“By the mid-nineteenth century, however, it had started to become apparent that the broad use of opiates carried a price…finally, around World War I, the medical profession recognized morphine’s intensive, habit-forming potential and the term addiction was first widely used.”
~Barry Meir, Pain Killer: A “Wonder” Drug’s Trail of Addiction and Death
In February of this year, the White House referred to the issue of the abuse of opiates– which includes both prescription medications and heroin –as an “epidemic”. To understand how to best respond to this crisis, we first must recognize the true scope of the problem and then gain a better understanding of why it is happening.
How Big is the Problem of Prescription Pain Medication Addiction in the United States, REALLY?
The abuse of opiate prescription medications in the United States exacts a terrible cost in the US, both in terms of financial and human terms:
- Since 2000, nearly 500,000 Americans have died because of drug overdoses.
- Every day 78 people in the United States die because of prescription overdoses.
- Prescription drug overdose deaths in the United States reached an all-time high in 2014.
- More than 60% of fatal overdoses are due to opiates.
- Since 1999, the amount of prescription opiates, the number of deaths associated with opiate prescription medications, and the rate of those deaths have all
As dramatic as those fatal overdose figures are, they only tell part of the story. For every single death caused by prescription medication, there are:
- 825 non-medical users of their prescription medication
- 130 people who are abusing or misusing their prescription medication
- 32 emergency room visits
- 10 admissions for prescription medication rehab
The dependence upon, misuse, and abuse of opiates also creates a financial burden of $55.7 BILLION per year, in terms of lost workplace productivity, health care expenditures, and criminal justice costs.
Kevin Sabet, formerly a senior advisor at the White House Office of Drug Control Policy, said, “There’s no doubt that this is a growing cost to society. We’re in the midst of an epidemic, and it’s really time for America to wake up.”
What Factors Contribute to an Addiction to Prescription Painkillers?
Several factors come into play that can make it much easier for a person to develop a dependency to their prescription medication, particularly opiates.
- Improper prescribing—Prescription opiates are supposed to be prescribed for short-term, acute pain, or for cancer/end-of-life patients, but too often they are given out—with repeated refills—for long-term, chronic
In March 2016, the Centers for Disease Control and Prevention released their first-ever guidelines for the dispensation of opiate painkillers, specifically recommending that doctors avoid prescribing them for chronic pain. Even for acute pain, the guidelines state that opiates should be given at the lowest dose and for the shortest duration possible.
CDC Director Tom Frieden said, “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently. We hope to see fewer deaths from opiates. That’s the bottom line. These are dangerous medications that carry the risk of addiction and death.”
- Patient Misunderstanding—Most patients don’t fully understand the dangers associated with opiates—dependence, diversion, addiction, and overdose. They are under the mistaken impression that their prescription medication MUST be safe, because they were legitimately given by a doctor.
But there is no test that a doctor can give that scientifically measures pain. Doctors must rely upon the subjective opinions of their patients. And, rather than under-prescribe relieving opiates to their patients in need, most doctors have to make their “best guess” as to when an individual prescription medication is warranted.
For patients in chronic pain, too many of them also are under the faulty impression that “if one is good, then two must be better” mentality, and will take more of the medication than is necessary or recommended.
- The Mechanism of Opiate Addiction—Oxycodone, hydrocodone, and other opiates attach to specialized proteins on the surface of brain cells sensitive to opiates, and this connection initiates the same biochemical process that rewards people with pleasurable feelings when they perform any activity that is necessary to promote life, such as sex or eating.
The repeated use of opiates can trigger use of the prescription medication simply for the sake of pleasure.
Other regions of the brain store a memory associating the activity—the drug usage— and the circumstances—the people, places, and things present during that usage—with the pleasure. This “conditioned response” can lead to cravings and drug-seeking when any of those circumstances are encountered again.
This severity of this conditioned compulsion grows stronger the longer and more frequently the opiates are taken.
Eventually, repeated ingestion of opiate prescription medication disrupts the brain’s reward pathway enough that the person can only feel “normal” when then drug is present. Conversely, they feel “abnormal”—anxious, irritable, depressed, pained—without it.
Over time, the individual will find that have to take ever-increasing amounts of opiates in order to experience the same pleasurable effect. These higher dosages are what lead to fatal overdoses.
- The Acceptability of Prescription Opiates—Painkillers are literally In 2012, 259 MILLION prescriptions were written, enough to give every American adult their own personal bottle of pills.
This means that, unlike as is the case with illicit drugs like cocaine or methamphetamines, there is no obvious reason for the average person to be concerned when they learn that a friend or family member is taking a prescription medication in the opiates class. The only way for them to know when their loved one has a problem is when that person begins to show signs of drug dependency or abuse.
And that point, professional help may already be necessary.
If you live in Idaho, Washington, or Oregon and you are struggling with opiates or any other prescription medication, get the information and help you need from NorthPoint Recovery – the highest-quality drug and alcohol rehab in the Treasure Valley.
Offering medically-supervised drug and alcohol detox and evidence-based, individualized treatment plans, NorthPoint Recovery can work with you along every step you take on your journey of sobriety.
CDC Vital Signs: Overdoses of Prescription Opioid Pain Relievers in the U.S. 1999-2008 (Nov. 2011)
Birnbaum HG, White AG, Schiller M, et al, “Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States”, Pain Med (2011)