By Ashley Fuoco Antonelli, Contributing Editor
The United States opioid epidemic killed more than 47,500 people in 2017. That's an average of 130 opioid-related overdose deaths per day. Even though preliminary CDC data suggest the rate of opioid-related drug overdoses might be falling, substance use disorder and public health experts warn the epidemic is far from over, and some worry the White House Office of National Drug Control Policy's latest strategy isn't innovative or aggressive enough.
So what's really going on with the opioid epidemic, and what's the best way for policymakers and other stakeholders to combat it? I spoke with top experts in the field to find out.
The faces of the opioid epidemic
First, it's important to understand the true extent of the opioid epidemic. While the media has focused on opioid-related overdose and death rates, Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management, told me he views the U.S. opioid crisis as bigger than its death count.
In order to curb overdose deaths and addiction rates, Kolodny explained you first need to understand whom the epidemic affects. According to Kolodny, the opioid epidemic encompasses three main groups:
- U.S. residents using heroin, who largely became addicted to heroin in the 1970s, generally are ages 50 and older, are more likely to be black than white, are more likely to be male than female, and are most heavily concentrated in urban areas "that were hit hard with heroin in the 1970s";
- U.S. residents who largely are in their 20s and 30s and white, who first became addicted to opioids post-1996 from using prescription opioids, either for medical purposes or recreationally, and "wound up switching to heroin" because they could no longer access prescription opioids; and
- U.S. residents who are generally ages 60 and older, white, and became addicted to prescription opioids post-1996 when taking the drugs for medical reasons, and who have continued taking prescription opioids for chronic pain.
A focus on Rx opioids
Many efforts to combat the epidemic have focused on ways to reduce prescription opioids, but data show that the addiction epidemic extends beyond prescribed drugs, as deaths involving illegal opioids such as heroin and illicitly manufactured fentanyl have been increasing.
Robert DuPont—president of the Institute for Behavior and Health, who has been working to combat substance use disorders in the United States for more than 50 years—told me that illicit opioids have long been a problem in the United States. He said the "focus on prescription opioids," while very important, "sort of distracted" attention away from the country's illicit drug market.
What's the best way to combat the opioid epidemic?
To truly combat the epidemic, Kolodny said the United States needs interventions, policies, and public health strategies that will help prevent opioid addiction and ensure people with opioid-related substance use disorders receive effective treatment, including medication-assisted treatments such as buprenorphine.
But he noted that those strategies should be adapted to fit local communities, as the opioid epidemic "looks very different in different parts of the country." For instance, Kolodny said, "Fentanyl is by far [the] number one" cause of opioid-related overdose deaths, but "we don't have a fentanyl problem in every state."
He added that targeting "specific drugs could be important on a local level in terms of informing public health strategy," but the "national focus needs to be on prevention and treatment."
DuPont similarly said the national focus on combatting the opioid epidemic should look beyond prescription opioids. "For the last 50 years," the United States has gone after "one drug at a time," he said, even though many drug users use multiple drugs.
That's not to say health care providers shouldn't continue to focus on reducing opioid prescriptions, Kolodny said. "Aggressive, high-dose prescribing was killing thousands of patients each year," he said, adding that health care providers still are "massively overprescribing, which means too many Americans are getting addicted" to the drugs.
But when it comes down to it, Kolodny said the strategies the United States needs today are the same strategies it's needed all along. "Make treatment [for opioid misuse] easier to get than pills, or heroin, or fentanyl," he said.
Kolodny said new funding streams could help those efforts and ensure everyone who needs treatment for an opioid-related substance use disorder can access it "regardless of insurance status or ability to pay." He noted the Ryan White HIV/AIDS Program, which helped more U.S. residents access antiretroviral medications, could serve as a model.
DuPont noted that, in addition to treatment access, patients need support. Finding ways to get patients' families more involved could help patients stay in treatment and in recovery, DuPont said.
Don't be fooled by the trends
DuPont urged that, even if the opioid epidemic begins to improve, the public and policymakers shouldn't take their attention away from it.
"One of the things that happens in the media and our political lives is that if something's going up, it's scary, and if something's going down, it's uninteresting," he said.
DuPont said opioid addiction is a problem that's "going to be with us forever," because patients will always have pain, and some will use opioid medications "inappropriately and addictively." And that leaves policymakers and public health officials in a complicated balancing act. It's vital they continue to "raise awareness" among prescribers and the public "about the risks associated with the non-medical use" and the misuse of opioids, while at the same time being careful to ensure patients who need prescription opioids can obtain them and know how to use them properly, DuPont said.
Access our new resources on the opioid epidemic
The opioid epidemic is a complex, multi-dimensional public health problem. Use this list of helpful resources on how hospitals and health systems can play a role to treat opioid addiction and prevent further increase in opioid abuse.
- Tool: Opioid Population Profiler
- Infographic: 9 imperatives for hospital and health system executives to confront the opioid epidemic
- Report: Get 15 best practices to reduce unwarranted opioid prescribing