The Epidemic of Opioids in America

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Table of Contents
The Epidemic of Opioids in America............................................................................................................4
Introduction.............................................................................................................................................4
Epidemiological Profile............................................................................................................................5
Literature Findings...................................................................................................................................8
Study 1:................................................................................................................................................8
Study 2:................................................................................................................................................9
Study 3:..............................................................................................................................................10
Current Interventions............................................................................................................................11
Role of Hospitals in Controlling Opioids Disorder Epidemic..................................................................13
Conclusion.............................................................................................................................................13
References.............................................................................................................................................14
 The Epidemic of Opioids in America
Introduction
Opioids are defined as the drugs that involve licit prescription and illicit non-prescription drugs.

The prescribed opioids might include pain killers such as hydrocodone, morphine, oxycodone,

fentanyl, codeine, and other such drugs while illicit drugs may include drug heroin. Opioid drugs

are chemically relevant and they formulate an interaction with the specific receptors on nerve

cells called opioids receptors in the nervous system & brain to relive pain and produce

pleasurable effects. Addiction is defined as a chronic condition or a primary & relapsing brain

disease. It involves pursuing relief or reward by substance use or drug use by an individual with

underlying pathology. The United States of America is currently severe epidemic of Opioids Use

Disorder (OUD), which includes inappropriate usage of opioids (prescription or illicit). The year

2020 was deadliest considering the opioids epidemic in the United States of America; more than

100,000 overdoses of drugs were recorded, among which 75,000 belonged to the overdoses of

prescribed or illicit opioids. This percentage refers to 30% increase in the overdoses from drugs

in 2019. Death rates associated with Opioids Usage Disorder (OUD) 68 percent every single

year. Moreover, the exceptional conditions of pandemic of Covid-19 might have played a role in

the deaths by overdose by the access to life-saving medicines including naloxone, diversion

treatments, and by limitations of support network. However, the epidemic of opioids use disorder

has always been a decades-long, complex, and constant crisis, since the inception in the year

1995. It was the year when OxyContin was enormously marketed and approved as a low-risk and

safe extension-release analgesic of opioid. The identification of underpinnings and underlying

factors of the opioids epidemic is often associated with the factors concerning American region.

This report will discover the epidemiological profile of these opioids, previous literature found
on opioids, recent interventions, and the role of hospitals in controlling the epidemic of OUD in

the USA.

Epidemiological Profile
Out of the 20.6 million individuals belonging to the United States of America of age 12 or older

had a drug usage disorder in the year 2015. Among this enormous count, 2 million individuals

have undergone drug abuse of prescribed pain killers and 5 million had a substance usage

disorder that involved heroin. According to a study, 24% of the individuals who used heroin

developed opioids addiction. The main cause of accidental deaths in the United States is drug

overdose. There were about 52,000 lethal opioids overdosed in the year 2015. This epidemic is

driven by the addiction of opioids, with about 20,000 deaths associated with the prescription

drugs for pain relief. 13,000 deaths were associated with the overdose of heroin in the year 2015.

At current, America is facing the situation of epidemic associated with the opioids overdose and

opioids addiction with an enormous level of mortality. The crises aroused pertaining to the

gigantic expansion of usage of opioids as medication, which is rooted to the use of opioids as

legitimate pain relievers back in 1990s as a treatment of pain, which was then unethically

exploited by the pharmaceutical companies in the pursuit of increasing their overall revenue. The

increase in the supplies of opioids promoted the high extents of diversion medications among a

vulnerable & economically suppressed population.

The currently occurring epidemic of opioids has marked differences from the epidemics of 1980s

& 1990s. These differences lie in the social backgrounds and extents of a massive component of

the impacted populations. In Canadian population that constitutes the second per capital

consumers in the United States, the increase in the lethal overdoses of opioids is connected to the

ad-mixing or high potency of other drugs as well in the localities where there was a relatively
higher incidence of usage of heroin. The beginning reactions were limiting the prescriptions of

painkillers and introducing the medicines that were hard to undergo manipulation. The decreased

supplies of prescribed opioids persuaded a critical minority of people with drug abuse of more

accessible and less expensive street heroin. Under the “iron law of prohibition”, more potent and

cheaper opioids that includes fentanyl and other such drugs, appeared increasingly in the

markets, which further paced the lethal overdoses.

Politicians and media in the American region have depicted the opioids abuse as an issue related

to the African-American populations and also linked with the rate of poverty and people from

these communities were punished with harsh penalties of criminal offense. Whereas, research

shows that since 1960s, more than half the people found to be having opioids usage disorder

were white. By the year 2010, about 92% of the people found to be involved in opioids-related

drug abuse were white. While the addiction associated with heroin is associated to one of the

urban issues, the recent waves of epidemic show a large quantity from rural areas. Although the

addiction or drug abuse related to opioids is linked to the poor class of people, the recent

epidemics show the trends of incidence in the people with worst fares since the financial clash of

2008, which includes the class of people who have fallen out of the middle class and are

working, or expected to have achieved the middleclass lifestyle.

From the year 2000 to 2008, the lethal overdosed, sales & treatment admissions related to drugs

use disorders in regard to the prescription pain killers have inclined exponentially. The death rate

due to drug overdose in 2008 increased four folds the rate of death due to drug overdose in the

year 2000, which depicts that the sales of prescription pain killers in the year 2010 were four

folds than those in 2000; consequently, the rate of treatment admission of drug use disorder in

2008 increased to six folds than that of 2000. In the year 2021, 260 million pain killer
prescriptions were given for pain management opioids, which show enough quantity to have the

bottles of pills of every adult American filled up. Every four out of five heroin users started

missing the pain relievers. A survey conducted in 2014 shows that 94 percent of respondents

undergoing the treatment of OUD claimed that they chose heroin because the prescription pain

opioids they were hard to obtain and far more expensive.

As per the epidemiological trends related to age groups, there are different trends shown by

different studies. In 2015, 270,000 adults were the illegal users of pain killers, with 122,020 had

an addiction the prescription pain killers. According to estimation, 22,000 adults utilized herein

in 2014, and about 5000 were currently consuming heroin. Moreover, about 6000 adults in 2014

had the disorder of usage associated to heroin. People share their unused pain killers without

being aware of the harmful consequences of opioids use. Most of the adult populations who get

addicted to the prescribed pain killers are provided them by a relative or friend for free. The

prescription rate of pain relieving opioids among the young & adult Americans tripled from 1999

to 2017 (Fig: 1).

Figure 1: Age-adjusted Opioids overdose death rates in the United States (Source: CDC, 2019)
As per the trends seen in the OUD depending upon genders, it can be observed that women are

more likely to develop chronic pains, prescribed more prescription pain killers, given more

higher dosage, and utilize them for more longer periods than that of men. Women are more

vulnerable to become opioids for pain relief addicted than that of men. 50,000 women died due

to the over usage of prescription pain killers during the years 2010 to 2017. Deaths caused by the

overdose of prescribed pain killers amongst women increased from 1999 to 2010 by 400 percent,

as compared to that of men (240%). Moreover, the deaths caused by heroin overdoses among

women have tripled. From the year 2010 through 2017, the trends of heroin intake increased

from 0.5 to 1.3 per 100,000.

Literature Findings
Study 1:
“Opioid Dependence” by Kokott, P (2020)

Hypothesis Methodology Findings

substance according to ICD- Opioids have anxiolytic,
10 is defined as a consumption hypnotic and analgesic effects.
behaviour that leads to A physical and psychological
damage to health and that can dependence develops quickly
be of a physical or in opioids, especially after
psychological nature. The heroin use, and psychological
drug effect (»quality of attachment and craving for the
intoxication«) is determined drug are typically high. In
by the characteristics of the addition to psychotherapeutic
person (current condition, procedures, such as cognitive
previous experience, mental behavioural therapy-based
instability:»set«), the intervention programmes,
characteristics of the situation pharmacotherapy of opioid
(alone, in the group:»setting«) dependence with opioid
and the characteristics of the agonists is standard in the
substance, so that individually substitution therapy of chronic
varying effects can occur. The opioid dependence.
opioids (morphine, heroin, Pharmacological therapy with
codeine) act primarily at the methadone is the therapy of
opioid receptor and lead to first choice.
euphoria and further substance
intake via dopaminergic
activation. Opioids have
anxiolytic, hypnotic and
analgesic effects.

Study 2:
“Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder:

Current understanding and approaches to management” by Pergolizzi et al. (2020)

Hypothesis Methodology Findings

Opioid use in the United The research articles regarding Tolerance/physical
States has reached OUD and its management dependence and the
unprecedented—some would have been reviewed behavioural characteristics
even say crisis—levels. thoroughly based on a associated with OUD reflect
Although many individuals PubMed literature search complex neurobiologic
use opioid drugs as part of using keywords related to adaptations in several major
legitimate pain management opioid dependence, its systems of the brain, including
plans, a significant number pathophysiology and current the locus ceruleus and
misuse prescription or illicit treatment strategies. mesolimbic systems. Physical
opioids. With regular opioid dependence is responsible for
use, individuals develop the distressing withdrawal
tolerance and physical symptoms individuals
dependence; both are experience upon abrupt
predictable, physiologic cessation or rapid dose
responses to repeated opioid reduction of exogenous
exposure. However, a opioids. Opioid withdrawal
substantial number of symptoms are a key driver
individuals who misuse behind continued opioid use,
opioids will develop opioid and a barrier to opioid
use disorder (OUD), a discontinuation. Several
complex, primary, chronic, opioid-based medications are
neurobiological disease rooted available to treat patients with
in genetic, environmental and OUD; these treatments can
psychosocial factors. This diminish opioid withdrawal
article discusses OUD, opioid symptoms and cravings as
receptor physiology, and well as block opioid effects in
opioid withdrawal the event of relapse.
symptomatology and Additionally, non-opioid
pathophysiology, as well as drugs may be used during
current treatment options acute detoxification to help
available to reduce opioid alleviate opioid withdrawal
withdrawal symptoms in symptoms. What is new and
individuals with physical conclusion: The opioid crisis
dependence and/or OUD. has produced many challenges
for physicians, one being the
need to determine which
patients would benefit most
from maintenance therapy and
which may be candidates for
opioid discontinuation. In
addition to summarizing
current understanding of
OUD, we provide a new
algorithm for determining the
need for continued opioid use
as well as examples of
situations where management
of opioid withdrawal
symptoms is indicated.

Study 3:
“The Opioid Epidemic” by Upp & Waljee (2020)

Hypothesis Methodology Findings

Upp & Waljee (2020) The methodology Although the growth of the opioid
found that Increases in adopted for this study epidemic may
opioid prescribing over by Upp & Waljee be slowing in some ways,13 prescription
the last several decades (2020) was the opioids
is correlated with an qualitative analysis of remain a leading cause of morbidity and
alarming increase in the previous studies mortality
opioid-related morbidity and recent trends in the United States.1 Surgeons continue
and mortality owing to noticed in the to contribute in large part to these
both prescription opioid consequences
misuse and abuse as well via postoperative opioid prescribing,
as heroin abuse. which carries
Prescribing after surgery the risks of NPU, misuse, diversion, and
is commonly in excess, adverse
and leftover pills are an events. However, there are several
important driver of strategies
opioid use disorders within the purview of the plastic surgeon
owing to diversion and for achieving adequate pain relief while
misuse. Creating mitigating opioid-related harm.
evidence-based Preoperative patient counseling, use of
prescribing guidelines PDMPs, consultation of opioid
based on patient- prescribing guidelines, and maximized
centered outcomes and use of
encouraging safe opioid nonopioid analgesia all hold promise as
storage and disposal is tools for
critical to curbing opioid reduction.
opioid-related morbidity Future work should build on existing
and mortality going evidence
forward and to ensure demonstrating the adequacy of
safe and appropriate innovative,
postoperative pain opioid-sparing pain management
management. approaches.
Further evidence is also needed to inform
the
development of prescribing guidelines for
plastic
surgery procedures, which are currently
lacking.
Finally, evaluation of the impact of
public policy,
with specific focus on the efficacy of
legislative actions and inadvertent
consequences, will also be
pertinent as such regulatory measures
continue
to roll out across the nation.

Current Interventions
Opioids Agonist therapy or the opioids replacement therapy (ORT) also called the the Opioids

Substitution therapy (OST) involves the treatment of replacement of the street opioids such as
heroin with the medical opioids substitutes under a degree of supervision, mostly with an opioid

that is more longer acting. The common drugs that are used for the replacement therapy are

buprenorphine or methadone (subutex, suboxone). Opioids replacement therapy, to date, is

described as the far best treatment to counter the problem of deaths caused by overdose of

opioids by fifty percent and it is more efficient known treatment declared by the World Health

Organization (WHO). It is supported by different agencies of United Nations, Health Canada,

The US Institute of Medicine, the United Kingdom’s National Institute of Health, the US

national Institute on Drug Abuse, and many more. It has been depicted to constantly reduce the

incidence of other blood-borne diseases, HIV spread, cutting crime, and drugs injection and

abuse. When a person is on the opioids replacement therapy, he/she does not get “high” and do

not depict the symptoms of drug withdrawal. The craving is relatively and significantly reduced.

Addiction is hence replaced with the physical dependence on drugs. Once the patient is

stabilized, he is able to work, drive and be with his family so that he cannot be criminalized

anymore. Other patients can take benefits from the opioids replacement therapy because it

decreases the risks of overdosing through a process called maintain ace of tolerance for opioids,

which is a defined as the process by which a patient of OUD uses heroin and relapses can

withstand the dosage they used to have, and hence decrease the extent of usage. There is a sound

amount of literature found in Europe that demonstrates that provision of an access to drugs under

supervision (also called heroin-assisted treatment) is efficient for a minute population of people

for whom the treatment of methadone does not work. Drugs including Dilaudid

(hydromorphone) also show progress. In the American states, the injections of Viviyrol

(naltrexone) in a monthly specific amount were approved in the year 2010 as another option for

medication in opioids replacement therapy.

In the United States, a monthly injectable form of long-acting naltrexone (Vivitrol) was approved
in 2010 as a third medication option for opioid addiction treatment.47 In the United States,
opioid substitution therapy and extended release naltrexone are grouped together in the category
“medication assisted treatment” (MAT), to distinguish these treatments from abstinenceonly
methods. Less than half a dozen trials of long-acting naltrexone have been published and they
show promising results in terms of reducing relapse.48 There is little long-term data, however,
and extended-release naltrexone has not been shown to reduce mortality or disease. It may even
increase overdose death risk upon cessation.49 Vivitrol is not approved in Canada, although it is
available under the country’s special access program in reaction to the opioid crisis.50

Role of Hospitals in Controlling Opioids Disorder Epidemic

Majority of clinicians believe that hospitals are significantly contributing to manage the OUD

epidemic. They believe that hospitals are playing major role in comparison to other healthcare

department of the United States to manage the epidemic of OUD. As the hospitalizations

requiring OUD immediate assistance is increasing & the epidemic tends to incline exponentially,

administrators, providers and policymakers found different ways to shorten the stay length,

improve the care for persons suffering from OUD, and decrease re-admissions of OUD patients.

Studies suggest that innovative delivery care mechanisms, for instance AMC, might assist in

attaining the goals & aims (Flaherty at al., 2019). Effective AMC practicing, however, requires

addiction medications, social workers, adequate nurse practitioners, and financing. Clinicians,

legislators, and policymakers rose concerns regarding the hospital-based clinicians & physicians

may be inappropriately prescribing the opioids to address the pain management of patients.

Conclusion
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2

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