Yesterday, the Washington Post report that opioid deaths in the U.S. have skyrocketed since 2005 according to a government report issued this month by the Healthcare Cost and Utilization Project.
The 2014 numbers, the latest available for every state and the District of Columbia, reflect a 64 percent increase for inpatient care and a 99 percent jump for emergency room treatment compared to figures from 2005. Their trajectory likely will keep climbing if the epidemic continues unabated.
The report, released by the Agency for Healthcare Research and Quality (AHRQ), puts Maryland at the very top of the national list for inpatient care. The state, already struggling with overdoses from heroin and prescription opioids, has seen the spread of the synthetic opioid fentanyl, which can be mixed with heroin or cocaine and is extraordinarily powerful. Gov. Larry Hogan (R) this year declared a state of emergency in response to the crisis.
The roots of the problem of opioid addiction are as old as history, but, the recent spike in opioid addiction and overdoses are attributed to two main factors, pain becoming a vital sign that a doctor looks at during an examination (remember the introduction of the smiley face posters for pain) and an extended release version of oxycodone released in 1996.
Fifteen years ago, a report by the Joint Commission on Accreditation of Healthcare Organizations, a nationally recognized medical society which accredits hospitals, stressed that pain was vastly undertreated in the United States. The report recommended that physicians routinely assess pain at every patient visit. It also suggested that opioids could be effectively and more broadly used without fear of addiction. This latter assumption was entirely mistaken, as we now understand. The report was part of a trend in medicine through the 1980s and 1990s toward treating pain more proactively.
The report was heavily publicized, and today it is widely acknowledged that it led to massive – and sometimes inappropriate – increases in the use of prescription opioid drugs to treat pain.
With more opioids being prescribed by well-meaning doctors, some were diverted from the legal supply chain – through theft from medicine cabinets or trade on the black market – to the street for illicit use. As more opioids leaked out, more people started to experiment with them for recreational purposes…
The second major factor was the introduction of an extended release formulation of the potent opioid oxycodone in the 1996. You may know this drug by its brand name, OxyContin. In fact, you might have been prescribed it after having surgery.
The drug was designed to provide 12-24 hours of pain relief, as opposed to just four hours or so for an immediate release formulation. It meant that patients in pain could just take one or two pills a day rather than having to remember to take an immediate release drug every four hours or so. This also meant that OxyContin tablets contained a large amount of oxycodone – far more than would be found in several individual immediate release tablets.
And within 48 hours of OxyContin’s release on the market, drug users realized that crushing the tablet could easily breach the extended-release formulation, making the pure drug available in large quantities, free from harmful additives such as acetaminophen, which most recreational and chronic abusers find irritating, particularly if they inject it intravenously. This made it an attractive option for those who wanted to snort or inject their drugs. Surprisingly, neither the manufacturer nor the Food and Drug Administration foresaw this possibility.
When one looks at the states that have the highest death rates for opioids, one can easily correlate this to the high number of prescriptions per 100 people. West Virginia, Ohio, and Kentucky have a rate of 96 to 143 prescriptions written to people. New Hampshire has a rate 72 to 81 prescriptions per 100 people. These numbers just astonished me. But, the sources of people that abuse these drugs vary widely.
Most people who abuse prescription opioids get them for free from a friend or relative. However, those who are at highest risk of overdose (using prescription opioids nonmedically 200 or more days a year) get them in ways that are different from those who use them less frequently. These people get opioids using their own prescriptions (27 percent), from friends or relatives for free (26 percent), buying from friends or relatives (23 percent), or buying from a drug dealer (15 percent). Those at highest risk of overdose are about four times more likely than the average user to buy the drugs from a dealer or other stranger.
What will the Trump administration do about the opioid crisis? Well, not much that will be productive.
The White House is calling for a 95 percent funding cut for the Office of National Drug Control Policy, the agency leading the charge against the country’s opioid epidemic, according to sources knowledgeable about the White House’s draft budget for the coming fiscal year. ONDCP is responsible for coordinating drug prevention programs across federal agencies and was slated to fund President Donald Trump’s much-lauded opioid commission.
The budget would slash ONDCP’s $380 million budget to $24 million. It would eliminate the High Intensity Drug Trafficking Areas program, which coordinates local, state, and national efforts to reduce drug trafficking and has a $250 million annual budget. It would also cut the Drug-Free Communities Support Program, which funds community-based youth substance abuse prevention programs. The budget calls both programs “duplicative of other Federal programs.” The budget is a “passback” draft: it was cleared by the White House budget office last week, but will still need to be approved by Congress.
On the campaign trail, Trump promised to “spend the money” to address the opioid epidemic, but his proposed budgets and policies thus far would drastically cut federal funding to tackle the issue.
MAGA
We invaded Afghanistan in 2001 and slowly began to replant the poppy fields that the Taliban had completely destroyed while they were in power.
By 2005 the poppy fields were fully operational and heroine began flooding Western countries.
Our opioid crisis is no accident.
Following the money in the opioid crisis and following the money in the crack crisis both lead back to the same source.
The CIA.
I wonder what drugs Trump uses. He famously doesn’t partake of alcohol. I doubt that he uses pot.
Many people thought that he was on some form of coke during a couple of the debates — he was sniffling and wheezing loudly.
Given his lack of discipline, it’s hard to believe that he doesn’t engage in some form of substance use/abuse. Is it possible that when he awakens each morning, he pops a pill or shorts a line and then commences tweeting?
Meth, definitely meth.