America's Addiction to Pain Killers

More Americans die from overdoses of pain killers than are killed in auto accidents or murdered by guns.  While lawmakers and activists are demanding action to reduce the carnage on the highways and on the streets, there is little outcry to deal with the rampant rise in opioid-related deaths.

There has been scant media coverage of the escalation of both the legal and illegal opioid use by Americans.  The number of legal prescriptions for opioids has skyrocketed from 76 million in 1991 to nearly 207 million in 2013, according to Congressional testimony.

Opioids are a class of drugs that include well-known prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine and fentanyl.  You might recognize the drug brand names: Vicodin, OxyContin and Percocet.  The illicit drug heroin is also an opioid.

These drugs work on the nerve cells in the brain and nervous system to produce euphoric effects and to relieve pain. When used properly, opioids help the more than 100 million people in the United States who suffer from chronic pain.

Despite the legitimate uses, opioids are often diverted for non-medical uses by patients or their friends.  In many cases, the drugs are sold on the street.  It has been estimated that non-medical use of opioid pain relievers costs insurance companies up to $72.5 billion annually.

In 2012, more than five percent of the U.S. population over the age of 12 used an opioid pain reliever for non-medical purposes.  "The public health consequences of opioid pain reliever use are broad and disturbing," testified Dr. Nora D. Volkow, M.D., to a Senate caucus in 2014.

Doctor Volkow is director of the National Institute of Drug Abuse at the National Institute of Health. She has been sounding the alarm about the increasing worldwide problem of opioid abuse, which affects nearly 36 million people across the planet.

Drug overdose is now the leading cause of accidental death in the U.S. There were 47,055 deaths in 2014.  The most recent statistics shows gun deaths in 2015 were 13,419.  Automobile accidents killed 38,300 people last year.  Why is there no outrage over the drug overdose epidemic?

The answer to that question underscores the problem with dealing with abuse.  Over the past 20 years, laws governing the dispensing of opioid prescriptions have been relaxed.  That has led to more doctors writing scripts for the drugs to patients who often demand the pills for minor pain.

Drug companies are also complicit, aggressively marketing the the safe use of pain killers.  However, there have been no studies on the longer-term affects of usage. Despite the lack of evidence, pain killers are often viewed as benign by both doctors and patients.  

The American Society of Addiction Medicine reports growing evidence of a relationship between non-medical usage of opioids and heroin abuse. It estimates that 23 percent of individuals who use heroin develop an opioid addiction. Four out of five new heroin users were first hooked on opioids.

The Center for Disease Control and Prevention found that women more often than men become addicted to pain killers because they are more likely to have chronic pain.  Studies show doctors often prescribe higher doses over longer periods of time to address the continuing symptoms.

In a 10 year period ending in 2010, 48,000 women died of prescription pain reliever overdoses, the center found in its ground breaking study entitled, "Prescription Painkiller Overdoses: A Growing Epidemic, Especially Among Women."

Urgent action is required to address this issue.  Opioid addiction is the main driver of the staggering rise in drug overdose deaths in the U.S.  In 2014, there were 18,893 overdose fatalities related to prescription pain killers.  That is 40 percent of all deaths caused by drug overdoses.

Even more disturbing, abuse by adolescents (ages 12 to 17 years old) has spiraled out of control.  A study by the Substance Abuse and Mental Health Services Administration documented that 168,000 adolescents are addicted to prescription pain relievers.  Many graduate from opioids to heroin.

The problem will only worsen without a declaration of war on opioid usage.  

Prevention of opioid abuse begins with education.  Although these drugs can be effective in reducing pain, primary care doctors and patients need to armed with more information about the dangers associated with continued use and the linkage to heroin abuse.

Other solutions include more research on the treatment of pain without the use of opioids.  More clinical studies are required to develop new drugs and compounds that do not have the same risks as opioids for dependence.  Prescribing opioids should be a last resort, not the first treatment option.

Lastly, treatment of opioid addiction remains in the infant stages.  More research should be undertaken to help patients deal with withdrawal symptoms and to regain control of their health. New medications need to be introduced as an essential part of weaning patients from opioids.

Dealing with opioid abuse must become a national priority.  If not now, when?  How many deaths will it take to awaken Americans to the problem?  Whatever the number, it is too high.  With so many lives at stake, further delay is unacceptable.