Opioid Crisis
Opioid Products and Their Effects
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as
fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®),
hydrocodone (Vicodin®), codeine and morphine.
Chemistry
Some prescription opioids are made from
ingredients that come from the opium
poppy plant.
Other prescription opioids are produced in
labs, using ingredients that share a
similar chemical structure to the properties in
opium.
Names
A list of commonly used opioids and their
generic names:
 Codeine
 Hydrocodone (Vicodin, Hycodan)
 Morphine (MS Contin, Kadian)
 Oxycodone (Oxycontin, Percoset)
 Hydromorphone (Dilaudid)
 Fentanyl (Duragesic)
CHEMICAL STRUCTURE CATEGORIES
The chemical structure of opioids is divided into three categories:
1. Those based on the 4,5-epoxymorphinan ring. These include morphine, codeine,
oxymorphone, oxycodone, buprenorphine, hydromorphone and hydrocodone.
2. Phenylpiperidines such as alfentanil, fentanyl and sufentanil.
3. Diphenylheptylamines such as methadone.
EFFECT
Although the compounds above differ in chemical structure, they share the same feature of
their interaction with the mu (μ) opioid receptor in the primary target. However, there are
differences in the clinical responses between the classes of opioids.
LIST OF OPIODS
Expanded list of opioid drugs:
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Codeine (only available in generic form)
Fentanyl (Actiq, Duragesic, Fentora, Abstral, Onsolis)
Hydrocodone (Hysingla, Zohydro ER)
Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
Hydromorphone (Dilaudid, Exalgo)
Meperidine (Demerol)
Methadone (Dolophine, Methadose)
Morphine (Kadian, MS Contin, Morphabond)
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Oxycodone (OxyContin, Oxaydo)
Oxycodone and acetaminophen (Percocet, Roxicet)
Oxycodone and naloxone
USE OF OPIOIDS
Opioids are often used as medicines because they contain chemicals that relax the body and
can relieve pain.
Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can
be used to treat coughing and diarrhea.
Misuse
Prescription opioids used for pain relief are
generally safe when taken for
a short time and when prescribed by a doctor.
However, they can be misused.
When misusing a prescription opioid, people
sometimes crush pills, open capsules, dissolve
the powder in water, and inject the liquid into a
vein. Some also snort the powder.
Addiction
Opioids can also make people feel very
relaxed and "high" - which is why they are
sometimes used for non-medical reasons. This
can be dangerous, because opioids can be
highly addictive, and overdoses and death are
common. Heroin is one of the world's most
dangerous opioids. However, it is rarely used
as a prescription medicine.
PATTERNS OF USE
Pattern
Medical prescriptions for opioids started to
increase sharply in the mid-to late 1990s.
Shortly thereafter, nonmedical opioid use also
started to increase markedly, reaching a peak
of 2.7 million new users in 2002.
Increase
The annual number of new nonmedical users
slowly declined to about 1.8 million in 2012,
but the overall pool of people continuing to use
nonmedically is very large.
From 1999 to 2011, hydrocodone use
increased more than two-fold, oxycodone use
more than five-fold.
REASONS FOR USE
Abuse
Prescription opioid abuse can occur for multiple reasons, including:
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Rise
Self-medication
Recreational highs
Compulsory habits, due to dependence or addiction
There are numerous factors underlying the rise of prescription opioid problems. A lot of it has to
do with how the drugs are viewed in wider society.
Non-medical prescription drug users are more likely to have positive expectations about the
effects of their using. However, many young users do not recognize the extent of the risks
associated with the use of opioids.
Examples
Young people may gain their understanding of prescription opioid use, by observing older
people taking pills. In addition, social media has expanded the scope of community connections,
allowing for substance-using teens to develop a network of like-minded peers.
Preferences
College students are reported to prefer prescription medications for the following reasons:
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For recreational highs, because they are easy to hide
They produce effects that last longer than other substances
It enhances the feeling of drunkenness
There are potentially less severe consequences if caught using them
CRISIS AND BURDEN
Crisis
Every day, more than 130 people in the United
States die from overdosing on opioid drugs.
The misuse of and addiction to opioids is
considered to be a national crisis in the US,
that affects public health and social and
economic welfare.
Burden
The Centers for Disease Control and
Prevention estimates that the total "economic
burden" of prescription opioid misuse is $78.5
billion per year.
This includes costs associated with
healthcare, lost productivity, addiction
treatment and the criminal justice system.
OPIOD MISUSE FACTS
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Roughly 21 to 29 percent of patients who are prescribed opioids for pain, end up
misusing them.
Between 8 and 12 percent of opioid users end up developing an opioid use "disorder".
An estimated 4 to 6 percent of people who misuse prescription opioids, go on to use the
illegal drug heroin.
About 80 percent of people who use heroin, began by misusing prescription opioids.
Opioid overdoses increased by 30 percent from July 2016 to September 2017 in 45 US
states.
EPIDEMIC WAVES
First Wave
The so-called "opioid epidemic" appears to have occurred in three waves. The first wave began
in 1991, when deaths involving opioids began to rise following a sharp increase in
the prescribing of opioid drugs.
Communities where opioids were readily available and prescribed liberally, were the first places
to experience increased opioid abuse and "diversion".
Diversion: Diversion is the practice where a medicine legally prescribed to an individual, end up
in the hands of another person illegally.
Second Wave
The second wave of the opioid epidemic began in 2010, when there was a rapid increase in
deaths from heroin use. Because there were efforts to decrease the prescribing of opioids after
the first wave of problems, people then turned to heroin.
Deaths due to heroin overdose increased by 286% from 2002 to 2013. Approximately 80% of
heroin users admitted to misusing prescription opioids before they started using heroin.
Third Wave
The third wave of the opioid epidemic began in 2013 with an increase in deaths related to the
use of synthetic opioids, such as fentanyl.
The sharpest rise in drug-related deaths occurred in 2016 when there were over 20,000 deaths
from the use of fentanyl and related drugs. This increase in fentanyl-related deaths has been
linked to illegally manufactured fentanyl.
MARKET AND PRODUCTS
The global opioids market was valued at USD 22.96 billion in 2016 and is projected to expand
(see chart below).
The increasing occurrence of diseases that cause chronic pain, such as cancer, lower back
pain, postsurgical pain, arthritis and fibromyalgia, is driving growth.
The opioids market is categorized into immediate-release and extended-release products (see
next page for a list of products). Extended-release was the largest segment in 2016 and is
expected to be the fastest growing segment in the future. This is owing to the development of
innovative dose dispensers, such as transdermal patches.
OPIOD PRODUCTS
Immediate-Release/Short-Acting Opioids
 Codeine
 Oxycodone
 Hydrocodone
 Fentanyl
 Morphine
 Hydroxymorphone
 Oxymorphone
 Propoxyphene
Extended-Release/Long-Acting Opioids
 Oxycodone
 Hydrocodone
 Methadone
 Fentanyl
 Morphine
 Oxymorphone
 Tapentadol
 Buprenorphine
 Hydromorphone
GROWTH AND SEGMENTS
Growth
Increasing usage of opioids for non-cancer
conditions and in palliative care is
promoting market growth.
Along with analgesic use, they are widely used
as an antidiarrheal medicine and as a
cough suppressant. Their use in anesthetics is
also increasing their market value.
GLOBAL MARKETS
North America
Segments
The global market for opioids
is segmented into pain relief, anesthesia,
cough suppression, diarrhea suppression and
deaddiction (see chart below).
In 2016, the pain relief segment dominated
the market, mainly due to the high usage of
opioids in pain-management therapies.
North America is leading the market in opioids, with a share of over 56.0%. One of the major
reasons for its dominance, is the rising geriatric population, with terminal conditions such as
rheumatoid arthritis.
The market is strictly regulated by the FDA, due to the substantial number of deaths from drug
abuse. The FDA has released guidelines for the manufacturing, marketing, storage and sales of
opioid products.
Asia-Pacific
Asia Pacific is expected to witness fast growth in opioid sales in the coming years, owing to
their rising geriatric population and an increasing focus on palliative care.
In addition, the need for improved infrastructure and the rise in healthcare expenditure, is
expected to drive the market further.
KEY MARKET PLAYERS
Some of the key players and manufacturers in the market are listed below. Key players are
focusing on expanding their business globally, to increase market share. For example, Purdue
Pharma is making inroads in Asia, Latin America, the Middle East and Africa.
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Purdue Pharma L.P.
West-Ward Pharmaceuticals Corporation
Allergan
Pfizer Inc.
Janssen Pharmaceuticals Inc.
Egalet Corporation
Sun Pharmaceutical Industries Limited.
MARKETING STUDY
A recent study by the Boston Medical Center's Grayken Center for Addiction, claims
that aggressive marketing by pharmaceutical companies to doctors, is a direct cause of the
ongoing opioid abuse epidemic in the US.
Analysis from the study showed that opioid use increased in places where drug makers
focused their marketing efforts. In addition, drug companies did not need to spend lavishly in
order to have an effect on opioid prescribing.
According to the findings, they gained as much influence after buying meals for doctors, as by
paying big cash for speaking and consultation fees.
DEATHS AND PAYMENTS
Correlations
The Grayken Center study found that opioid overdose deaths grew by 18 percent with every
three marketing payments that were made to physicians. In addition, sales reps downplayed the
risks of addiction and overdose from opioids.
The director of policy analysis and research at the Center, Linda Richter, said policymakers and
health regulators should prohibit licensed health professionals from accepting payments and
incentives from the industry.
Comparisons
The U.S. opioid addiction crisis continues. Abuse of the drugs led to approximately 50,000
overdose deaths in 2017, according to the Centers for Disease Control (CDC).
And according to the National Safety Council, Americans are more likely to die from opioid
overdose than from the following causes:
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Car/motorcycle crash
Falls
Drowning
Choking on food
FIGURES AND FINDINGS
Figures
Pharma companies spent $39.7 million
marketing opioid medications to 67,507
doctors across 2,208 counties in the United
States, between August 2013 and December
2015, according to the Grayken study.
There were 434,754 payments in total. One in
twelve U.S. physicians received marketing.
The proportion was higher for family
physicians, where one in five received
marketing for opioid products.
Findings
The findings of the study suggest that directto-physician opioid marketing runs counter to
national efforts to reduce overdose deaths and
that policymakers should consider limits on
marketing, as part of a serious response to the
opioid crisis.
It also found that heroin and non-prescribed
fentanyl are more commonly involved in U.S.
overdose deaths than prescription opioids.
However, prescription opioids are involved in
about one-third of opioid overdose deaths.
Effects, Treatment, and Recovery
RECOVERY STRATEGIES
Policy
Policymakers, the criminal justice system and
public health officials have begun to recognize
that a holistic, multi-faceted approach is
required in order to help people
to recover from Substance Abuse
Disorders (SUDs) and prevent people from
MLPs
Legal services can be delivered, as part of a
medical-legal partnership (MLP), where
lawyers are present in clinical settings and can
address patients’ legal problems.
becoming addicted in the future.
LEGAL SERVICES AND RECOVERY
Components of Recovery
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the United
States, has identified four evidence-based areas that are crucial to managing life in recovery:
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HEALTH
HOME
PURPOSE
COMMUNITY
This involves a full range of medical, social and legal services.
Legal Services
Legal services help individuals to address issues and barriers to the components necessary
for their recovery.
Legal services address the unmet social needs of patients, that would otherwise not be
addressed in clinical settings and that have a direct impact on health outcomes.
PRACTICAL BENEFITS
Legal Issues
Legal issues involved in
substance abuse recovery
include:
 Providing/increasing
recovery capital
 Organizing care and
custody issues for
children
 Ensuring people are
legally able to work
 Enforcing workplace
rights
 Preventing housing
evictions
Example
The Helping Opiate-addicted
Pregnant women Evolve
(HOPE) program,
in Cincinnati, Ohio connects
with more than 500 pregnant
women with opioidrelated SUDs annually. Many
of these women have legal
needs related to custody,
homelessness, domestic
violence, sex trafficking,
enslavement and access to
public benefits.
"These women have two
main goals...", says Dr.
Michael Marcotte, Medical
Director for the program "...sobriety and parenting and
these goals are intertwined."
Their legal needs can directly
and indirectly interfere with
Benefit
Individuals with SUDs have a
high correlation of
involvement with the criminal
justice system, that has made
many of them distrust lawyers
and the legal system
generally.
Being referred for legal
services through a health
care provider can help clients
trust these services, because
they already have a trusting
relationship with their health
care provider.
Additionally, many people do
not know their legal rights or
understand that a problem
they are facing may have
a legal solution. Solving
legal issues for clients can be
the stability and support
needed to pursue these
goals.
an important step in the
process of their recovery from
opioid misuse and addiction.
LAWSUITS AND ARGUMENTS
Lawsuits
Summer 2018 saw over
600 lawsuits confronting the U.S. opioid
epidemic.
Plaintiffs alleged that for over two decades,
drug makers have widely advertised their
opioid products as virtually non-addictive.
Arguments
Plaintiffs in the aforementioned lawsuits also
claimed that drug makers exaggerated the
advantages of opioids and glossed over the
chances of addiction that these drugs can
cause.
Companies named in the suits included:
Johnson & Johnson, Purdue Pharma and
Ohio’s Cardinal Health.
The drug manufacturers on the other hand,
contended that medications such as
Oxycontin®, have been cleared by the U.S.
Food and Drug Administration (FDA) and have
genuine medicinal value.
CASES AND JUDGEMENTS
Settlements
Two pharmaceutical companies reached settlements in August 2019 totaling $15 million. Dublin,
Ireland-based Endo Pharmaceuticals said it has agreed to pay the Ohio counties of Cuyahoga
and Summit, home to Cleveland and Akron, a total of $10 million to settle their lawsuits, which
are scheduled to go to trial against other drug makers and distributors in Oct. 21. Allergan, also
based in Dublin, agreed to pay $5 million to settle claims related to its branded opioid.
Ruling
In August 2019, U.S. District Judge Dan Polster, of the Northern District of Ohio, who is
overseeing most of the opioid lawsuits, ruled that drug manufacturers and distributors had a
legal obligation not to ship opioid orders that were considered suspicious. The companies had
argued there was a legal requirement to report suspicious orders, but not to stop from shipping
them.
Polster denied an additional request from the Ohio counties to rule before trial that defendants
did not comply with the requirement, saying there were factual disputes about that. His
ruling could be a major win for plaintiffs, particularly in their cases against distribution
companies and the big generic drug makers.
Oklahoma
An Oklahoma judge has found Johnson & Johnson and its subsidiaries helped fuel the state's
opioid drug crisis and ordered the consumer products giant to pay $572 million to help address
the problem. This marks the first time an opioid manufacturer has been deemed responsible in
court and made to pay damages. It could have implications for the slew of lawsuits filed against
opioid manufacturers and distributors throughout the country.
The financial implications of the $572 million judgment against Johnson & Johnson could extend
beyond Oklahoma, according to Tom Claps, a legal analyst with Susquehanna Financial Group.
Claps wrote that the Oklahoma settlement suggests future damages could total $37 billion to
abate the opioid crisis across the entire country.
PAIN MANAGEMENT
Opioids are a powerful class of drugs used for the treatment of pain. They are used by
healthcare providers to relieve pain that cannot be treated with other types of drugs.
Opioids are a type of analgesic drug that contain natural or synthetic chemicals based
on morphine, the active component of opium.
Opioids include illicit drugs, such as heroin. However, these are not generally used to treat pain.
USES AND SIDE EFFECTS
Varieties
Common opioids include heroin and synthetic (narcotic) medications such as oxycodone,
buprenorphine, morphine, codeine, methadone and fentanyl.
Opioids are the most commonly prescribed pain-relievers, because of their effectiveness.
Uses
Morphine is frequently prescribed to alleviate severe pain after surgery.
Fentanyl is also prescribed for this purpose.
Diphenoxylate or Lomotil is used to relieve severe diarrhea.
Codeine is used to ease severe coughs.
Side Effects
Common side effects of opioids include constipation, sleepiness, nausea, vomiting, clouded
thinking, respiratory problems and sexual dysfunction.
Some side effects can be minimized by adjusting the time doses are taken, for example after a
meal or at bedtime. Constipation can be lessened by drinking fluids, eating foods that are high
in fibre, or by taking a laxative.
PHYSIOLOGY
Receptors
Opioids contain chemicals that bind
to receptors in the brain and body that mimic
pain-relieving chemicals that the body
produces naturally. Endorphins, also called
endogenous or "natural opioids", are
responsible for eliminating minor pain.
Strength
Opioids, such as morphine and oxycodone,
are typically prescribed to people recovering
from major surgery or those who have been
seriously injured. In these situations, the
natural endorphins in the body are not strong
enough to combat the pain.
For example, when a person hits their elbow
on a doorframe it may hurt briefly, but the
brain immediately signals the release of
endorphins to counteract the pain. Once the
chemicals from the opioid attach to the body's
receptors, the pain signals are blocked.
Methods
Opioids can be taken orally by pill. They can also be taken through patches on the skin or
intravenously through the bloodstream.
BIOLOGICAL PROCESSES
Biology
When opioids are taken, a
series of events take place:
 The opioid molecules
bind to receptors,
which are located at
the end of nerves
throughout the body,
including the brain and
the spinal cord.
 The receptors are
activated and either
suppress or prompt a
reaction. In most
cases, opioids will
suppress pain signals
from being transmitted.
 Effects on receptors
are also responsible
for side effects, such
as respiratory
depression and
constipation.
Processes
Certain neurological
processes will occur in the
brain for everyone taking an
opioid, regardless of genetic,
environmental and social
factors:
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There is an increase in
dopamine production
in the limbic reward
system.
The brain
"remembers"
rewarding
experiences, making
them easier to repeat.
This mechanism
results in the formation
of habits and
reinforces the
connection between
taking an opioid and
the pleasurable feeling
associated with it.
Euphoria
Dopamine is often responsible
for the euphoric feeling many
people receive from
the recreational use of opioids.
Dopamine is also responsible
for encouraging the brain to
repeat "rewarding behavior".
However, the misuse of opioids
can lead to abuse and
addiction.
ADDICTON AND DISEASE
Numbers
In 2014:
- 4.3 million Americans were reportedly using
prescription opioids for non-medical reasons.
- 435,000 Americans aged 12 and older were
reportedly using heroin.
Chronic Disease
Addiction is a chronic disease. Like diabetes
and heart disease, there is no cure. However,
addiction can be managed and people with
addictions can and do recover.
BEGINNING RECOVERY
Effects & Assessment
Besides harming a person’s health, addiction changes how someone thinks and feels. This may
last a long time, leading to harmful actions and difficult relationships. Without treatment and
recovery, addiction will keep getting worse.
Seeking help is the first step to recovery. The next step is to meet with a qualified clinician. The
clinician will review or assess how someone is doing. This first meeting is called an assessment.
Treatment Plan
The goal of assessment is to gain a thorough understanding of the patient, which will help the
clinician and the patient to develop a suitable treatment plan.
The clinician will ask questions to understand almost every part of the patient’s life. Common
assessment questions include:
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How long has the person been using drugs?
What other medications are being taken, if any?
Are there additional social or financial needs?
Is there a family history of addiction?
Are there other mental or chronic health problems?
Clinician: A clinician is a health professional, such as a physician, psychiatrist, psychologist, or
nurse.
EXAM AND TREATMENT OPTIONS
Physical Exam
The next step in the treatment
plan process, is to complete a
thorough physical
examination to check the
patient’s overall health. This
includes finding any
conditions (physical or mental)
which may change how the
Treatment Options
After the assessment, the
clinician will
discuss treatment
options with the patient.
Every patient's situation is
different, so choosing the best
option is a shared decision
between the patient and the
Setting
Treatment can occur in
different settings, depending
on the medication being used
and the patient’s particular
situation.
Four broad treatment settings
can be considered:
patient is treated
and identifying any traces
of drugs already in the
patient's system.
clinician.
There are three main choices
for medication to treat opioid
addiction (details page #8):
1. Methadone
2. Buprenorphine
3. Naltrexone
1. Outpatient
2. Intensive outpatient or
partial hospitalization
3. Residential addiction
treatment
4. Hospital setting
These medications are used
alongside counseling and
other supports.
Drug Testing
The most commonly used drug test to test for the presence of drugs in the patient's system,
uses the patient’s urine and is called a 'Urine Analysis'.
AGREEMENT AND EXPECTATIONS
Agreement
After discussing the assessment and
treatment choices, it is common for the patient
and clinician to sign an agreement about what
to expect during treatment. This can include:
 Treatment goals
 Which medications are used
 Treatment schedule
 Counseling plan
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Expectations
Patient commitment to cooperate with
the treatment is essential.
Risks of relapse and other safety
concerns must be discussed.
Treatment will be ongoing, as addiction
is a chronic disease.
TRANSPARENCY AND RESPONSIBILITY
Transparency
A patient should expect to be treated with respect and dignity and have their concerns listened
to when starting or changing a treatment plan.
To avoid health problems, patients must share with clinicians any medications they are taking in
addition to those in the treatment plan and/or if they drink alcohol regularly.
This is important, as taking certain medications and alcohol at the same time, can cause
problems.
Responsibility
Common patient responsibilities include:
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Keeping appointments
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Agreeing to drug testing on a regular basis
Taking the medications as prescribed
Using only drugs that are prescribed
Allowing and encouraging involvement of family and friends
Avoiding persons, places and situations that may cause a person to use a substance
again
COUNSELING
Counseling is an important part of treatment and is usually a requirement in formal programmes.
Counseling helps patients to address personal, social and other issues that may contribute to
their substance abuse/addiction.
Examples of issues explored in counseling:
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Improving feelings of self-worth
Addressing difficult situations at work or at home
The problem of spending time with people who are using drugs or alcohol
OPIOD WITHDRAWAL
Opioid withdrawal refers to a wide range of symptoms that can occur after stopping the use of
opioid drugs. Withdrawal can last up to 10 days, but most often occurs between 3-5 days.
Although it can cause very troubling symptoms such as vomiting, cramps and sweating,
withdrawal is rarely life-threatening.
Using medications to control withdrawal (withdrawal management) is almost always
recommended, rather than trying to quit “cold turkey.” When patients try to quit “cold turkey,” it
can lead to stronger cravings and continued use.
MEDICATIONS
Methadone
Methadone is an
opioid, used to reduce
the desire to use
other problem drugs.
The patient taking
methadone feels
normal not "high", and
withdrawal symptoms
do not
occur. Methadone can
also reduce cravings.
Methadone comes in
pill, liquid or wafer
Buprenorphine
Buprenorphine acts
to reduce the desire
to use problem drugs.
It also helps the
patient to
avoid withdrawal
symptoms and
reduces cravings.
Buprenorphine comes
in tablet form.
Patients should wait
until they are
experiencing mild to
moderate opioid
Naltrexone
Naltrexone works by
blocking opioids from
acting on the brain. It
takes away the ability
to get "high" from
using opioids. This
makes naltrexone a
good option for
preventing relapse.
However, it may not
stop all drug cravings.
A person cannot have
any opioids in their
body when starting
Naloxone
Naloxone is used to
treat opioid overdose.
It can be injected or
sprayed in the nose.
Naloxone only works
for opioids. It may
need to be given
more than once for an
opioid overdose,
since its effects may
wear off before the
opioid does.
form. It is usually
taken once per day,
but over time dosage
may change. People
who are in stable
recovery may be
provided a supply of
the medication to take
at home.
withdrawal, before
taking the first dose of
buprenorphine. This
medication is usually
taken once per day.
naltrexone. If a
person does,
withdrawal may be
very strong.
Before a clinician
starts a patient on
naltrexone, the patient
must go through
withdrawal under
supervision, which
lasts between 7-10
days. Naltrexone
comes in pill form and
in extended release
form, by injection in
the buttocks.
OVERDOSE INCREASE
The National Center for Health Statistics, at the Centers for Disease Control and Prevention in
the United States, collects information on fatalities as a result of commonly used drugs. The
CDC also has a searchable database, called CDC Wonder.
More than 70,200 Americans died from drug overdoses in 2017, including illicit drugs and
prescription opioids. This represents a twofold increase in a decade.
Among the more than 70,200 drug overdose deaths estimated in 2017, the sharpest increase
occurred among deaths related to fentanyl and other synthetic narcotics, where there were
more than 28,400 overdose deaths (Source: CDC WONDER).
FATALITIES – ALL OPIODS
The chart below shows the total number of U.S. overdose deaths involving all opioids from
1999 to 2017. This includes heroin, methadone and other synthetic narcotics (mainly fentanyl).
Drug overdose deaths rose from 8,048 in 1999 to 47,600 in 2017. Overall, there were a higher
number of drug overdose deaths among males.
FATALITIES – PRESCRIBED OPIOIDS
The chart below shows the total number of U.S. overdose deaths involving prescription opioids,
from 1999 to 2017. Drug overdose deaths involving prescription opioids rose from 3,442 in 1999
to 17,029 in 2017.
FATALITIES – HEROIN RELATED
FATALITIES – PSYCHOSTIMULANTS RELATED
The chart below shows the total number of U.S. overdose deaths involving psychostimulants,
from 1999 to 2017. Drug overdose deaths rose from 547 in 1999 to 10,333 in 2017. The number
of deaths involving the combination of psychostimulants with any opioid, has been increasing
steadily since 2014.
FATALITIES – COCAINE RELATED
SUMMARY AND CONCLUSION
All Opioids
Drug overdose deaths
involving any opioid,
including synthetic prescription
opioids rose from 18,515
deaths in 2007 to 47,600
deaths in 2017. 68% of deaths
occurred among males.
From 2016 to 2017, the
number of deaths involving
prescription opioids remained
unchanged.
Combination
Overdose deaths involving
heroin, psychostimulants or
cocaine rose in 2017. Deaths
involving heroin and cocaine
were driven by deaths
involving the combination of
these drugs with
synthetic opioids.
Conclusion
Clearly the use of illegal and
prescription opioids, in
combination with other
substances, has resulted in a
sharp increase in the number
of drug overdose fatalities in
the United States over the
past 20 years.
PROJECTIONS AND CAMPAIGN
Study
A study from investigators at the
Massachusetts General Hospital (MGH)
Institute for Technology Assessment, projects
that the opioid overdose epidemic in the U.S.
is likely to increase in the coming years.
Illicit Drugs
The report published in JAMA Network Open,
notes that the nature of the opioid epidemic is
changing. It is now driven by the use of illicit
opioids such as heroin and fentanyl. Thus,
the potential impact of programs targeting
prescription opioids is reduced.
Measures based on restricting access to
prescription opioids will have a minimal impact
in reducing overdose deaths, it is claimed.
FENTANYL AND PROJECTIONS
Fentanyl
Jagpreet Chhatwal, PhD, of the MGH Institute for Technology Assessment (MGH-ITA)
and author in the aforementioned report said:
"In the past five years, deaths have accelerated with the introduction of the powerful synthetic
opioid fentanyl into the opioid supply, leading to a continuing increase in overdose deaths at a
time when the supply of prescription opioids is decreasing."
Projections
Chhatwal's team used data from sources such as the National Survey on Drug Use and Health
and the Centers for Disease Control and Prevention, to develop an Opioid Policy Model. They
then used that model to make projections for probable outcomes up to 2025.
TREND AND INITIATIVES
Fatalities
Under a status quo scenario,
the opioid policy model
projects that the annual
number of opioid overdose
deaths will increase from
33,100 in 2015 (when the data
began) to 81,700 in 2025.
This represents a 147 percent
increase.
The model also predicts that
approximately 700,000 people
will die from opioid overdose,
with 80 percent of these from
illicit drugs such as heroin and
fentanyl.
Illicit Drugs
Researchers estimate that by
2025, half of all new opioid
users will begin
with illicit drugs, rather than
prescription drugs. In the
scenarios tested, interventions
directed towards reducing the
misuse of prescription opioids,
would only decrease overall
overdose deaths by 3 to 5
percent.
Initiatives
Co-author of the study, Marc
Larochelle, MD, MPH, of the
Grayken Center for Addiction
at Boston Medical Center
said:
"This study demonstrates that
initiatives focused on the
prescription opioid supply
are insufficient to bend the
curve of opioid overdose
deaths in the short and
medium term. We need policy,
public health and health care
delivery efforts to amplify
harm reduction efforts and
access to evidence-based
treatment."
INITIATIVE
AAOA
Allied Against Opioid Abuse (AAOA) is a
national education and awareness initiative in
the United States, that helps to prevent the
abuse and misuse of prescription opioids.
Collaborative
The AAOA initiative is a collaborative effort. It
includes diverse partners from across the
pharmaceutical supply chain as well as
organizations that are experts in healthcare
and public health.
Their goal is to contribute to solving the opioid
crisis in a meaningful way, by educating
patients about the rights, risks and
responsibilities associated with prescription
opioids.
RESOURCES AND SUBSCRIPTION
Resources
AAOA provides facts, information and resources concerning the Opioid Abuse Epidemic,
including references to organizations such as the Centers for Disease Control and Prevention
and the National Survey on Drug Use and Health (SAMHSA).
In the video on the NEXT slide, healthcare professionals and patients discuss alternatives to
opioids for pain management.
Subscription
You can subscribe to the Allied Against Opioid Abuse (AAOA) mailing list, to learn more about
the campaign and to receive regular updates. Their website features surveys and reports on
issues such as the need for better consumer education, alternative pain treatments and
managing prescriptions safely.
For more information and to get involved, visit: https://againstopioidabuse.org/
LESSON SUMMARY
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Policymakers, the criminal justice system and public health officials have begun to
recognize that a holistic, multi-facited approach is required in order to help people to
recover from Substance Abuse Disorders (SUDs) and prevent people from becoming
addicted in the future.
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the
United States, has identified four evidence-based areas that are crucial to managing life
in recovery: Health, Home, Purpose and Community.
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Legal services help individuals to address issues and barriers to the components
necessary for recovery.
Individuals with SUDs have a high correlation of involvement with the criminal justice
system.
Summer 2018 saw over 600 lawsuits confronting the U.S. opioid epidemic, namely drug
makers and suppliers.
Federal court cases are being likened to a 1998 ruling against tobacco companies, that
gave a total of $206 billion to forty-eight states.
Opioids are a type of analgesic drug that contain natural or synthetic chemicals based
on morphine, the active component of opium. They are used by healthcare providers to
relieve pain that cannot be treated with other types of drugs.
Opioids include illicit drugs, such as heroin.
Common side effects of opioids include constipation, sleepiness, nausea, vomiting and
respiratory problems.
Opioids contain chemicals that bind to receptors in the brain and body, that mimic painrelieving chemicals that the body produces naturally.
Opioids can be taken orally in tablet form, through patches on the skin or intravenously.
Dopamine is responsible for the euphoric feeling many people receive from the
recreational use of opioids.
In 2014, 4.3 million people reportedly used prescription opioids for non-medical reasons.
Addiction is a chronic disease, but recovery is possible through appropriate treatment.
More than 70,200 Americans died from drug overdoses in 2017, including illicit drugs
and prescription opioids.
Among the more than 70,200 drug overdose deaths estimated in 2017, the sharpest
increase occurred among deaths related to fentanyl and other synthetic narcotics.
A study from investigators at the Massachusetts General Hospital (MGH) Institute for
Technology Assessment, projects that the opioid overdose epidemic in the U.S. is likely
to increase in the coming years.
Initiatives focused on the prescription opioid supply are insufficient to bend the curve of
opioid overdose deaths, as they do not sufficiently address the proportional use of illicit
opioid use.
Allied Against Opioid Abuse (AAOA) is a national education and awareness initiative in
the United States, that helps to prevent the abuse and misuse of opioids.