A National Epidemic

What are Prescription Opioids?

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. Opioids can be highly addictive, and overdoses and death are common.1


Common Prescription Opioids:
Hydrocodone (Vicodin®)
Oxycodone (OxyContin®, Percocet®)
Oxymorphone (Opana®)
Morphine (Kadian®, Avinza®)
Codeine
Fentanyl

Defining the Opidemic

Arkansas Drug Director Kirk Lane commonly refers to the Opioid Epidemic plaguing the nation as the “Opidemic” in speeches and presentations. He also frequently makes reference to an alarming statistic and then poses a question for everyone.

“An average, 198 people die everyday from drug overdoses,” Lane said. “If the airlines crashed into the ground and killed 198 people every day – how long would it take to shut down the airlines?”

Opioid addiction (Opioid Use Disorder) is a medical condition of a repetitive and problematic pattern of opioid use which causes clinically significant impairment or distress. The recurrent use of opioids creates a reliance on the opioid, increased tolerance to opioids, and withdrawal syndrome when opioids are abruptly discontinued.

Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience.

Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, or death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether the damage can be reversed.1

Prescription opioids and heroin are chemically similar and can produce a similar high. Nearly 80% of Americans using heroin (including those in treatment) reported misusing prescription opioids prior to using heroin.

“Thirty years ago, the heroin dealers drove through Arkansas” on their way to more populous and lucrative markets, Dr. G. Richard Smith, professor of psychiatry, medicine, and public health at the University of Arkansas for Medical Sciences, told STAT news. “That’s not the case now: People are switching from legal prescription meds, rightly or wrongly prescribed, to heroin.”


Tolerance vs. Dependence vs. Addiction

Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.

Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life-threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.

Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs.1

More than 40% of all U.S. opioid overdose deaths in 2016 involved a prescription opioid, with more than 46 people dying every day from overdoses involving prescription opioids. 

In 2016, a total of 63,632 drug overdose deaths occurred, a 21.4% increase from 2015.2

In 2016, 11.8 million people over the age of 12 misused opioids in the past year and the majority of that (11.5 million) is pain reliever misuse rather than heroin use.3


Changing Stigma to End the Opidemic

The concept of stigma describes the powerful, negative perceptions commonly associated with substance abuse and addiction. Stigma has the potential to negatively affect a person’s self-esteem, damage relationships with loved ones, and prevent those suffering from addiction from accessing treatment.

Stigma is a public health issue — it contributes to high rates of death, incarceration, and mental health concerns among dependent populations.

Defining Stigma

Stigma is defined as a set of negative beliefs that a group or society holds about a topic or group of people. According to the World Health Organization (WHO), stigma is a major cause of discrimination and exclusion and it contributes to the abuse of human rights. When a person experiences stigma they are seen as less than because of their real or perceived health status. Stigma is rarely based on facts but rather on assumptions, preconceptions, and generalizations; therefore, its negative impact can be prevented or lessened through education. Stigma results in prejudice, avoidance, rejection, and discrimination against people who have a socially undesirable trait or engage in culturally marginalized behaviors, such as drug use (Link, 2001).

Family, friends and the general public can carry negative feelings about drug use or behavior. They may even use derogatory terms such as “junkie,” “alcoholic,” or “crackhead.” These thoughts, feelings, and labels can create and perpetuate stigma.

How Prevalent is Addiction Stigma?

We live in a society where millions of Americans are dependent on drugs or alcohol and only a small percentage receive treatment at a facility. In fact, the 2014 National Survey on Drug Use and Health found that 21.5 Americans age 12 and older had a substance use disorder in the previous year; however, sadly only 2.5 million received the specialized treatment they needed.

Stigma affects all of us – and nearly everyone has felt stigmatized or has stigmatized others at some point in their lives. In a study done by Johns Hopkins Bloomberg School of Public Health, the general public was more likely to have negative attitudes towards those dealing with drug addiction than those who were dealing with mental illness. Additionally, researchers found that people don’t generally support insurance, housing, and employment policies that benefited people who were dependent on drugs (JHU, 2014).


1National Institute on Drug Abuse

2Centers for Disease Control & Prevention (CDC)

3Substance Abuse & Mental Health Services Administration (SAMHSA)