The Real Reasons for the Opioid Epidemic (And How We Can End It)

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Did you know that the leading cause of accidental death in America today isn’t car accidents or suicides, but rather, drug overdoses? It’s true. According to the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the United States, with opioid addiction as a primary, driving force.

Opioids are a particular type of drug that binds to opioid receptors on nerve cells. Examples include prescription drugs such as hydrocodone, oxycodone, codeine, morphine, and fentanyl, and illegal drugs such as heroin. These drugs are powerful, and they can be deadly. National Institute on Drug Abuse (NIDA) data tell us that in 2018 alone, opioid overdoses will claim over 41,975 lives. That’s 115 preventable deaths every single day – a terrifying statistic.

The Opioid Crisis in America Today

April is National Alcohol Awareness Month, and it’s tremendously important to be honest about the damage that drinking can do. However, it’s also imperative to highlight the devastation caused by the opioid epidemic. In fact, opioid abuse is so significant that in 2016, former President Barack Obama designed a week in September as “Heroin and Opioid Awareness Week.”

Though some might assume that the epidemic has slowed down since then, that’s sadly not the case. While the overdose deaths of celebrities such as Tom Petty, Prince, and Cory Monteith have certainly raised awareness around the issue, these tragedies have not lessened the opioid overdose trend.

Despite public outcry, opioid overdose rates are climbing rapidly. According to NIDA, “Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.” How did this happen? Why are so many people dying from drug abuse?

Driving Forces Behind the Opioid Epidemic

  • Driving Force #1: Dramatic Increase in Pain Medication Prescriptions and Pharmaceutical Marketing

    In the earlier part of the twentieth century, doctors were typically cautious about prescribing pain medication. They restrained their use of pain prescriptions, which meant that pills were harder to obtain. Sometimes, people with legitimate pain could not receive medication for their symptoms.As a result, there was a huge emphasis on responding swiftly to patient pain in the 1980’s and 1990’s. This was fueled in part by a true desire to alleviate human suffering…and in part by drug manufacturers and pharmaceutical companies eager to sell their products.

    Drug companies claimed that their products were not addictive, and doctors were trained to prescribe painkillers early and often. In fact, to this day many doctors receive lower patient evaluation scores – which are legally linked to hospital payments – if they don’t prescribe opioids. In short, physicians feel pressure from both their workplaces and their patients to pull out their prescription pads.

    Here’s how Steve Diaz, an emergency medicine doctor in Maine, described the situation in USA Today:

    “The patient says, ‘I’m in pain, and you’re not meeting my needs.’ And [doctors] might say, ‘I’m being graded on this. I’ll give this patient something, to get them over the hump,'” he said. “No one will overtly say, ‘I’m doing this to not get a bad score. But in the back of their mind …”

    All of these additional prescriptions led to a lot of misuse and abuse; the pendulum swung far in the opposite direction. According to the US Department of Health and Human Services, 11.5 million people misused prescription opioids in 2016 alone. Once people had more easy access to opioids, the rate of abuse skyrocketed. And of course, it didn’t help that pharmaceutical companies increased their marketing efforts tremendously at the same time.

  • Driving Force #2: Uptick in Loneliness and Social Disconnection

    In his popular TED talk Everything You Think You Know About Addiction Is Wrong, British journalist and author Johann Hari highlights the link between addiction and social bonding. Hari describes our intrinsic need to connect with one another. He also notes that when we are blocked from making these connections due to physical isolation or trauma, we turn to substitutes. We connect with drugs rather than one another. If we don’t address the pain of personal isolation, we won’t stem the tide of the overdose epidemic. The rise of social media platforms isn’t helping; in fact, the illusion of connectivity may be contributing to our lack of it.

    According to researchers at the University of Pittsburgh, “…the people who reported spending the most time on social media — more than two hours a day — had twice the odds of perceived social isolation than those who said they spent a half hour per day or less on those sites.”

    While researchers noted that heavy social media use does not necessarily cause social isolation, it’s clear that we have a real issue with social isolation in our modern world. This translates to vulnerability for drug addiction.

  • Driving force #3: Rise of Untreated Mental Health Issues

    As opioid overdose rates rose, so did rates of depression, anxiety, and other mental health issues linked to drug abuse. Anxiety disorders now affect 40 million adults in the US, according to the Anxiety and Depression Association of America (ADAA). That makes anxiety the most prevalent mental illness in the country, impacting 18.1% of the adult population. Plus, depression – which often co-occurs with anxiety – is the leading cause of disability in the United States among people ages 15-44.We now know that many people who struggle with addiction have a dual diagnosis: a substance abuse issue combined with a mental health concern. So, it’s no surprise that when mental health issues surge, so do addictions. This is true for the young as well as the old. With depression and anxiety on the rise, millions of people over 50 are getting hooked on prescription pills.

    Our current epidemic of depression and anxiety renders senior citizens increasingly vulnerable to opioid addiction. Adults with depression and anxiety reach for opioids in order to alleviate their emotional suffering.

What Can Be Done to End the Opioid Crisis? 

Here are just a few possibilities for us to curtail the opioid epidemic. As a society, we can…

  • Educate doctors about the dangers of over-prescribing opioids, and teach proven, research-based pain management therapies and techniques that don’t rely on opioids.
  • Make changes to the healthcare system to prevent over-prescribing and alleviate the pressure on doctors to over-prescribe (for example, by changing the form and content of patient satisfaction surveys, and also employing the use of alternative pain management therapies).
  • Curtail aggressive marketing by drug companies, and limit our own exposure to these ads (for example, by not buying magazines or watching programs that feature them).
  • Create families and communities characterized by connection: purposefully putting down our devices, signing out of social media, and conversing heart-to-heart more often.
  • Provide professional counseling to address and heal mental health issues, the true root causes of addiction.

The relapse rate for opioid addiction is very high; some estimates put it at over 90%. Numbers like those make some people despair of ever finding a solution. However, though the current crisis is complex and multifactorial, it’s also just the latest manifestation of an age-old problem. The opioid epidemic is fueled by the same thing that fuels all addictions: disconnection, depression, anxiety, and deep mental and emotional pain.

The good news is that, as mental health professionals, we know how to address and heal those issues. We know how to work with depression and anxiety and trauma.

Going forward, it’s our job to help and support as many people as we can in healing these underlying core issues. If we can do that, we’ll have brought our country one step closer to ending the opioid epidemic for good.

 Images Courtesy of iStock

What Are Your Thoughts on this Topic?

  • Sandi Lierley

    Good article. I would just say physical pain is a major factor for me. It starts the cycle of depression and obsession which leads to withdrawal from society, making me too extra sensitive to participate comfortably or change my mood OR fake it in any way. So, I need to work on taking care to be pain free physically, mentally and spiritually. As a trauma survivor, I work at my recovery every day. It has caused many pains from scoliosis to cancer and all that comes with them (chemo,radiation damage etc). Trauma shuts down the system when triggered, depression doesn’t give a hoot (can’t, exhaustion, dehydration, sadness, pity party etc.). These are all human ailments and very painful stuff nobody wants to go thru without benefit of pain relief. I know I don’t. I hope we can get people to understand how much more powerful these drugs are getting and how they change body chemistry so drastically as to make an instant addict out of just about anyone who takes them. Not only that but they are being laced with poison fentynal on the streets. And many other drugs are too now. We have become the nation of out of control everything. I have been sober 29 years this year. Watched the progression of this and am still baffled at why people are still going hard core drugs when they can kill and we all know that by now. RECOVERY is available, for free here in the USA. Just show up. Ask questions, make friends, network, celebrate accomplishments. Learn faith. Get some tools. Get a hug, respect, validation, integrity, confidence, laugh, dance, sing. Etc.

    • Carlos

      Agreed. For me, it was the awful pain, and for those who’ve never been addicted should know, withdrawal from opiates is a different kind of pain as to a sober person getting injured and having 20 staples on your stomach. I had open gallbladder surgery. Getting my gallbladder removed was terrible pain, but it doesn’t compare to opiate withdrawal in my case. Everyone is different, I’m speaking only my experience. At the time I made a decision to let go of the fear that I was going to have to endure, and quit cold turkey, being on a high dose that most would consider beyond the lines. Naturally, in the beginning, when I took my fist 10mg hydrocodone from a bad back injury, it didn’t even touch the pain. 20mg, still no help. 30mg took the edge off and that was all I needed. Note that this was my first time ever taking a narcotic after denying it 3 days in a row from my wife who told me it would help. That led to dependency pretty fast for my back pain didn’t subside for 2-1/2 months. By then I was already addicted and would take them to stay from withrawing. It’s been a little more than a year of being abstinent. I still feel like crap, of course not like the first 2 weeks, but I guess this feeling is something I have to live with. I only blame myself. The sad thing is getting help. I openly admitted and was honest about my addiction with several doctors. What is unbelievable is that most doctors/ Psychiatrists, and even some specialists in addiction medicine are not educated enough on substance abuse. I always was more knowledgeable than the doctor I was seeing, which if you know, they don’t like that. Inferiority complex. I’ve even seen doctors Google a certain medication they didn’t know about. It amazes me how a doctor could not know what a benzodiazepine is. You don’t have to be a specialist to know. You don’t have to be a doctor to know. It’s understandable, nobody can know about every medication, but we’re talking about opiates and benzos here. I mean come on. They shouldn’t be able to prescribe these. In fact I don’t think anyone should be able to prescribe them, unless they’ve walked that path themselves. I’m sorry, is it my body or theirs? They also assume that they know exactly what you need, an ssri, or a physichiatrist that again are able to push whatever medication they want. God forbid if you’re more knowledgeable than a physichiatrist with antidepressants. (Inferiority complex) what a grown adult eh? Post acute withdrawal can last a very long time. I’ll laugh at a doctors face who tells me antidepressants are not habit forming. I literally have to give them a taste of their own medicine, on all levels. I do not boast, people nowadays mistake confidence with being cocky. I am the most modest person I know, but with this subject, I try, I try, to be slow to anger. The U.S. needs help sad to say. Get this straight, nobody is going to help you, only you can help you.

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