- The US is seeing the highest drug overdose death rates ever recorded in history.
- Opioid painkillers are the heart of the problem.
- People are overdosing on prescription drugs from doctors and illegal drugs purchased on the black market.
The path to death can start innocently, with a benign prescription for painkillers from a doctor. But after weeks or months on a powerful drug like morphine, a small percentage of patients will become dependent – a function of innate human wiring.
Every year, thousands of patients receive a prescription for drugs ranging from morphine to fentanyl – and every year thousands of people die from an opioid overdose. Nearly 64,000 lives were lost in 2016.
It is a problem of epic proportions, and it shows no signs of slowing down.
“We’re currently seeing the highest drug overdose death rates ever recorded in the United States,” Anne Schuchat, the acting director for the Centres for Disease Control and Prevention, said on a call with reporters this week. According to a new report that the CDC released on Tuesday, emergency department visits for suspected opioid overdoses climbed 30% from July 2016 to September 2017.
If opioid painkillers were not so widely prescribed, the problem would likely be much less severe, experts say.
A boom in opioid prescribing
Today, people are overdosing both on prescription drugs from physicians, like morphine and oxycodone, and illegal drugs purchased on the black market, such as heroin.
The boom in opioid prescribing began in the 1990s with support from medical groups who claimed doctors were not properly diagnosing and treating severe pain.
An article published in the January 1980 issue of the New England Journal of Medicine appears to have added fuel to that fire by portraying opioids – then known as narcotics – as safe, with a very low risk of addiction or misuse.
Pharmaceutical representatives later used that letter to promote more widespread opioid prescribing, and peddled strong new drugs like OxyContin, which were designed to relieve pain for as long as 12 or 24 hours. Around the same time, medical groups including the American Pain Society and the American Pain Foundation started referring to pain as the “fifth vital sign.”
How opioids work and why they’re addictive
Opioids are distinct among painkillers in their ability to work fast and produce feelings of pleasure. They do so by capitalising on our body’s natural pain-relief system and blocking pain signals from travelling along our nerves to our brain.
In addition to acting on our brain’s pleasure and reward centres, opioids tap into the parts of our brain that play a role in learning and reinforcing behaviour. This is one of the reasons that many neuroscientists understand addiction as more of a learning disorder than a disease – you brain and body learn to want opioids, and at some point that wanting turns into needing.
But other drugs appear to work just as well as opioids – without the deadly side effects.
In a comprehensive, well-designed study published yesterday in the Journal of the American Medical Association, researchers compared how well opioids performed for pain against two popular over-the-counter pain relievers: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (like Advil). After studying how all three drugs performed in random groups of adults over the course of a year, they found that the opioids worked no better than the non-addictive Tylenol or Advil.
When opioids turn deadly
In addition to the pain-relieving qualities of opioids, the drugs also act as powerful sedatives, slowing down our breathing and making us feel sleepy. If someone takes too many, the drugs can actually stop breathing completely and kill.
That potentially fatal outcome is even more likely if someone takes an opioid before or after taking another drug with similar effects, such as benzodiazepine, which can be prescribed to treat anxiety but also slows down breathing.
This is thought to be how Rock & Roll Hall of Fame musician Tom Petty died; he had been prescribed the opioid painkiller fentanyl for hip pain but was also taking an anti-anxiety drug in the benzodiazepine class.
Fake painkillers are another important piece of the overdose puzzle.
Doctors are finally starting to curb how much they prescribe opioids, but many people who’ve come to depend on the drugs are finding other means of getting them. Many pills sold on the black market carry labels for brand-name painkillers like Norco and Percocet but actually contain more dangerous combinations of drugs. Some people are also turning to heroin for relief, as that drug functions similarly in the brain and body.
Because fentanyl is so much stronger than morphine or other painkillers (some estimates say it’s 30 times more powerful than heroin), fake drug makers only need a minuscule amount to create pills with roughly the same effect as Norco or Percocet. That makes their fake drugs cheaper to buy and manufacture – and even more profitable to sell to people who are desperate.
But fentanyl packs a powerful punch, and a tiny bit too much can kill.
Music legend Prince, who died last year from an opioid overdose, may have been a victim of one of these schemes. Pills found in his home were labelled “Watson 385,” a stamp used to identify some hydrocodone-based painkillers, but tests revealed that those pills contained fentanyl instead.
“The bottom line is that no area of the United States is exempt from this epidemic,” Schuchat said.
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