It's the medical elephant of the century. Sometime around 8 years ago, headlines surrounding opioid abuse infiltrated newspapers and social media alike. We were raided by large images of heroin, and we gasped at the towering overdose death count. You know at least one person who died. 2019 is right around the corner: was 2018 a good or bad year for the Opioid Crisis?
The Numbers
As of right now, the CDC has only published national overdose fatality tolls for 2018 up to the month of May. From what I can see from the data, overdose deaths in the United States ride around 70,000 a year, which is a significant increase from pre-2017 years. I'm actually a little disappointed that most of these statistics from official government sources show "drug overdose fatalities" and not "opioid overdose fatalities," but I understand it is difficult number to ascertain. It appears that over two-thirds of all drug overdose deaths are related to opioids. If the 2018 statistics follow those of recent years, the following trends will be apparent: overdose death rates for the 25-34 and 35-44 year old age brackets will match the overdose death rates from the 45-54 year old age bracket---the latter age bracket had predominated the overdose death rate since 2003. Additionally, Western states will have fewer drug overdoses than Eastern states, and males will account for significantly more overdose deaths over women--a gap we might see widened in 2018.
A solidified shift in drug of choice
People unfamiliar with the opioid epidemic may be shocked that public health officials are more worried about synthetic drugs, like fentanyl, over heroin and prescription opioid abuse. Synthetic opioid variants are more potent versions (50-100 times the strength of morphine!) of commonly known opioids. Thus, only trace amounts of fentanyls are needed for clinical purposes. A fentanyl abuser can easily overdose if the drug gets measured inaccurately, and fentanyl is commonly laced within heroin. Oh man. At the beginning of the millennium, fentanyl overdoses accounted for around 3,000 deaths. That's old news. Fentanyl was the culprit of over 28,000 deaths in 2017---a 45% increase in synthetic opioid related deaths in a year's span! I await the 2018 results, but this trend in particular is troublesome.
Legislation
Let's sink our teeth into a bill that was signed into law by President Donald Trump in October 2018.
The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. With only 9 members of Congress objecting, this landmark legislation allocates funds to federal and state agencies to make addiction treatment a priority, expand first responder access to overdose-reversal medications, clear more clinicians to prescribe medicine used in addiction treatment, limit opioid over-prescribing, heave hefty penalties for manufacturers and distributors that facilitate over-prescribing, raise drug enforcement at the border, among other measures. I think this is a step in the right direction, mainly because there are glimpses inside this bill that suggests the government believes addiction is a disease.
Many experts agree that the opioid epidemic is hands-down deserving of a massive multi-year effort worth over $100 billion. Let's react to this epidemic the way--maybe in an even bigger way--the federal government attacked HIV/AIDS. We need to research and go very, very local to the communities that are hit the hardest by this problem. This has been an issue for years; we should have enough data by now to start honing in on where specifically the funds need to be allocated. Send caseworkers out to these areas, go to community centers, knock on doors. Find out what social determinants are linking a population to addiction. Go to prisons and ask to sit in on patient encounters. How are the interactions between medical staff and inmates? Do inmates have access to addiction treatments? Do doctors, regardless of sector, have enough time to investigate a patient's addiction behaviors?
These are the questions we need to answer. When the complete overdose numbers come out for 2018, we are not going to be happy. Let's create some clear, public benchmarks that we would like to see in terms of our progress for treating this national issue. What would we like to see on a national level by February, March, and so forth? Transparency and energy can be the keys to success here: make this a national campaign that will turn heads from coast-to-coast. Make people with addictions feel like they are part of something bigger than themselves. If we wait until the end of 2019 to adapt our strategy, we will have failed the country once again.
Sources:
Katz, Josh, and Margot Sanger-katz. “'The Numbers Are So Staggering.' Overdose Deaths Set a Record Last Year.” The New York Times, The New York Times, 29 Nov. 2018, www.nytimes.com/interactive/2018/11/29/upshot/fentanyl-drug-overdose-deaths.html. Lopez, German. “Trump Just Signed a Bipartisan Bill to Confront the Opioid Epidemic.” Vox.com, Vox Media, 24 Oct. 2018, www.vox.com/policy-and-politics/2018/9/28/17913938/trump-opioid-epidemic-congress-support-act-bill-law. “National Center for Health Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Dec. 2018, www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Sotomayor, Marianna. “Trump Signs Sweeping Opioid Bill with Vow to End 'Scourge' of Drug Addiction.” NBCNews.com, NBCUniversal News Group, www.nbcnews.com/politics/congress/trump-signs-sweeping-opioid-bill-vow-end-scourge-drug-addiction-n923976.
Ezra Guttmann is a medical student at the Touro College of Osteopathic. Posts on this blog are representative of Ezra's views only. There is no medical advice on this website.
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