Over the last decade and a half, communities across the United States have been devastated by increasing prescription and illicit opioid use and overdose. About 91 Americans die every day from an opioid overdose. According to recent data from the National Center for Health Statistics at the Centers for Disease Control and Prevention, Americans can now expect to live 78.6 years on average — a decline of 0.1 years for 2016 over the figures from 2015, which also represented a drop. The back-to-back drops coincide with an average annual increase in opioid-related overdose deaths of about 20 percent. About 64,070 people died from drug overdoses in 2016, of which 75 percent were caused by opioids. That’s more deaths than the peak year for AIDS, which was 51,000 in 1995. According to Police Executive Research Forum (PERF), an independent research organization that focuses on critical issues in policing, more Americans died from drug overdoses in 2016 than the number of American lives lost in the entirety of the Vietnam War, which totaled 58,200.
The swath of destruction caused by opioids can be felt by all across the United States. Besides the climbing death statistic, what goes unnoticed are the invisible victims of this epidemic. Data from the Department of Health and Human Services indicates that nearly three-quarters of states have seen an unprecedented increase in the number of children entering foster care. Parental substance use is being cited as the primary reason. The number of babies born in the United States with Neonatal Abstinence Syndrome, which occurs shortly after birth, primarily among infants exposed to opioids such as prescription painkillers and heroin while they are in the womb, has quadrupled over the past 15 years. Toddlers and young children are increasingly being found unconscious or dead after consuming opioids. The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being. Parental substance use is one of these ACEs. Children in households where parents struggle with substance use are more likely to experience long-term effects of neglect or abuse than other children. This early trauma exposure makes them more likely to suffer later mental health disorders including substance abuse, anxiety disorders, mood disorders and trauma-related disorders.
Thousands of parents continue losing sons and daughters across the country to this opioid epidemic. In my clinical practice, parents often share the difficulty they experience in finding the right kind of support. The stigma related to substance use does not get buried with the death of an opioid user; it continues to haunt their well-wishers for the rest of their lives. These grief-stricken parents often get tossed around in endless waves of sadness, guilt, and anger. C. Everett Koop, the 13th surgeon general, also known as America's Family Doctor, championed the fight against AIDS. He was persistent in shifting the terms of the public debate over AIDS from the moral politics of homosexuality, sexual promiscuity and intravenous drug use, to concern with medical care, economic position and civil rights of AIDS sufferers. His efforts redefined the prevalent scientific model of the disease, from a contagion akin to bubonic plague, yellow fever and other deadly historic epidemics that required the strongest public health measures — mandatory testing and quarantine of carriers — to a chronic disease that was amenable to long-term management with medications and behavioral changes. Dr. Koop once said that self-help brings together two central but disparate themes of American culture, individualism and cooperation. Exemplifying such kind of help in this age of the opioid crisis are organizations, such as Grief Recovery After Substance Passing (GRASP) and Broken No More. The goal of these organizations, in addition to providing understanding, compassion and support for those who have lost someone they love through addiction and overdose is also to reduce the stigma and help stem the tide of addiction and overdose.
We have to adopt a pluralistic approach to curtail the mortality and ramifications emanating from this unrelenting crisis. This fatal disease calls for various segments of our society — that is, the medical community, the legal community, social service agencies, faith-based nonprofits and neighborhood groups — to form partnerships, with the goal of meeting drug users “where they’re at” and addressing conditions of use along with the use itself.
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. It incorporates a spectrum of strategies, such as substituting one opioid for another (medication-assisted treatment — methadone, naltrexone, buprenorphine), or using an antidote (naloxone), or engaging in safer use (safe injection facilities), or abstinence. To ensure medication compliance, we have options, such as a monthly injection of naltrexone (Vivitrol), a monthly injection of buprenorphine (Sublocade), and a buprenorphine implant inserted in the upper arm that lasts 6 months (Probuphine). The FDA recently approved NSS-2 Bridge, a device mimicking a hearing aid, to help reduce opioid withdrawal symptoms. According to Vivek Murthy’s 2016 Surgeon General Report, which happens to be the first-ever Surgeon General’s Report on Alcohol, Drugs and Health, only about 10 percent of Americans with a drug use disorder obtain specialty treatment. The report attributes the low rate to severe shortages in the supply of care, which can lead to waiting periods of weeks or even months. Further, over 40 percent of people with a substance use disorder also have a mental health condition, yet fewer than half receive treatment for either disorder.
The CDC estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement. Policymakers, while drafting policies to curb this epidemic, need to conceptualize this deadly disease as a physical illness, rather than a weakness of willpower or morality because if we continue latching onto such deeply entrenched and irrational beliefs, there will be no dearth of funerals to attend, skin-tone ashen bodies will continue getting discovered under bridges, alleys, parks and public restrooms, and our already saturated prison system will sadly continue being the biggest provider of mental health services. My hope is that with the opioid epidemic being declared a national public health emergency by our president on Oct. 26, 2017, policymakers will make evidence-based treatments, such as MAT, readily accessible, instead of patients having to wait for months to see a specialist and in the interim, the opioid incapacitating the respiratory centers of the brain, making them take their last breaths.
Although the Rolling Stones’ psychedelic song, “Mother’s Little Helper,” from 1966 related to the popularity of anxiolytic drugs, such as Valium and Meprobomate and the potential hazards of addiction and overdose, the lyrics, five decades later, continue reverberating: “Doctor please, some more of these, outside the door, she took four more. … Life's just much too hard today. … And if you take more of those, you will get an overdose no more running for the shelter of a mother's little helper they just helped you on your way, through your busy dying day.”
A quote from American novelist, Chuck Palahniuk echoes the reasonable foreseeability of death associated with the first drug epidemic of the 21st century: “I admire addicts. In a world where everybody is waiting for some blind, random disaster, or some sudden disease, the addict has the comfort of knowing what will most likely wait for him down the road. He's taken some control over his ultimate fate, and his addiction keeps the cause of death from being a total surprise.”
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Dr. Shobhit Negi is a board-certified child and adolescent, adult and forensic psychiatrist. He sees patients in Carroll and Howard counties. Reach him at firstname.lastname@example.org.