Drug overdose has been the leading cause of accidental death in the US, with 52,404 lethal overdoses in 2015. In Ventura County, deaths from opioid overdose were nearly 50% higher compared to California in 2014. Although opiate addiction constitutes 10-20% of all addiction, death by opiate overdose comprises over 50% of lost lives. There is a close correlation between access and use. Sales of opiate medication increased by four times between 1999 and 2004, which was the same increase in both number of addicted individuals and overdose deaths.
Opiates are a class of drugs that include heroin, morphine, and its synthetic versions: oxycodone, hydrocodone, codeine, fentanyl, and others. These chemicals interact with opioid receptors in the nervous system to produce pleasurable results and relieve pain. They also decrease respiratory drive and are mood depressants.
Most alarming is the frequency with which certain drugs containing opiates are prescribed under ordinary circumstances. It is valuable to note the brand name of drugs that contain these addictive substances, such as:
Percocet- Percodan
- Tylenol #3
- OxyIR
- Roxicet and Roxicodone
- Vicodin
- Dilaudid
- Aqtiq
- Numorphan
It is important to ask your prescribing physician or dentist, if the medications contain any opiates and what cautions should be taken when using the medication, or request alternative pain relief medications.
Use Among Adolescents and Women
Two particular populations heavily impacted by opiate use are adolescents and women. In 2014, 28,000 adolescents had used heroin in the previous year, mostly because prescription agents that they used early in their addiction were too expensive and harder to obtain. Most adolescents polled reported that their first access to these agents were from leftover or unused prescriptions of others.
Additionally, statistics have shown that women are more likely to suffer from chronic pain and be prescribed higher doses of opiates for longer periods of time. Several studies performed by the Centers for Disease Control indicate that women may develop addiction to opiates more rapidly than men. In addition to females overdosing with prescribed opiates increasing by 400% (compared to 237% for men during the same time period), heroin overdose death rates tripled for women from just 2010 to 2013.
Recognition and Prevention
Identification of compulsive opiate use is often difficult, since in the early stages use of prescription opiates usually accompanies pain or a bona fide injury. However, chronic use can lead to tiredness, decreased productivity, diminished interest in previously enjoyed activities, and a change in behavior towards focusing on obtaining the drugs. Physical signs of dependency can include of shortness of breath, dry mouth, constricted (small) pupils, disorientation, cycles of hyper alertness followed by suddenly nodding off, and wearing long sleeves in terribly hot weather.
It is often quite difficult to confront someone abusing these agents, in that so often they are convinced of the necessity of these drugs as medication. It would not be uncommon for someone to self-justify the use of chronic opiate medication for back pain or migraine headaches, even when recent literature indicates that long term use of opiates can lower one’s pain threshold, thereby worsening the benefit of these agents even in the short term.
Prevention is best summed up by one word: access. Although the United States comprises 20% of the world’s population, we consume 80% of all opiate medication produced. In 2015, 259 million prescriptions were written for opiates, which is more than enough to provide every adult person with a bottle of pills.
Treatment
Finally, treatment options have been expanded and insurance companies are now recognizing that one of the best approaches towards treatment is rapid and early referral. CSEBO’s Kaiser and Anthem options provide access to group and individual therapy, medically-assisted replacement and craving suppression (such as methadone, suboxone, and Vivitrol), and residential treatment if necessary. These programs are supported by aftercare programs in an effort to decrease misuse, abuse, addiction, and stigma. In addition, CSEBO’s Employee Assistance Program is able to provide on-going case management to assure that patients stay focused on recovery once primary treatment is complete.
The new century ushered in a group of medications intended to ease physical pain and suffering, and its second decade will end with rational pain management that does not lead to anguish and addiction.
Resources and Support
If you need to seek mental health or substance abuse treatment, members should use the Anthem Blue Cross or Kaiser contact information on their insurance card.
Your Employee Assistance Program (EAP) can be a great first step when seeking help. EAP counselors routinely screen for substance use and are well-positioned to facilitate referrals to treatment programs. Optum EAP provides you and your family members in the immediate household with free and confidential counseling sessions for issues including addiction, depression, anxiety, stress and grief. Call Optum EAP at (888) 444-8624 to discuss your options, available 24 hours a day.
To ensure that unused medications do not fall into the wrong hands or contaminate the environment, the Ventura County Sheriff's Office provides safe, confidential disposal options. [Additional details here]
References
- The author conducted an independent analysis of the National Survey on Drug Use and Health (NSDUH), 2010. The data and materials can be found here: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/64
- The author conducted an independent analysis of National Survey on Drug Use and Health (NSDUH), 2004- 2014. The data and materials can be found here: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/64
- Data on the number of people who abused or were dependent on pain medications can be found here: https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf. To determine the percentage of people who used heroin among those who abused or were dependent on pain medications the authors conducted an independent analysis of National Survey on Drug Use and Health (NSDUH), 2010. The data and materials can be found here: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/series/64
- Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760,DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.This publication may be downloaded from http://store.samhsa.gov. See Table 9, page 34.
Adapted from Avante Behavioral Health, with permission, by Claremont Partners, Inc.