An Epidemic Hiding in Plain Sight
The world watches with great apprehension the spread of two deadly communicable diseases: Ebola and MERS. There is no denying that the lethality of these viruses is appropriately frightening. There is something terrifying about mankind’s inability to counter these viruses and the deadly consequences thereof. Yet, the number of deaths from these two scourges is insignificant when compared to a growing, silent epidemic of death across the United States.
The current outbreak of Ebola in West Africa has resulted in 467 deaths. The global toll from MERS is now 282. This represents a combined total of 749 lives lost. By comparison, 677 people died of heroin related caused in 2013 in Maryland and Virginia.
This is not, however, another tired “war on drugs” analysis; for while heroin related deaths are a growing tragedy, they are also a symptom of a deeper crisis.
Approximately two years ago, an historic fact emerged. For the first time, deaths from prescription painkillers [opioid or narcotic pain relievers, including drugs such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone]
surpassed those from illicit “street drugs;” heroin and cocaine combined. This has been driven in large part by nonmedical use of prescription painkillers—using drugs without a prescription, or using drugs just for the "high" they cause. According to the CDC, in 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year. In fact, “enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month. Although most of these pills were prescribed for a medical purpose, many ended up in the hands of people who misused or abused them.” (CDC)
There is a seductive logic to abusing prescription drugs. Users will tell you they are safe, after all “they were prescribed by a doctor.” High profile celebrities entering “rehab” for prescription drug abuse seem distant from the reality of here and now. There is, however, another pressing reality: the cost of prescription drugs. Prescription painkillers are expensive, whether in the pharmacy or on the block market. Heroin offers a far less expensive opioid alternative. Consequently, heroin abuse has moved from the inner city and backstage to suburbia, school, office, and workshop.
And deaths due to overdoses have doubled from 2011 to 2013. This dramatic jump in the number of deaths is largely attributed to heroin spiked with non-prescription fentanyl, an opioid analgesic (painkiller). The death in February of Philip Seymour Hoffman in New York was such a case.
These deaths do not occur on the periphery of society. Media reports of otherwise healthy 20-something men and women overdosing on heroin are now common. Prescription painkiller deaths are mainstream event – if largely unnoticed. Middle-aged adults have the highest prescription painkiller overdose rates. The number of deaths due to prescription drug and heroin overdoses is greater than that attributable to vehicle accidents. Long relegated to the inner city, this is impacting the middle class and the affluent as well.
Cautious prescribing, strict adherence to physician orders, and disposal of unused medications can limit access to prescription painkillers. So, too, can awareness. Understanding the absolutely seductive nature of abuse – these substances mimic the effect of endorphins that produces the body’s “natural high” – is a first step. Still, no addict ever sets out to become addicted. Individual awareness must be augmented by community involvement and adoption of sound policy.
The Trust for America’s Health recommends the following to help stem this growing epidemic.
Ensure responsible prescribing practices, including increasing education of healthcare providers and prescribers to better understand how medications can be misused and to identify patients in need of treatment;
Increase understanding about safe storage of medication and proper disposal of unused medications, such as through "take back" programs;
Make sure patients do receive the pain and other medications they need, and that patients have access to safe and effective drugs;
Improve, modernize and fully-fund Prescription Drug Monitoring Programs, so they are real-time, interstate and incorporated into Electronic Health Records, to quickly identify patients in need of treatment and connect them with appropriate care and identify doctor shoppers and problem prescribers;
Make rescue medications more widely available by increasing access for at-risk individuals to naloxone and provide immunity for individuals and others seeking help; and
Expand access to and availability of effective treatment options as a key component of any strategy to combat prescription drug abuse.