America is facing a crisis of addiction and opiod use disorder (OUD). It is estimated that 2.5 million American adults abuse opiates. More than 90 people die everyday from an opioid overdose. For many American's struggling with opioid abuse disorder, the addiction started in their doctor's office. An estimated 3-19% of people prescribed pain medication develop an addiction.
It's common for people with opioid dependency to find drugs illegally once their doctor stops prescribing their medication. Withdrawals occur when an opiate user abruptly stops taking their medication. Once people develop a dependency to this drug, they might find that pills are no longer available. In a desperation to curb withdrawal symptoms, they may switch to heroin. 45% of people who use heroin started with prescription opioids. Heroin may also contain fentanyl, a synthetic opioid that is 50 to 100 times more potent than heroin. Fentanyl has a higher risk for overdose or death.
America only makes up 4.4% of the total world population, but they consume more than 80% of the opiates. Physician Ronald Hirsch admits that doctors are partially to blame for this epidemic, "We overprescribe opioids, just as we overprescribe antibiotics...there are also what are known as 'pill mill' doctors who set up shop, accept cash as the only payment and are willing to prescribe to anyone for any ailment, real or feigned." While there are some doctors who overprescribe without regard to their patient's well-being, most doctors are well intentioned and prescribe these medications because they don't want their patients to be in pain. While doctors are partially to blame for the country's opiate epidemic, they were also deceived about the risks of dependency. This is mainly due to predatory pharmaceutical industry, capitalizing on people's pain for profit.
Purdue Pharmaceuticals, the manufacturer of OxyContin, played a huge role in the opioid epidemic. They used unethical marketing tactics to persuade doctors to prescribe their products to patients. These tactics included inviting medical professionals to "pain-management" conferences at lavish resorts, all expenses paid. They also sent coupons for free samples of OxyContin and free "merchandise" to doctors (t-shirts, plush toys, hats, etc.) Their marketing plan also included identifying doctors who most frequently prescribed opioids. They were targeting their product towards doctors with the most chronic-pain patients. Their database had details of doctor's prescribing habits and locations.
In addition to these faulty and immoral promotional tactics, they downplayed the risks for opiate dependency, falsely claiming that the risk of addiction is "less than one percent."
Purdue company executives plead guilty and paid fines for misbranding OxyContin. Purdue filed for Chapter 11 bankruptcy protection in September 2019 and avoided further lawsuits. The Sackler family (owners of Purdue Pharma) agreed to a $6 billion settlement in exchange for legal immunity but this offer was denied. This case has made its way to the Supreme Court and is still being debated. Victims are still waiting on a settlement to be determined.
Purdue Pharma and the Sackler family damaged the lives of millions of Americans for their own personal gain. No amount of money could make up for the pure evil, selfishness, and disdain for human life.
To this day, millions of Americans are affected by OUD. According to a 2021 survey, only about 1 in 5 adults (22.3%) suffering from OUD received medication (including methadone, buprenorphine, or extended-release naltrexone). This disparity has disproportionally affected women and black patients in the United States. It was found that women and black patients are less likely to receive medication to help OUD. There were several other factors that affected the likelihood of receiving medication for OUD; people who are unemployed or work part time, people who are uninsured and people living in rural areas were less likely to receive treatment. These inequalities could be indicative of a larger societal issue: rising healthcare costs and lack of adequate patient care in rural communities.
The rise of telehealth has been particularly beneficial to people living in rural areas. Those receiving substance abuse treatment via telehealth had increased odds of receiving medications for OUD. Despite rising the trend of telehealth, it was found that people living in non metropolitan areas still had reduced odds of receiving medication for opiate abuse.
There have been some initiatives to expand access for medications used to treat OUD. Recently, the Biden-Harris administration announced their initiatives to spend $50 million to support opioid treatment and recovery services in rural areas. This plan aims to increase access to medication for OUD. The funding will go towards transportation to appointments, facilitating employment opportunities for people in recovery, and mobile units providing medication to treat OUD in secluded communities around the country.
Currently medications to treat opioid use disorder are highly regulated. Suboxen, a drug containing buprenorphine and naloxone, is regulated by the Department of Health and Human Services (HHS) and Substance Abuse and Mental Health Service Administration (SAMHSA.) Additionally, the Drug Enforcement Administration (DEA) oversees the activities of Suboxone prescribers.
The Modernizing Opioid Treatment Access Act would further expand access to these life saving medications by removing barriers to treatment. This act "waives provisions of the Controlled Substances Act that require qualified practitioners to obtain a separate registration from the Drug Enforcement Administration (DEA) to prescribe and dispense methadone to treat OUD." This act has been introduced to the Senate but has not yet been voted on. This issue must be treated with more urgency and barriers must be lifted in order to provide the best care possible to Americans affected by this epidemic.
To prevent prescription drug abuse it is important to never share your prescriptions, take the medication as prescribed and securely store/dispose of unused medication. You can also ask your doctor about alternative pain relief options to reduce your risk of developing opioid use disorder. Please consult your doctor if you think you may be suffering from opioid dependency.
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