Med Wreck: The Rising Opioid Epidemic

91 deaths daily in the U.S. alone

Any discussion of medication safety today must consider the rising epidemic of opioid abuse and deaths in the United States.  According to the Centers for Disease Control (CDC at CDC.gov), 91 Americans die every day from opioid overdose, a number that includes both heroin and prescription narcotics.

That is more than half a million people in the past 15 years. In fact, the rate of death from prescription opioids, like oxycodone, hydrocodone and methadone, has quadrupled since 1999.

Heroin Overdose is on the rise…

Heroin is illegal in the United States and is considered one of the most highly addictive opioids.  While injection is the most common route of use, users may also smoke or snort it.  They often use heroin alongside other drugs or alcohol.  This increases the risk of overdose and death.  In 2015, there were 12,989 reported deaths from heroin overdose.

Because of needle sharing, users have a high risk for serious viral or bacterial infections, such as HIV, hepatitis or bloodstream infections.

The U.S. Drug Enforcement Administration (DEA) reports a 400% increase in heroin seized at the southwest border of the United States.  Annual seizures have grown from 500 kg in 2000-2008 to almost 2,200 kg in 2013.  In addition to an increase in supply, the heroin has been a higher purity and lower price than in the prior decade.

Risks of Heroin Abuse

Three out of four new users of heroin report use of prior prescription opioids.  Most have used three or more other drugs, typically cocaine, marijuana and/or alcohol.  According to the CDC, people abusing other drugs have the greatest risks of abusing heroin as shown in the table below:

Table showing addiction risks between heroin and other drug addictions
Other gateway drugs to heroin addiction.

Other Risk Factors include:

  • People without insurance or enrolled in Medicaid
  • Non-Hispanic whites
  • Males
  • People living in large metropolitan areas
  • 18 to 25 year olds.

Fentanyl as a rising threat…

Fentanyl is a synthetic opioid pain reliever, typically used for anesthesia and for advanced cancer pain. It is 50 to 100 times more potent than morphine (the most common naturally occurring opiate). Like heroin, it is typically injected, though doctors prescribe it in transdermal (through the skin) patches and as lozenges.

While pharmaceutically produced fentanyl may be obtained, most overdoses and deaths from fentanyl are now linked to illegally produced forms.  Fentanyl is frequently mixed (without the user’s knowledge) with heroin and/or cocaine to increase its euphoric effect (the “high”).

According to the CDC (2015 statistics), fentanyl deaths increased 73% in one year and 264% from 2012 to 2015. Four states, West Virginia, Ohio, Maine and Virginia have seen the largest spike in fentanyl overdose deaths.

Prescription Pain Killers Remain the Largest Gateway

Out of the 91 Americans dying daily from opioid overdose, 40 (44%) are from prescription opioids (including use and misuse). In 2013, physicians wrote almost 250 million prescriptions for opioids, which amounts to a bottle for every adult American.  The most common prescription opioid deaths include:

  1. Methadone
  2. Oxycodone
  3. Hydrocodone

Opioids are intended for short term pain relief, or for amelioration of suffering from terminal events like cancer. There is little evidence to support opioid use for chronic pain syndromes. Despite this, there has been an increase in the use of these medications for chronic, non-cancer pain such as from arthritis or low back pain.

We have a huge opportunity in the U.S. to prevent opioid abuse and overdose through a more thoughtful use of narcotics and awareness of the problem.

But there is more to be done…

Learn more about how we could improve medication safety in the U.S.  Download the free e-Book: Med Wreck: A Proposal for Overcoming the Nightmare of Medication Reconciliation at https://healthITAccelerator.com/med-wreck/.

 

Common opioids (Brands) in the U.S.

Illegal Opioid:

  • Heroin

Mainly Injection:

  • Morphine
  • Hydromorphone (Dilaudid)
  • Fentanyl (Sublimaze, Duragesic)

Mainly by Mouth:

  • Codeine
  • Hydrocodone (Vicodin)
  • Oxycodone (OxyContin)
  • Tramadol (Ultram)
  • Methadone (Dolophine, Methadose)
  • Tapentadol (Nucynta)
  • Anileridine (Leritine, not U.S.)
  • Levorphanol (Levo-Dromoran, rare use)
  • Buprenorphine (Subutex, Butrans)

Drug for reversing overdose

  • Naloxone (Narcan)

 

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