The U.S. Centers for Disease Control and Prevention (CDC) has labeled deaths from prescription painkiller overdoses an epidemic. The United States is home to less than 5% of the world’s population but consumes about 75% of the world’s prescribed opioids. As a result of the unprecedented rise in prescribed opioids, opioid-related deaths more than tripled in the U.S. between 1999 and 2012.
This dramatic increase in prescription opioid use has led to an emerging heroin epidemic. Once prescription opioid users outgrow their source of pills, either legally prescribed or illicitly obtained, heroin becomes a substitute that is cheaper and easier to obtain. Approximately three out of every four new heroin users abused prescription opioids prior to using heroin.
The demographics of the heroin user have changed. Once a drug associated with inner-city crime, heroin has moved to white-collar professionals and suburban teenagers, as well as small towns and rural areas throughout the U.S. Though heroin use in the general U.S. population is low compared with many other drugs, the number of new heroin users continues to increase and the number of overdose deaths continues to climb. From 2001 to 2013 there was a five-fold increase in the number of heroin overdose deaths.
What measures can be taken to address this challenge? Right now there is a strong focus on two responses to this epidemic: using Naloxone (Narcan) to reverse the effects of an overdose, and using one of the prescription drugs methadone or buprenorphine in medication-assisted treatment (MAT). Although both have their merits, these two responses fail to respond to the chronic nature of the disease of addiction. Narcan is a naloxone-hydrochloride that combats the effects of heroin and instantly reverses overdose. Making this life-saving drug available to emergency medical professionals and others is an important positive step. However, there is a larger concern that the use of Narcan does not address. What happens to these victims after they recover from the overdose? For far too many, the answer is nothing. They go right back to an often fatal pattern of opioid use. That pattern needs to change. An individual recovering from an opioid overdose needs to be evaluated by an addiction specialist in the hospital emergency room. Connections need to be made to abstinence-oriented treatment programs that may include the use of MAT. And the families should be involved, if possible.
While the use of MAT, with methadone or buprenorphine, is an often-used treatment response to opioid addiction, these medications only work while they are taken. Research shows that in the real world, the actual use of MAT is mostly short-term. Relapse and return to opioid use is common even after years and years of abstinence.
Opioid dependence is a lifetime disorder. However, treatment of opioid dependence is always short-term, and the risk of relapse is substantial. It is essential that this chronic and often fatal disease be monitored and treated over many years, as are other serious chronic diseases.