The Opioid Epidemic by Jasmin Zaman

          It is as easy as breaking your arm after a hard hit in a football game. It is as easy as landing wrong from a jump and tearing your ACL (anterior cruciate ligament). Becoming addicted to opiate drugs is as quick and easy as the doctor who signed you a prescription for them with no intention of turning your life into a living hell. Thousands of people, including recovering addict, Johnathan Maresca, are in complete opposition of abusing opiates one day, and the next they are at risk of being just another statistic: one of the 64,000 Americans that die from overdosing on opioids every year, with numbers only rising (Pratt, Santhanam). Maresca says, "I had built [the drugs] to be such a monster in my mind that when [I tried them] … [they were] so opposite of what I had built it up to be that it almost took me by surprise" (Pratt).  Shockingly, the amount of deaths associated with opioid abuse exceed those who die from vehicle-related accidents, and gun homicides in a year combined (Santhanam).  In October of 2017, president Trump declared the opioid crisis “a national, public emergency under federal law,” which displays the extreme prevalence of the opioid issue today (1). While this epidemic is solvable, it is not only going to take time, but "the mobilization of government, local communities, and private organizations" to fix (1).

            Opioids are pain-relieving medications most commonly prescribed to treat the one in ten Americans suffering from chronic illness (Pratt). They include prescribed pain medications such as morphine, oxycodone, codeine, and hydrocodone; synthetic drugs such as fentanyl; and the illegal drug heroin. Opioids work in the bodies nervous system by interacting with opioid receptors that affect the brain’s pleasure system and regulate pain (Carroll). They have mood-altering effects to reduce one’s emotional response to pain 100 to 1000 times stronger than what their natural hormone levels can do (Pratt). This is what makes these drugs such powerful and highly addictive painkillers.

            Opioid history dates to over 200 years ago when a German chemist discovered a way to isolate the sap of the opium plant and acquire morphine (“The History of Opioid Use in the United States”). The findings soon made their way into prescribed, and over the counter medications, and were often used to relieve injured civil war veterans of their pain (1). Furthermore, in 1898, Bayer Company began the production of the “wonder drug,” heroin, which was first used as a cough suppressant (Moghe). In the 1970’s, opioids such as Percocet and Vicodin came on the market, and in the 1980’s pharmaceutical companies launched major campaigns promoting these powerful drugs (1).  Perhaps, these campaigns were prompted by a New England Journal of Medicine article that stated, "the development of addiction is rare in medical patients with no history of addiction" (“Inside the Worst Drug-Induced Epidemic in US History”). These campaigns made doctors very comfortable prescribing such medications, and patients confident in what they were taking. In 1996, the opioid epidemic that we face today started with the release of OxyContin, and from 1995 to 1996 the number of painkillers prescribed jumped by eight million (Moghe).

            Obama explains that the main reason it took so long for the opioid crisis to become an urgent topic is that for so long the nation viewed it more as a criminal law problem than a public health issue (“Prescription for Change: Ending America’s Opioid Crisis”). In 2003, even the government was spending over a billion dollars more on law enforcement (6.7 billion) than on treatment (5.2 billion) (1). Today, viewpoints are shifting from regarding opioid addiction as a crime to understanding that it is a disease (1). The sad, but true reality of this shift is mainly due to addiction becoming prevalent in white communities that have more power to facilitate change (1). Sometimes this power doesn’t come from their actions, but rather the notion that Americans are more likely to see the opioid crisis as a disease (instead of a crime) when whites are suffering (1).

            Understanding the distinction between dependence and addiction is significant (“Physical Dependence and Addiction”). In short, dependence is the withdraw one suffers after stopping a drug and can be easily managed (1). On the other hand, addiction is a disease that causes compulsion to the point where one loses control over their life (1). Donald Fleming, who is seeking rehabilitation at the Jericho House in Sautee, Georgia, says; “I wouldn’t be able to work, drive, or take a shower… without [my drugs] it was almost impossible” (Pratt). Therefore, one must understand that drug addiction is “not a moral weakness or a lack of willpower…”, but “a chronic disease accompanied by significant changes in the brain” (Hardee). Surgeon General, Vivek Murthey, tells the Washington Post, “I am calling for a culture change in how we think about addiction” (Chen). Individuals who become addicted to opioids will tell you that they hate what has happened to them, but they don’t know a way out. Without their daily doses of opioids their body will go through painful, and sickly withdraws that includes vomiting, nausea, chills, fatigue and even depression that can last for weeks.

            The massive numbers of those becoming addicted to opiate drugs favors no single subgroup (Santhanam). There is no race, sex, rural or suburban residences, or even age excluded from the equation (1). Anyone can become addicted (1). This includes the one baby every half an hour in the United States who is born with Neonatal Abstinence Syndrome (withdrawal infants experience caused by exposure to drugs in their mother) (Martin).  However, the agonizing stress placed on these vulnerable lives begins long before they even take their first breath. Drugs taken by the mother during pregnancy crosses the placenta and prenatally causes 55% to 94% of all exposed fetuses to become addicted in the womb (Smith). Carla Saunders, head neonatal nurse at East Tennessee’s Children’s Hospital’s Detox Center, explains how those affected “have really bad jitters... irritability, vomiting, diarrhea, [and] stomach cramping” (“Drug-Dependent Infants Detox at Tenn. NICU”). The way to relieve this excruciating pain is to give the babies the narcotic back, and then slowly wean them off it; a process that can take weeks or even months (Martin). The even sadder reality is that while mothers of these children were fully aware of the risks associated with maternally using opiates, sometimes the guilt of this just wasn’t enough (Martin). The drugs were entirely too powerful. In fact, nurses working in a neonatal care unit in Indiana report cases where mothers admit to shooting up heroin in the parking lot right before delivering their baby (1). Through this, it is plain to see how opioids are so easy to make themselves a number one priority against all of one’s morals and values.

            Not only are children enduring physical pain, but they are also being exposed to unhealthy and neglected lifestyles at the most critical stage in all human development -childhood. With lack of adequate guidance and nurturing these children may face distresses, along with social and behavioral issues for the rest of their life (“Addiction Affects Everyone”).  U.S. Senator, Joe Manchin, visited Oceana middle school in West Virginia where he was met with the touching stories of children born into addicted families (1). Perhaps, one story shared by a twelve-year-old girl exemplifies the awful magnitude of the opioid crisis (1). Her step-father had held a gun to both her mother and her own head because of her mother’s refusal to use drugs that he was taking (1). She ends with the sight of her stepfather shooting himself right after murdering her mother by injecting her with three rounds of OxyContin (1). Shanda Lester, the principal of Oceana, explains how many children in situations such as this one, “don’t know another world exists, and to them, this is normal” (1). Another child, Ben Horton, suffers from post-traumatic stress disorder, aggression, and sleep apnea which is largely the result of horror movies he was made to watch as his father injected himself with heroin (“The Young Victims of America's Opioid Epidemic”). It seems unfair how such innocent lives must experience tragedies that many of us never even will. Lacking sturdy foundations at home can also put these children at a disposition for drug or alcohol abuse later in life.

            Furthermore, these children are usually pried from the unstable hands of their addicted guardian (or guardians), and will contribute to the foster care system’s flooding new faces (Simon). In 2015, about 274 thousand children entered foster care in the United States, and in less than a year, this number grew to 437 thousand (“Opioid Crisis Straining Foster System as Kids Pried from Homes”). While welfare agencies are working as hard as they can, the demand for homes and resources has gotten so large that in some cases kids are being placed to sleep in social workers offices (Lachma). Others are having to move from home to home, never allowing them time to make any real connections (Simon). These children face worsening feelings of neglect as time progresses, and it is making the opioid crisis that much harder on everyone.

            Social issues directly related to the opioid epidemic are drowning this country not only in humanitarian aspects, but also America’s economy through an increase in both criminal justice and healthcare costs, as well as straining the job market. In the twenty years before 2013, statistics estimate that the lives lost associated with the opioid crisis cost all economic factors of the economy nearly 78.5 billion dollars (“How the Opioid Epidemic Affects the Economy”).

            The increase in crimes that the government is cracking down on is primarily fueled by the eighteen percent of convicted criminals who are trying to obtain money to purchase street drugs, and the gang-related incidents involved in the illegal drug trade (“How the Opioid Epidemic Affects the Economy”). Individuals are stealing by breaking into homes and participating in violent acts to feed their addiction. In addition, to house and feed incarcerated drug offenders, it is costing every taxpayer about fifty-two dollars annually (“How the Opioid Epidemic Affects the Economy”). Georgia’s Drug Detox Organization says, “Even if you don’t know someone currently abusing or addicted to opioids...it is an absolute fact that the epidemic has affected your life through your wallet” (1).

            Medical care costs have also increased at alarming rates. Insurance companies pay out, on average, five times greater for opioid abusers than those who do not abuse them (“How the Opioid Epidemic Affects the Economy”). Also, the cost of treatment for those abusing opioids including detox centers, rehabilitation, and medication amounts to about $20,000 per person (1). The economy is also taking a hit by the increasing demands for nurses, doctors, and medical supplies as the opioid crisis worsens (1).

            Lastly, the ravaging effects of this drug crisis are contributing to struggles within the job market including rising worker’s compensation costs, and the lack of healthy and willing employees (“How the Opioid Epidemic Affects the Economy”). In fact, these issues are estimated to cost employers $25.5 billion annually (1). There are many reasons that individuals who abuse painkillers often are unemployed, or not even looking for a job. Those at risk of failing drug screenings won’t apply in the first place, and often feel it is easier to ask others or engage in crime for money. An addict interviewed in a VICE documentary says, “...I give everything to the disease... and I wind up on the street with no friends, no family, no one to turn to” (“Fentanyl: The Drug Deadlier than Heroin”). Furthermore, those who do work, and abuse painkillers typically have trouble holding a job and are often too dope sick to even function while there. This can then lead to an increased risk of workplace injury. Today, many companies have done away with their drug testing system (Noguchi). Nate Miller, the owner of Express Employment Professionals that places workers at local manufacturing companies says, “it’s not necessarily the best practice, but it is something that they do because they need people, and they need them so badly" (1). Not only are companies struggling to find workers, but sometimes when they do these workers are participating in illegal activity while on the job (1). Metal parts maker Mursix Corporation, for example, caught 300 employees dealing drugs on their factory floor (1). This hindered the company’s development by having them refocus efforts on implementing new procedures to prevent this from happening again (1).

            Finding a solution to this ravaging epidemic is anything but easy. There is no one overlying approach for solving it; however, it is evident that involvement from all areas of society and across the entire nation is crucial. Solving this opioid crisis requires efforts toward treatment solutions for those already addicted, as well as attention towards preventing people from becoming addicted in the first place. Currently, the two main options for patients who seek help include medical assisted treatment and detoxification.

            You may feel uneasy to learn that many physicians who are “supposed to be saving our lives,” are actually causing us harm (“What Can Solve the Opioid Epidemic in America?”). Many professionals prescribing opiates lack adequate knowledge of the power of the drugs.  Anesthesiologist, Dr. John Dombrowsk, says anesthesiologists are currently working to educate physicians and surgeons on great post-operative care (“What Can Solve the Opioid Epidemic in America?”). Furthermore, many professionals have become conniving in the way in which they run their practice because their salaries are dependent on their popularity (1). Because opiates are quick to relieve people of their pain before they become addictive substances, patients will refer their friends to the same doctor fueling the same type of treatment (1). No longer can we rely on professionals to be the ones educated on various treatment options, all individuals being effected  by this epidemic need to acquire substantial knowledge to work towards solving this issue.  Perhaps, an educated community is the most important component to finding a solution to treating those who already have been addicted.

            Pharma-therapy based treatments, such as the use of Naltrexone, Methadone, and Sydoxone have become increasingly controversial. Many view this approach as replacing one drug with another – which sounds contradicting for anyone lacking knowledge on the reasoning behind it (“Medication-Assisted Treatment Overview: Naltrexone, Methadone & Suboxone”). These medications work to stabilize the brain and allow people to feel better in the state of sobriety while having the energy to support a new healthy lifestyle (“Medication Assisted Treatment Opiates and Alcohol”). Dr. Edwin A. Salsitz, attending physician in the Mount Sinai Beth Israel , Division of Chemical Dependency, supports this argument by explaining that medications “are replacing short acting opioids causing damage to the brain, with a long acting opioid which aims at stabilizing the brain” (“Medication-Assisted Treatment Overview: Naltrexone, Methadone & Suboxone”). Naltrexone works by blocking opioid receptors (“Medication Assisted Treatment Opiates and Alcohol”). Therefore, if one were to relapse while using this medication, they will not receive a high (1). Methadone acts as a replacement therapy that suppresses cravings, lessening the effect of an opiate withdraw (1). Lastly, Suboxone contains both buprenorphine, which works to produce less of a euphoric effect when attaching to opiate receptors, and Naloxone that acts as a blocker (1). These drugs are taken as part of a complete treatment program which includes regulation, counseling, and psychosocial support (1).

            The main controversy concerning medication as a solution to opioids is due to the risk of people becoming addicted to the treatment itself. However, by using proper dosages and working with a licensed practitioner this risk can be reduced significantly (“Why I Treat Opiate Addiction with Opiates”). In fact, brain imaging reveals that there is an area of the brain in actively using opiate addicts that lights up as opposed to those who do not use (“Clinical and Radiological Findings in Methadone-Induced Delayed Leukoencephalopathy”). Studies have shown that after 6 months of Methadone treatment, the brain of an addict can reveal that of someone who does not use (1). This is sufficient evidence to conclude that while a patient is being treated for their opiate addiction with medication, the neural issue in their brain is being fixed (1). Furthermore, Dr. Nora Volkow, director of the national institute of drug abuse says, “overwhelming evidence shows that Suboxone improves outcomes in people with opioid use disorders, and that about 32% come clean after 42 months of [it]” (Macy). This evidence supports that targeting individuals addicted to opiates through medications may be a realistic way to treat this issue.

            Attending a detoxification center, the other most common form of treatment, requires an individual to have complete abstinence from opioids, leading to painful withdraw symptoms. Here, the patients are monitored with a doctor on site, and after their completion they may be admitted into a rehabilitation program. Dr. John Zipperer, a pain management doctor of over 20 years in Anchorage, reveals that 97% of those who go into detox end up relapsing, and this is a reason medicinal therapies are then implemented (“Why I Treat Opiate Addiction with Opiates”). It seems as if throwing addicts into what is called “cold turkey” may not be the easiest, nor the most sufficient way to help an opioid addict.

A solution regarding the financial side of the opioid epidemic should also be addressed. An article published in the New York Times revealed how a panel of thirty experts – made up of credible doctors, directors in drug control and opioid treatment, and researchers – would spend 100 billion dollars over a period of five years to solve the opioid crisis (Katz). While there were disagreements how funds should be divided between treating addiction, and trying to prevent it in the first place, the consensus revealed four major areas of concern (1). These areas and their respective percentages of the 100-billion-dollar budget are as followed: 47% in treatments, including pharma-therapy and attention to the issue in prisons; 27% for demand that includes education, community development, and post-incarceration support; 15% for harm reduction towards areas such as Naloxone carrying requirements, surveillance, and drug checking; and 11% on supply aspects such as prescription monitoring, police forces, and interdiction (1). The panel also conversed on the significance of combatting the divisions between public health, and law enforcement (1). Ultimately, the nation needs to focus their efforts on individuals needing help, rather than spending time in disputes against one another.

Another approach to a solution is for physicians to encourage alternative treatments instead of immediately prescribing opioids for their pain. One approach is an immersive video game developed under Dr. Hunter Hoffman, a research scientist in medical engineering at the University of Washington School of Medicine, called “SnowWorld” (Hellerman). Hoffman conducted experiments in healthy volunteers using a metal device that calibrates and cautiously delivers heat to the brain that it interprets as “pain” (1). The results reveal that pain is reduced by 30%-50% through distracting the mind (1). Hoffman says, “...pain requires attention, and for some reason, going into the computer world takes a lot of attentional resources” (1). Currently, “SnowWorld” is being used by burn patients at Harborview and Shriners Hospital for Children in Galveston, Texas (1). More technologies such as “SnowWorld,” may help many cope with painful chronic conditions and regular appointments that require uncomfortable physician work.

Another therapy, the implementation of Colorado’s Alternative to Opioids Project (ALTO), is also on the rise  (“Colorado Opioid Safety Pilot Results”). In a six-month pilot project conducted in 2017, ten hospitals located in Colorado implemented the ALTO project into their emergency rooms (1). This approach combines the use of trigger point injections guided by ultrasounds, nitrous oxide, non-opiate patches, and non-addictive anesthetics for pain (1). The goal of the project was to decrease first-line treatment for opioid use by fifteen percent, and the results were overwhelming (Daley). The hospitals were successful in cutting down opiate use by an average of 36 percent (1). In fact, this number amounts to 35,000 fewer opioid administrations than the same six-month period in 2016 – a number that can have significantly positive effects on the reduction of opiate overdoses and addictions (“Colorado Opioid Safety Pilot Results”). Claire Duncan, a clinical nurse coordinator in the Swedish Medical Center emergency department hospital in Colorado, describes how a cultural change is needed (1). She comments that physicians and staff have to change their conversations with patients to model ways to “treat your pain to help you cope with your pain to help you understand your pain,” rather than just discussing medication (Daley). Dr. Don Stader, an emergency medicine doctor and associate medical director at Swedish Medical Center in Englewood, Colorado, makes a powerful statement as he quotes, “...I think if we did put this [ALTO] in practice in Colorado and showed our success that this would spread like wildfire across the country” (1). It is evident, that long-standing physician prescribing behaviors need to be restructured towards resolving the opioid epidemic. If implemented across the nation, ALTO, could be one of the largest factors in solving this alarming crisis.

Camus and Absurdity

Albert Camus, confronted one of the fundamental questions of life: the problem of suicide (“Camus: The Absurd Hero”). He wrote, "There is only one really serious philosophical question, and that is suicide. Deciding whether or not life is worth living is to answer the fundamental question in philosophy” (1). In relation to opioids, Camus would comment that they are absurd because people continue to rely on them and search for a meaning of life through their effects. He would agree that those who use opiates, in an abusive manner or not, are ultimately trying to fight their pain and prolong their inevitable death. Camus believes that once the absurd has been recognized, there are three ultimate choices one can make: committing suicide; revolting against the absurd; or distracting themselves from what is happening (“Camus: The Absurd Hero”). In the case of the opiate epidemic, this respectively means a person who is addicted can: end their life because their chronic pain and the miserable path associated with opiates is too much to withstand; try to resolve their opiate use manage pain through alternative treatments; or continue to use opiates, never wanting to address that their addiction is in fact an issue. By Camus’s philosophical ideas, the opioid epidemic could never be solved because the diversity of this this nation will not allow it (“Camus: The Absurd Hero”). He thinks that because the world is searching for so many answers, there is no ultimate answer to settle the chaos associated with the epidemic. According to him, professionals are wasting their resources by spending millions of dollars searching for a solution to the opioid crisis- one that they will never find. Camus would also affirm that through the opioid crisis, people are finding their reasoning through life in areas such as faith and illusions when in fact they are just intrinsic comforts.

The opioid epidemic is leaving thousands of families, and friends each year devastated by the loss of a loved one. No longer will the joys in life be able to be celebrated in their presence, nor will memoires be made with them.  Opiates, what once were marketed as non-addictive and safe, have proven to ultimately control anyone’s life, effecting humanitarian and economic areas of the entire nation. Finding a solution to this epidemic is urgent, and everyone is desperate for answers. Ending this plague is going to take the effort, and collaboration of the “government, local communities, and private organizations” in finding alternative treatment options, and educating one another (Santhanam). If we do not continue to address both treatment and prevention options associated with opiates, the toll it may take on society will be unimaginable.  

Works Cited

“Addiction Affects Everyone.” PBS, Public Broadcasting Service, www.pbs.org/video/addiction-affects-everyone-43qm7x/.

 “Camus: The Absurd Hero.” YouTube, 26 Jan. 2015, youtu.be/aAb7nwtHvTU.

Carroll, Aaron. The Science of Opioids.

Chen, Angela. Addiction Is a Brain Disorder, not a Moral Failing, Says Surgeon General. 17 Nov. 2016.

“Clinical and Radiological Findings in Methadone-Induced Delayed Leukoencephalopathy.” Journal of Rehabilitation Medicine - Clinical and Radiological Findings in Methadone-Induced Delayed Leukoencephalopathy - HTML, 4 June 2014.

“Colorado Opioid Safety Pilot Results.” The Colorado Opioid Safety Collaborative, 2017, pp. 1–11.

Daley, John. “Ten ERs In Colorado Tried To Curtail Opioids And Did Better Than Expected.”Kaiser Health News, 23 Feb. 2018, khn.org/news/ten-ers-in-colorado-tried-to-curtail-opioids-and-did-better-than-expected/.

“Drug-Dependent Infants Detox at Tenn. NICU.” ABC News, ABC News Network, abcnews.go.com/Nightline/video/drug-addicted-infants-detox-tenn-nicu-16759741.

“Fentanyl: The Drug Deadlier than Heroin.” 22 July 2016.

Hardee, Jillian. “Science Says: Addiction Is a Chronic Disease, Not a Moral Failing.” Is Addiction a Disease? Science Says Yes, 19 May 2017.

Hellerman, Caleb. “Finding Alternatives to Opioids.” PBS, Public Broadcasting Service, 31 Aug. 2017, www.pbs.org/wgbh/nova/next/body/opioid-alternatives/.

“How the Opioid Epidemic Affects the Economy.” Georgia Drug Detox, 3 Oct. 2017, georgiadrugdetox.com/resources/opioid-epidemic-affects-economy/.

“Inside the Worst Drug-Induced Epidemic in US History.” Performance by Rick Leventhal, 10 Apr. 2017.

Katz, Josh. “How a Police Chief, a Governor and a Sociologist Would Spend $100 Billion to Solve the Opioid Crisis.” The New York Times, The New York Times, 14 Feb. 2018, www.nytimes.com/interactive/2018/02/14/upshot/opioid-crisis-solutions.html.

Lachman, Sherry. “The Opioid Plague's Youngest Victims: Children in Foster Care.” The New York Times, 28 Dec. 2017.

Macy, Beth. “Addicted to a Treatment for Addiction.” The New York Times, The New York Times, 28 May 2016.

Martin, Nick. “Babies Born Hooked On Heroin: Special Report.” Sky News, 7 Sept. 2015, news.sky.com/story/babies-born-hooked-on-heroin-special-report-10347175.

“Medication Assisted Treatment Opiates and Alcohol.” 1 Apr. 2016, www.youtube.com/watch?v=2CIqcEqsjoE.

“Medication-Assisted Treatment Overview: Naltrexone, Methadone & Suboxone.” 17 June 2013.

Moghe, Sonia. “Opioids: From 'Wonder Drug' to Abuse Epidemic.” CNN, Cable News Network, 14 Oct. 2016.

Noguchi, Yuki. Opioid Crisis Looms Over Job Market, Worrying Employers and Economists. 7 Sept. 2017.

“Opioid Crisis Straining Foster System as Kids Pried from Homes.” NBCNews.com, NBCUniversal News Group, 12 Dec. 2017.

 “Physical Dependence and Addiction.” The National Alliance of Advocates for Buprenorphine Treatment, www.naabt.org/addiction_physical-dependence.cfm.

Pratt, Savannah, director. Addicted: The Opioid Epidemic. 2 Dec. 2017.

“Prescription for Change: Ending America’s Opioid Crisis.” 11 Oct. 2016, www.mtv.com/episodes/heir4r/prescription-for-change-prescription-for-change-ending-america-s-opioid-crisis-ep-1.

Santhanam, Laura. “WATCH: Donald Trump Declares Opioid Crisis a Public Health Emergency.” PBS, Public Broadcasting Service, 26 Oct. 2017.

Simon, Scott. “The Foster Care System Is Flooded with Children Of The Opioid Epidemic.” NPR, 23 Dec. 2017.

Smith, Fran. “Babies Fall Victim to the Opioid Crisis.” National Geographic, 19 Oct. 2017.

“Solving the Opioid Crisis in America.” 9 Aug. 2017, www.youtube.com/watch?v.

“The History of Opioid Use in the United States.” Performance by Dr. Andrew Kolodny, 19 Apr. 2017.

“The Young Victims of America's Opioid Epidemic.” The Wall Street Journal, Dow Jones & Company, 15 Dec. 2016.

“What Can Solve the Opioid Epidemic in America?” Fox Business, Fox Business, 8 Aug. 2017, video.foxbusiness.com/v/5535704186001/#sp=show-clips.

“Why I Treat Opiate Addiction with Opiates”. 11 July 2015.