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Opioid Epidemic

This guide contains information on the misuse of and addiction to opioids. Additionally, it explains the "economic burden" of prescription opioid addiction, including the cost of addiction.

Prescription Opioids

Opioids are a class of drugs used to reduce pain.They include illegal drugs such as heroin, as well as prescription medications used to treat pain.

Prescription opioids can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side effects.

Common types are oxycodone (OxyContin), hydrocodone (Vicodin), fentanyl, tramadol, morphine, and methadone. Some opioids are made from the opium plant, and others are synthetic (man-made).

In addition to the serious risks of addiction, abuse, and overdose, the use of opioids can have a number of side effects, even when taken as directed:

  • Tolerance—meaning you might need to take more of the medication for the same pain relief
  • Physical dependence—meaning you have symptoms of withdrawal when the medication is stopped
  • Increased sensitivity to pain
  • Constipation
  • Nausea, vomiting, and dry mouth
  • Sleepiness and dizziness
  • Confusion
  • Depression
  • Low levels of testosterone that can result in lower sex drive, energy, and strength
  • Itching and sweating

CDC

Additional Information

 For Patients:

Living with chronic pain can be devastating and effective pain management is important to getting your life back. It is essential that you and your doctor discuss treatment options, carefully considering all of the risks and benefits. Some medications, such as prescription opioids, can help relieve pain in the short term but also come with serious risks and potential complications and should be prescribed and used carefully.

For Providers:

Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.

CDC developed and published the CDC Guideline for Prescribing of Opioids for Chronic Pain for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain outside of active cancer treatment, palliative care, and end-of-life care.

Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the risk of opioid use disorder, overdose, and death. 

  • An estimated 11% of adults experience daily pain;
  • Millions of Americans are treated with prescription opioids for chronic pain;
  • Primary care providers are concerned about patient addiction and report insufficient training in prescribing opioids

CDC

Opioid addiction in the United States has reached epidemic proportions, threatening not only public health but economic output and national security.

More than nine hundred people a week die from opioid-related overdoses, and some experts say the death toll may not peak for years. Meanwhile, millions more Americans suffer from opioid addiction.

The crisis has reached such a scale that, beyond the risks it poses to public health, it is becoming a drag on the economy and a threat to national security. Analysts say the problem started with the overprescription of legal pain medications, such as oxycodone, but note that it has intensified in recent years with an influx of cheap heroin and synthetic opioids, such as fentanyl, supplied by foreign-based drug cartels.

Council of Foreign Relations

Updated 1/17/19

Symptoms of an opioid overdose include:

  • Marked confusion, delirium, or acting drunk
  • Frequent vomiting
  • Pinpoint pupils
  • Extreme sleepiness, or the inability to wake up
  • Intermittent loss of consciousness
  • Breathing problems, including slowed or irregular breathing
  • Respiratory arrest (absence of breathing)
  • Cold, clammy skin, or bluish skin around the lips or under the fingernails

Depressed breathing is the most dangerous side effect of opioid overdose. Lack of oxygen to the brain cannot only result in permanent neurologic damage, but may also be accompanied by the widespread failure of other organ systems, including the heart and kidneys. If a person experiencing an opioid overdose is left alone and asleep, the person could easily die as their respiratory depression worsens.

American Addiction Centers

People can easily take too much of a prescription painkiller like Vicodin, OxyContin, or morphone, whether they struggle with addiction to these medications or not. If overdose is suspected, it is vitally important to get emergency medical help as soon as possible by calling 911. While waiting for emergency medical help to arrive, roll the person suffering from the opioid overdose on their side to protect them from choking in the event that they vomit while unconscious. If the individual is conscious, keep them awake and talking as much as possible. 

Do not leave a person who has potentially overdosed on Vicodin, OxyContin, or morphine alone. Individuals experiencing an opioid overdose can get worse quickly and should not be alone. If they are conscious, they could wander away and hurt themselves; if they are unconscious, they could stop breathing without it being easily-detected.

Once the individual suffering from an opioid overdose receives emergency medical attention, doctors may perform a variety of lifesaving treatments, including:

  • Airway management/intubation, to ensure the individual can breath
  • Activated charcoal administration to minimize further absorption of any ingested intoxicants
  • Gastric lavage, or stomach pumping may be performed in addition to charcoal administration
  • Treatment for cardiac arrest, if heart problems occur
  • Venous line access for administration of intravenous fluids to stabilize hydration and to correct any electrolyte imbalances or hypoglycemia, which may be a result of vomiting and/or lack of intake
  • Naloxone administration
  • Acetylcysteine administration (should there be a potential for acetaminophen toxicity)

Naloxone

One of the most important treatments for opioid overdose is naloxone. This medication has been used in emergency rooms for several years to reverse opioid overdoses, especially heroin overdoses. However, with the growing prescription painkiller abuse epidemic, states are pushing emergency responders and even caregivers to carry injectable or nasal spray forms of naloxone to treat people who might suffer from an opioid overdose. 

Naloxone binds to the same receptors in the brain as opioid drugs, preventing the drug from creating a "high" for up to one hour after administration. If given early enough, naloxone may effectively reverse an overdose for a period of time, which can be enough time for additional life-saving medical interventions to begin. Naloxone can be an effective "antidote" for opioid overdose, but it is not failsafe. Depending on the amount and potency of opioid drugs having been used, as well as whether multiple substances have been taken, naloxone may not fully reverse the effects of an overdose, or may require multiple administered doses over time. People who suffer an opioid overdose may need further medical attention. Because of this uncertainty, it is still necessary to call 911 for emergency medical help.

American Addiction Centers

The economic cost of the growing opioid epidemic topped an estimated $1 trillion from 2001 through 2017.

And the opioid crisis is projected to cost the United States an extra $500 billion through 2020 unless sustained action is taken to stem the tide.

The number of fatal opioid-related ODs is estimated to have topped 62,500 last year.

The analysis also estimated the costs from lost tax revenue to state and local governments, additional spending on health care, social services, education and criminal justice.

Health-care costs alone related to the crisis reached $217.5 billion from 2001 to 2017, according to the report.

In 2001, the nation’s annual cost from the opioid crisis stood at $29.1 billion. That more than doubled to $60.9 billion in 2011, and then hit a whopping $115 billion in 2017.

The growth rate between 2011 and 2016 was double the rate observed between the previous five years

CNBC

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