America’s been waging a war on drugs for decades, but it’s never faced an adversary as deadly as the current opioid crisis.
“Virtually all experts agree it’s the worst drug epidemic we’ve seen for 40 to 50 years — it may be the worst drug epidemic ever,” says Peter Provet, president of Odyssey House, a drug and alcohol rehabilitation center in New York City.
“Opioid overdose is the No. 1 cause of death under 50 years old.”
What makes opioids — a class of drugs intended to relieve pain that includes both prescription formulas like morphine, oxycodone (OxyContin), hydrocodone (Vicodin) and codeine, as well as illegal versions like heroine — so dangerous is both their addictive quality and their accessibility.
The number of opioid overdoses involving prescription painkillers alone has quadrupled since 1999, according to the Centers for Disease Control (CDC) — and so did the sale of prescription drugs.
That’s no coincidence, says Michael Fiori, director of addiction services for Mount Sinai-Beth Israel Medical Center in New York City.
“It actually runs parallel,” he says. “I think (overprescribing is) a mistake that the medical profession clearly now sees.”
Today, thanks to government mandates, better education and extensive training, physicians are more cautious when prescribing the use of opioids for the treatment of chronic pain like back, bone or headaches, chronic pain syndromes like fibromyalgia, or dental procedures.
This is largely due to a lack of evidence indicating that in these instances, opioids can “help people to feel less pain, be less disabled and function better,” says Dr. Fiori.
The research that is currently available in this regard “is very controversial,” he says.
But just as one supply route started to be cut off, another, much more dangerous painkiller has become accessible: synthetic opioids.
Manufactured in laboratories, these new designer drugs, commonly known as fentanyl and carfentanil (which is actually an elephant tranquilizer) are more potent than their predecessors — and potentially more deadly.
“Fentanyl is 100 times more powerful than morphine, and 50 times more powerful than heroin,” says Lindsey Vuolo, associate director of health and law policy at the National Center on Addiction and Substance Abuse (NCASA).
“And that is what has caused the surge in deaths — there was a 72% increase in overdose deaths from synthetic opioids between 2014 and 2015.”
Synthetic opioids are predominantly being used and abused “east of the Mississippi (River),” she adds.
According to the CDC, the areas of the country seeing the most significant increases in opioid overdoses are the Northeast and the South. Individual states hit the hardest include Connecticut, Florida, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Washington and West Virginia.
But overall, opioid usage is skyrocketing across the country — opioids were involved in more than 33,000 deaths in 2015, according to the CDC. And unlike earlier drug epidemics, this current one is no longer concentrated in urban areas.
“The way that this epidemic is particularly unique is that it has really impacted suburban and rural areas,” says Vuolo.
And while addiction is an indiscriminate disease, according to the latest statistics, the highest rate of increased overdoses is occurring in Caucasian and Native American populations.
“I think a lot of people were surprised by those recent statistics,” says Dr. Fiori.
Something else that’s very different about this drug epidemic? “Men are (still) more likely to die of an overdose than women, but that gap is closing,” he says. “And it’s not clear to me why the rates of overdose are increasing in women.”
One thing that is clear is that “any use of opioids right now carries the risk of overdose,” says Ben Nordstrom, MD, chief clinical officer at Phoenix House, a nationwide holistic drug and alcohol treatment center.
But there is hope, Nordstrom adds. With proper medical intervention, “100% of those deaths are preventable.”
For starters, a drug known as Naxolone is able to reverse an opioid drug overdose when administered in time. It’s now available at pharmacies in New York City (go to nyc.gov/health/map for a list of participating locations) and can be paid for through insurance or out-of-pocket (cost starts at $45). Community programs throughout the city will also provide it free of charge; they can be located by calling 311.
Prevention, especially among children and young adults — people ages 18 to 25 have the fastest growing rate of drug use, specifically opioids — continues to be a first wave of defense and the best long-term solution for stemming the tide of substance abuse.
But advancements in drug and alcohol treatments, as well as greater accessibility thanks to substance abuse rehabilitation being covered under the Affordable Care Act, are making it easier and more affordable than ever for people dealing with substance abuse issues to find help.
“Assessments are very fast,” says Dr. Nordstrom. “It’s a 45-minute investment of time that can literally save your life.”