For the past two decades, opioids have been a scourge on U.S. society, causing an addiction crisis and deaths in communities from coast to coast.
From 1999 to 2017, according to the Centers for Disease Control and Prevention, more than 702,000 people died from drug overdoses. Nearly 68% of those involved a prescription or illicit opioid. As concern about the opioid epidemic and resources to fight it have expanded, researchers have increasingly found evidence of a new healthcare concern -- a dramatic rise in heroin, methamphetamine and synthetic opioid use, specifically illegal fentanyl. Some refer to it the nation's forgotten epidemic.
The growth in heroin and fentanyl use
An exclusive report by the Washington Post released Dec. 23 said 12 billion prescription oxycodone and hydrocodone pills were being sent to U.S. pharmacies by 2011 at the height of shipments.
Opioid-related deaths reached as high as 47,600 in 2017, according to the CDC. That was three times higher than a decade earlier.
While the national average was 4.5 deaths per 100,000 people from 2006 to 2012, some counties in West Virginia and Kentucky experienced a rate of 39 deaths per 100,000. A national effort to limit opioid prescriptions has had some impact. The American Journal of Managed Care, in an analysis of more than 86 million insured patients from July 2012 to December 2017, said prescribing has dropped 50%, though some providers continue to write "high-risk initial opioid prescriptions." The Post's data shows that a rise in heroin began as early as 2013. That shifted to fentanyl in 2016. The report noted that the Baltimore area is one of the nation's hardest hit by fentanyl deaths, rising from 340 in 2015 to 1,888 in 2018, according to the Maryland Department of Public Health. Heroin-related deaths peaked in 2016 at 1,212, jumping 110% from only two years earlier in the area.
Epidemic knows no boundaries
This switch to more powerful and dangerous drugs isn't only a Baltimore problem. The Washington Post says more than 1,300 counties across the country experienced a similar shift. A study by San Diego's Millenium Health of more than 1 million urine drug tests from across the U.S. echoed the concerns about fentanyl and methamphetamines, which often are being used together.
"Fentanyl is 50 to 100 times more potent than morphine, and consequently may lead to respiratory depression and death," said Robert Glatter, an emergency medicine physician in New York City.
The study noted positive urine tests for fentanyl quadrupled from 2013 to 2019, while positive tests for methamphetamines have grown sixfold -- from 1.4% of positive samples in 2013 to 8.4% of tests last year. Tests showing fentanyl and methamphetamines being used together were 14 times higher last year than in 2013. "We are talking about serious and deadly risks -- patients who may stop breathing and suffer heart attacks, strokes or develop bleeding on the brain," Glatter said.
Issue continues to rise
The National Institute on Drug Abuse, which is part of the National Institutes of Health, used 2016 data to tell a harrowing story about the growth of synthetic opioids. In 2016, according to its research, synthetic opioids (primarily illegal fentanyl) were involved in nearly 46% of the 42,249 opioid-related deaths. Researchers said that in 2010, synthetic opioids were identified as the cause in only 14% of deaths. Commitment from the top In response to these statistics, the U.S. Dept. of Health and Human Services has published five recommendations it will commit to slow the epidemic:
- Improving access to treatment and recovery services
- Promoting use of overdose-reversing drugs
- Strengthening our understanding of the epidemic through better public health surveillance
- Providing support for cutting-edge research on pain and addiction
- Advancing better practices for pain management
Take these courses to learn more about opioid use:
Responsible Opioid Prescribing, Chronic Pain, and Addiction (1.5 contact hrs) The goal of this continuing education program is to provide nurses with information about best practices in the prescribing of controlled substances, including safe and effective prescribing, administering, and dispensing of controlled substances to the patient with chronic pain. Patient Counseling: Preventing and Combating Opioid Misuse (1 contact hr) With the current opioid epidemic, learn critical information professionals need to know to assess the nature of patient's and client's opioid use, provide education and/or counseling for opioid use, and refer persons to applicable resources for substance misuse or abuse. Heroin: The Illegal Opioid (1.5 contact hrs) The history of diacetylmorphine (heroin) along with current epidemiological data and overdose statistics together illustrate the dangers associated with use and abuse of, dependence on, and addiction to this drug. Characteristics of heroin such as its appearance, chemical structure, administration, metabolism, and mechanism of action are addressed in this continuing education module to elaborate on how the drug elicits such a strong, unique euphoric effect compared to other opioid medications. Additionally, various treatment approaches for the management of acute and chronic heroin use are discussed.
