Understanding the Opioid Crisis
Oct 13, 2017 Cedars-Sinai Staff
It's no secret that opioid abuse and addiction are major problems in the United States. Drug overdoses are now the leading cause of accidental death among Americans under 50, rising 19% in 2016. Ninety-one Americans die from an opioid overdose every day.
We sat down with Dr. Itai Danovitch, associate professor and chair of the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, to shed some light on how we got here, how you can identify friends or family who may be at risk, and what can be done to stop the epidemic.
"The opioid crisis is a symptom of a cultural trend where we expect a pill for every ill."
Q: How did the current crisis start?
It's the result of several developments over the last couple of decades. Beginning in the 1990s, there was a significant push to better treat pain, an under-recognized and inadequately treated problem that affected many people.
Regulatory bodies like the Joint Commission—which accredits and certifies healthcare organizations and programs—established pain as the fifth vital sign. Doctors were encouraged to treat pain more aggressively. At the same time, the pharmaceutical industry started heavily marketing opioids, sometimes leaving out key information. The risk of addiction was greatly minimized, for example. Expert panels on pain management had members who were receiving payments from the pharmaceutical industry.
Taken together, these factors led to a big increase in opioids being prescribed.
Q: How bad are things?
Opioid overdoses increased 400% over a 20-year period. In 2015, some 33,000 people in the US died from opioid overdose. About 15,000 of those overdosed on commonly prescribed drugs.
It's gotten so serious that the CDC and the Surgeon General describe the opioid crisis as an epidemic. For every overdose death, there are around 200 people who are misusing opioids and suffering other consequences, such as problems in relationships and work.
The broader impact of this crisis is really tremendous.
Q: What does addiction to opioids look like?
When you take opioid medication regularly, you'll start to build tolerance. If you're using the drugs over an extended period of time, you may go through withdrawals when you stop. Withdrawal and tolerance are normal parts of physical dependence, which is different than addiction.
Addiction has to do with losing control over your use of a drug. You start to use it compulsively, spending more and more time, money, and energy making sure you have access to the drug. Chasing after it becomes all-consuming, replacing other important life activities.
We should also remember that there are two separate but related problems in the opioid crisis—one is addiction and the other is overdose. Both are significant. Addiction causes serious problems even for people who don't overdose.
Q: Which drugs are opioids?
Opioids are a family of medications that stimulate opioid receptors. There are two types: opioids that are derived from the opium poppy—like morphine and heroin—and synthetic opioids, like fentanyl. There's a wide range of medications that fall into that class, including Vicodin, Norco, OxyContin, and oxycodone.
Q: How can you tell if someone close to you has a problem?
Addiction manifests itself in different ways. The most universal clue is when somebody doesn't seem like themselves anymore. Maybe they often appear intoxicated or distracted. If you raise concerns and they're unable to stop, then that suggests there may be a problem.
The hallmark of addiction is needing a drug to such an extent that it's destructive. If you notice alarming behavior in a loved one, and you're concerned that it's because of drug use, you should encourage them to talk openly with their doctor as soon as possible.
Addiction is not just something that happens to somebody else—it is a chronic, relapsing, medical condition that can affect people across all segments of society.
Q: What should be done to stop this epidemic?
We need more education for physicians. Any doctor who can prescribe opioids should be trained in how to get patients off them too. The public also needs to be educated, learning to ask questions about the drugs they're prescribed so they take exactly what they need—no more, no less.
There should also be better access to medications that can reverse opioid overdose—like naloxone—so that first responders have them on hand. Families of at-risk people can learn how to use the reversal agent as well. Help should be available to anyone with a substance-use disorder, so we need more funding and better access to treatment. Physicians need to be trained in evidence-based methods for substance use disorders, such as medication-assisted treatment.
Q: Is there anything else you want people to know about the opioid crisis?
I think the opioid crisis is a symptom of a cultural trend where we expect a pill for every ill. As long as we're focused on mitigating short-term symptoms without regard to long-term impact, we're opening ourselves up to problems.
Right now, there's a lot of focus on opioids. But there's another problem on the horizon—sedative hypnotics, such as benzodiazepines like Ativan, Xanax, and Valium. Two-thirds of opioid overdoses also involve these drugs. Many prevention efforts are geared towards opioids, but it is important to recognize that other commonly prescribed medications can lead to dependence and cause significant harm when misused.
Ultimately, what we need to learn from this crisis is to avoid relying on medications alone for complex medical problems like chronic pain, and recognize that addiction is not just something that happens to somebody else—it is a chronic, relapsing, medical condition that can affect people across all segments of society.