violation of sobriety. A number of medications now exist for drug and alcohol addiction (tobacco too) that improve rates of abstinence – or reduce use, called harm reduction. These include buprenorphine (Suboxone), methadone, naltrexone (including the 28-day injectable Vivitrol) and naloxone. Let’s give people in recovery as good a chance as possible not be drawn into puritanical and outdated notions of recovery.
10. Keep hope alive. People with substance use disorders can recover. That takes good treatment, hard work, ongoing support and keeping hope alive. People with addictions do get on the path to recovery – but it is hard to predict when that will happen. For some it is early, even after one or two rehabilitation programs. For others it may take five, 10 or 20 rehab programs, and the pain and suffering of too many relapses. Persons affected, their families and clinical providers need to sustain hope that recovery can happen during what can be a protracted and very dark time. The darkest moments, the most deadly, are when hope evaporates, which is when exile from family, friends and communities and suicide are more likely.
We surely have an epidemic of drug use and abuse. This country, and others, have successfully faced and overcome many an epidemic. The sooner we act, the more comprehensively we act, the more lives and families will be spared.
9 Ways to Fight the Opioid Crisis in Your Community
With the new President’s Commission on Combating Drug Addiction and the Opioid Crisis, we’ve updated this article which first appeared in August 2016 written by Marty Harding, Director of Training and Consultation, Hazelden Betty Ford Foundation
These are difficult times for many communities. Budgets are being cut; resources are dwindling. Law enforcement personnel, county officials, social services agencies, and healthcare providers are struggling to do more with less. At the same time, the opioid epidemic is devastating families and communities throughout America.
(Editor’s Note) With 91 Americans dying each day from opioid overdoses, the Centers for Disease Control and Prevention have characterized it as an epidemic.
For the past year, I’ve had the opportunity to work in six states to mobilize communities to address this epidemic: Massachusetts, Minnesota, Wisconsin, Kentucky, Florida, and Arkansas. In each state, people from every community sector have shared devastating stories of how they have been affected by opioid use. People who work in emergency rooms of their local hospitals are seeing a flood of overdose patients (from young teens to older adults), and first responders tell of the role they are now playing in saving lives by administering Narcan.
Law enforcement officers talk about their struggle to crack down on dealers and distribution networks. Employers are worried about lost productivity in the workplace due to opioid use. Faith leaders are overwhelmed by the number of deaths in their congregations. Community leaders are concerned about public safety. Educators ask if they’re doing enough to prevent opioid use among adolescents and how to intervene. And probably the most heartbreaking of all the stories are those told by parents who have lost a child to an opioid overdose.
As a local government administrator, you’ve seen and heard it all. Opioid use affects all of the departments you administer: public safety, facility management, transportation, fire and emergency services, and community and economic development. People turn to you for guidance about public policy.
Fortunately, communities are finding solutions to these concerns and working together across sectors to prevent opioid use, intervene, and provide resources for those who are affected by opioid use. This is a critical time for cities and counties to mobilize and provide their communities with vital information and tools to combat heroin and prescription painkiller abuse with the goal of minimizing its social and economic impact.
There is hope! Communities can successfully mobilize and take action.
On August 31, 2016, ICMA conducted a webinar on solutions that cities and counties are implementing to respond to the opioid epidemic. Lee Feldman, 2016-2017 ICMA president, and city manager, Fort Lauderdale, Florida, joined me for this webinar, and we explored these ideas that counties and cities have explored:
- Creating community coalitions to work together across sectors. Managers have joined or started community coalitions that focus directly on the opioid crisis. They have recruited members from such diverse sectors of the community as employers, youth workers, faith community leaders, school administrators, teachers and counselors, public health and human services personnel, treatment professionals, law enforcement and county court services personnel, local pharmacists, and doctors, as well as other committed individuals, including people from the recovering community. These coalitions have joined forces and disseminated relevant information, conducted visioning sessions, developed and implemented action plans, and conducted educational sessions and informational campaigns throughout their communities.
- Developing ordinances and places for safe drug disposal. Generally, these safe disposal sites are located in city halls under the supervision of law enforcement. Although drug take-back days are effective in increasing public awareness of the problem of unwanted prescriptions, a consistent, 24-7 lockbox for safe drug disposal dramatically increases the pounds of unwanted prescriptions that are collected, keeping them out of the hands of children and out of our water and landfills.
- Establishing drug diversion task forces. Dedicated to sharing information and investigations to combat prescription fraud and illegal trafficking of prescription painkillers.
- Providing training for first responders in the use of naloxone (Narcan) for reducing opioid overdoses. This strategy has been successfully implemented in many communities throughout the country, saving countless lives. New intranasal Narcan makes administration easier for both law enforcement and emergency personnel. Stigma about using Narcan still abounds, however, and city/county administrators must be armed with a strong rationale for counteracting negativity toward this approach.
- Using drug courts to fight opioid addiction and trafficking. This approach reduces recidivism, encourages compliance with treatment, and supports families of drug court participants. It also reduces some of the burdens on jails by creating an effective diversion program.
- Creating referral programs through law enforcement agencies. Some communities are trying innovative programs that allow people to voluntarily obtain help by going to the local sheriff’s office and requesting assistance. The community, county, or individual donors often cover the cost of treatment in these instances.
- Disseminating information about state laws that encourage intervention. Good Samaritan laws protect citizens when they intervene to save a life due to an opioid overdose. Drug overdose amnesty laws allow people to call 911 when a friend or family member is overdosing without fear of being arrested themselves for opioid use or possession.
- Building awareness about their state’s prescription drug monitoring program (PDMP). These efforts are critical to cutting down on “doctor shopping” and preventing opioid overdoses, but they are underused for a variety of reasons. Cities and counties are involving local doctors and pharmacies to build awareness of PDMPs and remove barriers to implementing them fully.
- Hosting community mobilization events to put tools into the hands of every community sector. Community mobilization events, using Hazelden’s “Toolkit for Community Action,” have reached more than a 1,000 people in the past six months. We’ll share what we’ve learned from these events, and let you know how you can plan and launch an event in your community.
Mobilizing your community doesn’t happen overnight, and it requires hard work. But the return on your investment of time, money, and effort is worth it. Imagine…. If hospital admissions for overdose death decrease. If law enforcement costs are reduced. If employers in your community see a rise in productivity. If violence, theft, and other crimes in your community decrease. If schools are a safer place for your children. If one life is saved. It’s worth it.
Eight Steps to Effectively Controlling Drug Abuse And the Drug Market
The United States has been fighting a losing war against drugs for decades. Budgets have increased dramatically over the last two decades and drug-related incarcerations consistently reach new records yet drug problems worsen: adolescent drug abuse is increasing, overdose deaths are at record levels, heroin and cocaine are cheaper, more pure and more available than ever before, and health problems related to drugs, especially the spread of HIV/AIDS are mounting. Meanwhile an expensive and ineffective international counter narcotics policy entails growing human rights and environmental costs. Drug problems can be reduced at less cost if we change course and adopt strategies that work. At a time when the federal budget is limited programs need to be re-evaluated. Funding needs to go to programs that work. We need new ideas to save lives – we can’t afford to continue to be wrong.
- Shift Resources Into Programs That Work:
US drug control strategy has been approached primarily as a law enforcement issue. Police have done their jobs with record arrests, drug seizures and record incarceration of drug offenders yet drug problems continue to worsen. Expensive eradication and interdiction campaigns abroad have brought few results and many costs. Two-thirds of the federal drug control budget continues to go to incarceration, interdiction and law enforcement programs while treatment, prevention, research and education divide the remaining third. Government needs to accept that the law enforcement paradigm will never work and shift to treating drug abuse as a health problem with social and economic implications. The solutions are in public health approaches which focus on addicts and abusers – not all users – as well as social services to reduce many of the root causes of abuse, economic strategies to develop alternative markets and also control drug markets. The federal drug budget should recognize this by shifting resources to prevention, treatment and education.
- Make Treatment Available on Request Like Any Other Health Service:
Making treatment services widely available undermines the drug market and reduces the harms from drug abuse. Treatment needs to be defined broadly to not only include abstinence-based treatment but also easier access to methadone and other alternative maintenance drugs. In addition it is important to provide mental health treatment, as well as services for victims of sexual abuse, spousal abuse and child abuse in order to resolve the underlying causes of addiction. Treatment also needs to be user friendly, i.e. designed to meet the needs of special populations, especially women, children and minorities. Finally, it needs to be focused on abusers and addicts rather than all drug users. The best way to accomplish this distinction is to allow people who need treatment to choose it, rather than law enforcement choosing treatment for people who happen to get caught.
- Prevent Drug Abuse By Investing in American Youth and Providing Them with Accurate Information:
The most effective way to prevent adolescent drug abuse is to invest in youth and keep them interested and involved in life. Government should increase funding for after school programs, mentor programs, skills building/job training programs and summer job programs. The Higher Education Act provisions denying college aid to students convicted of drug offenses should be repealed as barriers to education and employment are counterproductive to preventing drug abuse. Education needs to be fact-based, accurate and taught by trained educators and health professionals, not by police. Resources should be shifted away from ineffective programs like the ONDCP media campaign and the DARE program and toward research to develop more effective drug education approaches and programs to keep youth active.
- Focus Law Enforcement Resources on the Most Dangerous and Violent Criminals:
Half of drug arrests in the United States are for marijuana offenses and possession cases. Low-level, non-violent drug-using offenders dominate police time, waste the time of courts and fill US prisons. The drug war has resulted in record-breaking prison populations giving the US the highest incarceration rate in the world. Arrest and incarceration also have a devastating impact on individuals and families. The focus of the federal government in drug enforcement should be large cases that cross international and state boundaries. Smaller cases that are intra state should be left to the states. Law enforcement should stop wasting its limited resources on simple possession charges. Small-time dealers who essentially sell to support their habit should be given the choice of treatment instead of prison. Drug offenders, particularly marijuana, should be the lowest law enforcement priority while violent criminals should be priority number one. All correctional systems in the US should be less restrictive in granting parole to bona fide nonviolent drug prisoners at review time, less restrictive in granting compassionate release and less restrictive in allowing family visits. These modest changes would give prisoners a motive for good behavior to earn their way out of prison and back to their families and communities.
- International Drug Control Efforts Should Be Demilitarized and Focus on Economic Development:
Focus international drug control efforts on economic development to undermine the incentives for producing drugs and rely on civilian institutions, not militaries, for eradication and interdiction. We must get serious about alternative development initiatives for drug-producing regions with community-based programs including attention to marketing so farmers have real choices. The US must stop all aerial fumigation programs because of their unacceptable environmental and human costs. Law enforcement aid should be channeled where it belongs, through police and other civilian institutions rather than the military. Human rights concerns must be attended to in all international drug control programs. Finally we must recognize that reducing demand at home is the most effective international strategy because supplies will develop as long as there is a demand.
- Restore Justice to the US Justice System:
Drug enforcement is racially unfair at every stage of the justice system. Police profiling of communities and individuals consistently favors whites, as does prosecutorial discretion. False testimony by police to justify searches and convict suspects is too widespread. We must acknowledge the racial unfairness, document it and make it illegal to restore justice. Sentencing discretion must be returned to judges by repealing mandatory minimum sentencing at the state and federal level and by making the Sentencing Guidelines discretionary. The disparity between crack and powder cocaine sentencing has also had a racially unfair impact. End the disparity in crack and powder sentencing by reducing crack sentences to the same as cocaine powder.
- Respect State’s Rights and Allow New Approaches to Be Tried:
The Federal government should work with states. State-initiated reforms have included treatment instead of prison, medical use of marijuana, marijuana decriminalization and stopping abuse of forfeiture laws. The federal government has opposed many of these reforms and taken steps to block them from being implemented. Yet the states are laboratories for new approaches that should be tried and if effective duplicated in other parts of the United States.
- Make Prevention of HIV and Other Blood Borne Diseases a Top Priority:
HIV/AIDS, Hepatitis-C and other blood borne diseases are rapidly spread through the sharing of contaminated syringes. Needle exchange and syringe deregulation have been shown to be effective ways to reduce the spread of disease without increasing drug abuse. Also these services often lead to reductions in drug abuse by getting hard-core users into treatment.
Understanding the Epidemic
The number of drug overdose deaths increased by nearly 5% from 2018 to 2019 and has quadrupled since 19991. Over 70% of the 70,630 deaths in 2019 involved an opioid. From 2018 to 2019, there were significant changes in opioid-involved death rates:
- Opioid-involved death rates increased by over 6%.
- Prescription opioid-involved death rates decreased by nearly 7%.
- Heroin-involved death rates decreased by over 6%.
- Synthetic opioid-involved death rates (excluding methadone) increased by over 15%2.
From 1999–2019, nearly 500,000 people died from an overdose involving any opioid, including prescription and illicit opioids1.
This rise in opioid overdose deaths can be outlined in three distinct waves.
- The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 19993.
- The second wave began in 2010, with rapid increases in overdose deaths involving heroin4.
- The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl5,6,7. The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.8
Many opioid-involved overdose deaths also include other drugs9.10.
CDC is committed to fighting the opioid overdose epidemic and supporting states and communities as they continue work to identify outbreaks, collect data, respond to overdoses, and provide care to those in their communities. Overdose Data to Action (OD2A) is a 3-year cooperative agreement through which CDC funds health departments in 47 states, Washington DC, two territories, and 16 cities and counties for surveillance and prevention efforts. These efforts include timelier tracking of nonfatal and fatal drug overdoses, improving toxicology to better track polysubstance-involved deaths, enhancing linkage to care for people with opioid use disorder and risk for opioid overdose, improving prescription drug monitoring programs, implementing health systems interventions, partnering with public safety, and implementing other innovative surveillance and prevention activities.
CDC’s work focuses on:
- Monitoring trends to better understand and respond to the epidemic.
- Advancing research by collecting and analyzing data on opioid-related overdoses and improving data quality to better identify areas that need assistance and to evaluate prevention efforts.
- Building state, local and tribal capacity by equipping states with resources, improving data collection, and supporting use of evidence-based strategies. Overdose Data to Action (OD2A) is a cooperative agreement that aims to increase the timeliness and comprehensives of data and to use those data to inform public health response and prevention activities.
- Supporting providers, healthcare systems, and payers with data, tools, and guidance for evidence-based decision-making to improve opioid prescribing and patient safety.
- Partnering with public safety officials and community organizations, including law enforcement, to address the growing illicit opioid problem.
- Increasing public awareness about prescription opioid misuse and overdose and to make safe choices about opioids.
Collaboration is essential for success in preventing opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance use treatment providers, community-based organizations, public health, and members of the community all bring awareness, resources, and expertise to address this complex and fast-moving epidemic. Together, we can better coordinate efforts to prevent opioid overdoses and deaths.
neurosciences.stanford.edu, “Prescription drugs: The epidemic of addiction in the U.S;” nimhd.nih.gov, “The Drug Overdose Epidemic Affects All Communities”; baltimoresun.com, “Drug addiction is a serious epidemic, why don’t we treat it like one?” By REBECCA FLOOD; gatehousetreatment.com, “The History of Addiction Epidemics in the United States”; thedispatch.in, “Kashmir sees rise in heroin epidemic, 95% addicts consume drugs”; missouriindependent.com, “How the pandemic helped spread fentanyl, drive opioid overdose deaths to a new high,” By Andrew Kolodny; cnn.com, ” Americans are overdosing on a drug they don’t know they’re taking.” By Zachary B. Wolf; msn.com, “DEA seizes 300 kilos of Fentanyl, say Mexican Drug Cartels fueling record high overdose deaths.” By Christina Aguayo; usnews.com, “Take Action Against Addiction: Drug abuse affects all of us, and we must act to prevent more unnecessary deaths.” By Lloyd Sederer; icma.org, “9 Ways to Fight the Opioid Crisis in Your Community: The opioid crisis presents local governments with some real challenges, but there are best practices that local governments can use to fight this epidemic;” csdp.org, “Eight Steps to Effectively Controlling Drug Abuse And the Drug Market”; cdc.gov, “Understanding the Epidemic”;
The History of Addiction Epidemics in the United States
What is going on now with opioids, this isn’t the first addiction epidemic the United States has had. It has had multiple different addiction epidemics with different substances and addiction treatment centers. From alcohol, to crack cocaine, to opioids, and heroin.
The History of Addiction in the United States
In the sixteenth century, alcohol (called “spirits”) was used mostly for medicinal purposes. At the beginning of the eighteenth century, the British parliament passed a law encouraging the use of grain for distilling spirits. Cheap spirits flooded the market and reached a peak in the mid-eighteenth century. In Britain, gin consumption reached 18 million gallons, and alcoholism became widespread.
The nineteenth century brought a change in attitudes, and the temperance movement began promoting the moderate use of alcohol—which ultimately became a push for total prohibition.
In 1920 the US passed a law prohibiting the manufacture, sale, import and export of intoxicating liquors. The illegal alcohol trade boomed, and by 1933, the prohibition on alcohol was removed.
Today, an estimated 15 million Americans suffer from alcoholism, and 40% of all car accident deaths in the US involve alcohol.
Amphetamines fueled the first addiction epidemic. Synthesized in 1887 and gaining popularity in the 1920’s, amphetamines had been used in the medical community for raising blood pressure, enlarging nasal passages, and stimulating the central nervous system.
Abuse of amphetamines started in the 1930’s when it was marketed as an over the counter inhaler. It took off even further during World War II, where it was widely given to soldiers to combat fatigue and improve endurance. As legal usage of amphetamines increased, a black market emerged. (Sound familiar?)
Cocaine and Crack Cocaine Epidemic
The next addiction epidemic came in the form of cocaine. Cocaine was also given to soldiers and used medically at first. In fact, by 1902 there were nearly 200,000 legal cocaine addicts in the United States. Cocaine usage in the United States peaked in 1982 after it was declared illegal.
After cocaine, as most know, came the crack epidemic, and what an epidemic it was. Crack cocaine first appeared in big cities such as LA, Miami, and NY around 1985. Crack was cheaper than cocaine and for a lot of people, more readily available. Between 1984 and 1990, when the drug spread across American cities, the crack epidemic dramatically increased the number of Americans addicted to cocaine. In 1985, the number of people who admitted using cocaine on a routine basis has risen from 4.2 million to 5.8 million.
Then came opioids. Opioids have been used medicinally since man first had pains. Starting with opium smoking, into synthesizing the opium into a more potent medicine known as morphine—but they called it heroin.
The Civil War led to the United States’ first wave of morphine addiction. In the second major wave, it was heroin on the jazz scene during the 1930’s and 40’s. From there, use stayed steady. Now, the number of heroin users is astronomical, in part to do with the fact that so many were addicted to legal forms of the drug. Oxycontin, Percocet, Vicodin, etc. From 2000 to 2015 more than half a million people died from drug overdoses. 91+ Americans die every day from an opioid overdose.
Whatever the substance, one thing is for sure, the United States has had multiple addiction epidemics, and the opioid epidemic is one of the worst. Finding easy access to a local drug addiction treatment center is critical.
If you need help for addiction and have questions about addiction treatment centers, please contact GateHouse Treatment today. You can heal, We can help! (855) 448-3588
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