Opioid epidemic

Opioids are a diverse class of moderately strong painkillers, including oxycodone (commonly sold under the trade names OxyContin and Percocet), hydrocodone (Vicodin, Norco), and a very strong painkiller, fentanyl, which is synthesized to resemble other opiates such as opium-derived morphine and heroin. The potency and availability of these substances, despite their high risk of addiction and overdose, have made them popular both as medical treatments and as recreational drugs. Due to their sedative effects on the part of the brain which regulates breathing, the respiratory center of the medulla oblongata, opioids in high doses present the potential for respiratory depression, and may cause respiratory failure and death. What the U.S. Surgeon General dubbed 'The Opioid Crisis' likely began with over-prescription of opioids in the 1990s, which led to them becoming the most prescribed class of medications in the United States. Opioids initiated for post surgery or pain management are one of the leading causes of opioid misuse, where approximately 6% of people continued opioid use after trauma or surgery. When people continue to use opioids beyond what a doctor prescribes, whether to minimize pain or induce euphoric feelings, it can mark the beginning stages of an opiate addiction, with a tolerance developing and eventually leading to dependence, when a person relies on the drug to prevent withdrawal symptoms. Writers have pointed to a widespread desire among the public to find a pill for any problem, even if a better solution might be a lifestyle change, such as exercise, improved diet, and stress reduction. Opioids are relatively inexpensive, and alternative interventions, such as physical therapy, may not be affordable. In the late 1990s, around 100 million people or a third of the U.S. population were estimated to be affected by chronic pain. This led to a push by drug companies and the federal government to expand the use of painkilling opioids. In addition to this, organizations like the Joint Commission began to push for more attentive physician response to patient pain, referring to pain as the fifth vital sign. This exacerbated the already increasing number of opioids being prescribed by doctors to patients. Between 1991 and 2011, painkiller prescriptions in the U.S. tripled from 76 million to 219 million per year, and as of 2016 more than 289 million prescriptions were written for opioid drugs per year.:43 Mirroring the growth of opioid pain relievers prescribed is an increase in the admissions for substance abuse treatments and opioid-related deaths. This illustrates how legitimate clinical prescriptions of pain relievers are being diverted through an illegitimate market, leading to misuse, addiction, and death. With the increase in volume, the potency of opioids also increased. By 2002, one in six drug users were being prescribed drugs more powerful than morphine; by 2012, the ratio had doubled to one-in-three. The most commonly prescribed opioids have been oxycodone and hydrocodone. The epidemic has been described as a 'uniquely American problem'. The structure of the US healthcare system, in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies. According to Professor Judith Feinberg, 'Most insurance, especially for poor people, won't pay for anything but a pill.' Prescription rates for opioids in the US are 40 percent higher than the rate in other developed countries such as Germany or Canada. While the rates of opioid prescriptions increased between 2001 and 2010, the prescription of non-opioid pain relievers (aspirin, ibuprofen, etc.) decreased from 38% to 29% of ambulatory visits in the same time period, and there has been no change in the amount of pain reported in the U.S. This has led to differing medical opinions, with some noting that there is little evidence that opioids are effective for chronic pain not caused by cancer. The annual opioid prescribing rates has been slowly decreasing since 2012, but the number is still high. There were about 58 opioid prescriptions per 100 Americans in 2017. Cities that are smaller, with more dentists and primary care doctors, with more White residents and with a higher uninsured or unemployment rate tend to have a greater number of opioids prescriptions per resident.