Running Head: THE OPIOID EPIDEMIC 1

Paola A. Zuniga

The Opioid Epidemic: Rising in Numbers

The University of Texas at El Paso

THE OPIOID EPIDEMIC 2

Abstract

The opioid epidemic has been occurring since the 1990s and has only continued to escalade

through the years. The epidemic can be outlined into three waves where the epidemic rose

significantly. The three waves include the 1990s with prescription opioids, 2010 with heroin and

2013 with synthetic opioids. This epidemic has no preference on who becomes affected, it can be

people of all races, living wages and social status. There are two factors that have been found to

contribute most to the epidemic: prior drug use and the over prescription of opioids. Since the

1990s when the problems first arose, the numbers in overdose deaths related to opioids have

continued to rise. Several strategies have attempted to combat the crisis but fail to be successful.

Most plans will only address either the supply side or demand side of the epidemic. By leaving

one part out, the epidemic will never be solved. Instead, a multi-strategical plan of action will

need to be enacted to successfully defeat the epidemic.

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The Opioid Epidemic: Rising in Numbers

Every day, hundreds of people are becoming addicted to opioids. Some people, like

Blake Landry from Arizona, began by smoking marijuana and worked her way up to

methamphetamine and eventually heroin (Uhl, 2017 pp. 44). Several more people however,

become addicted to opioids after being injured and prescribed pills such as Vicodin. This

happened to Karen Franklin from California when she got injured at her job and needed

medication to deal with the pain (Uhl, 2017 pp. 44). Instances like these are categorized under

the opioid epidemic.

The opioid epidemic is an ongoing crisis where people all over the world are becoming

addicted to opioids and eventually overdosing on the drug, whether they are prescriptions,

synthetic opioids, or illegal opioids such as heroin. Any person can become affected by opioids

despite their living class or education level. Contrary to popular belief, it is not only people

living in poverty who become addicted, rather, it is people from across the range of income

levels. There have been several famous people such as Prince or Tom Petty who died of opioid

overdose. Although the number of deaths caused from opioids are continuously rising, a large

majority of populations are oblivious to the epidemic. If not addressed soon, the numbers in

opioid related deaths will continue to rise. Through understanding the origins, pertaining facts,

and previous approaches to end the epidemic, a plan of action to address the crisis will be

devised.

Although opioids have been present in America for centuries, the rise in opioid addictions

and deaths became evident beginning in the 90s. The Center for Disease Control and Prevention

outlines the crisis through three waves in spikes of opioid overdoses. As seen in Figure 1, the

first major spike began in 1990 with an increase of prescribed opioids. This includes any natural
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opioids, semi synthetics, and methadone, which can all be prescribed by doctors. Prescription

opioids are used for patients with moderate pain usually after surgery, injury or with diseases

such as cancer. However, during the 90s, it became increasingly common to prescribe opioids to

patients with chronic pain and even non-cancer

patients. Despite knowing their long-term side

effects, doctors continued to prescribe them,

creating the first wave of the Opioid Crisis. The

second wave, about two decades later in 2010, was

led by the illegal opioid, heroin. During this wave,

the use of heroin increased among all people,

including men and women of all age groups. Even

Figure 1 Three waves of the Opioid Crisis
Opioid Overdose: Data Analysis and Resources. groups such as women, people with private
(2019).Center for Disease Control and Prevention.
Retrieved from
https://www.cdc.gov/drugoverdose/data/analysis.html
insurance, and people with high incomes spiked in

heroin use despite having some of the lowest rates in history. Following closely with only a

three-year gap, came the third wave of the opioid crisis in 2013. This wave was caused by the

use of synthetic opioids including Fentanyl, which can be up to 100 times more potent than

morphine. Fentanyl is prescribed by doctors, but the increase in deaths is rooted in illegally

produced fentanyl. Illegally made fentanyl is made through the combination of heroin and/or

cocaine (Opioid Overdose, 2018).

As mentioned previously, the opioid crisis can affect anyone despite their income level or

lifestyle. Contrastingly, a correlational research study conducted by the Office of Assistant

Secretary for Planning and Evaluation, found that counties with higher poverty rates and higher

unemployment rates also had higher opioid sale rates (Gherter & Groves 2018). However, when
THE OPIOID EPIDEMIC 5

taking into account that higher rates in poverty and unemployment indicate a higher general

population, the correlation between the crisis and economic opportunity was ultimately found to

be negative. Without consideration of the general population rate, it is easy to confuse the

correlation originally found. This misunderstanding is what causes the misconception of people

living in poverty being more prone to opioids. Ultimately, the ethnic group, poverty level, living

wage or culture have no effect on who is affected by opioid use. What does contribute to the use

of opioids are factors such as the over prescription of opioids and prior drug use.

Many people who have gotten severely injured, have surgeries, or have illnesses like

cancer will often be prescribed opioids such as OxyContin (Jones, Bruera, Salahadin, & Hagop,

2018). OxyContin is a type of opioid and is highly addictive. Once they run out of their

prescription, they will be more than likely addicted and will return to the doctor for another

prescription. Once they have tirelessly obtained opioids through their doctors, they will look to

purchase the drug elsewhere, even if that means illegal opioids. It was found that an estimated

amount of 20%-30% of patients prescribed opioids for chronic noncancer pain misuse them. Of

that percentage, 8%-12% of the patients progressed to develop an opioid use disorder (Jones et

al., 2018). This finding indicates that opioid prescriptions are contributing to the amount of

people becoming addicted to opioids. Several pharmaceutical companies including Purdue

Pharma and Johnson & Johnson have been sued because of their contribution to the crisis,

despite knowing the side effects that come with the prescriptions (Jones et al., 2018).

Besides the pharmaceutical impact, people can also become addicted to opioids,

especially heroin, due to prior drug use and addiction. According to The Center for Disease

Control and Prevention (CDC) people already addicted to opioid painkillers are 40 times more

likely to become addicted to heroin (2018). As seen in Figure 2, people addicted to alcohol,
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marijuana or cocaine are also at risk to becoming addicted to heroin. Nonetheless, when a person

has history of drug use, their likelihood of later use of opioids is increased, similar to the true

story mentioned earlier of Blake Landry from Arizona, who began using marijuana and later

moved on to using opioids.

Together, the over

prescription of opioids and

the prior use of drugs can

lead to the eventual use of

opioids. Most cases of

overdose have been found

Figure 2 Likelihood to become addicted to the illegal opioid, heroin due to prior drug use
Opioid overdose: Understanding the epidemic. (2018). Center for Disease Control and
Prevention. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html to have a history of one of

the two contributing factors present before the overdose (Data Analysis and Resources, 2019).

Since the 1990s when the crisis first began, the deaths related to opioid overdoses have

continuously gone up. Based on statistics found by the CDC, the number of overdose deaths

involving opioids in 2017 was 6 times higher than in 1999 (2018). Besides the increase in deaths,

the total number of drug overdose deaths between 1999-2017 is astonishing. More than 700,000

people have died of a drug overdose from 1999-2017. 68% percent of the 70,200 people from

2017 alone were involved in an opioid overdose (Understanding the Epidemic, 2018). Also

found by the CDC is the statistic that “On average, 130 Americans die every day from an opioid

overdose.” (2018). In 2016, the Department of Health and Human Services found that 116
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people died every day from opioid related crises, as

seen in Figure 3(Konschak, 2018). From this

information, it is evident that from 2016 to 2017,

the number of overdose deaths related to opioids

have gone up on average by 14 people. The

tremendous amounts of people whose lives are

being lost to opioids will only continue to rise if not

addressed correctly. Several actions have already

Figure 3 Opioid Epidemic by the Numbers
Konschak C. (2018). The evolving roles of health IT in been taken in attempt to minimize the use of
fighting the opioid crisis. Divurgent. Retrieved from
https://www.divurgent.com/knowledge-center/health-
opioids, yet the numbers continue to rise.
it-opioid-crisis/

An article written at the University of Pennsylvania by a blog from the Leonard Davis

Institute, titled Health Policy$ense, states why deaths continue to rise. Health Policy$ense

believes the policies being implemented either focus on reducing the demand or the supply of

opioids (Glickman & Weiner, 2019). By only reducing either the demand or the supply, the

policy leaves out one part of the problem. Reducing only the supply of opioids would reduce the

number of people who could develop an opioid use disorder (OUD) but fails to address the

people who have already developed the disorder. Vice versa, reducing only the demand of people

who already have an OUD will fail to focus on the people at risk. Therefore, Glickman and

Weiner of Health Policy$ense concluded that in order to end the crisis, a strategy that involves

prevention as well as treatment is necessary (2019). Another article which can be found in the

Yale Medicine Magazine, suggests a similar strategy to combat the crisis. Dr. Davis Fiellin who

was interviewed for the magazine article says, “We need to decrease the availability of all types

of opioids, and we need to increase the availability of the most effective forms of treatment.”
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(Hamm, 2018). Along with this suggested strategy, Hamm believes society needs to first stop

shaming people and instead provide empathy to people with opioid use disorder as they are not

“junkies” but instead people with a disease (Hamm, 2018). Once society sees them as people

with a disease, solutions including treatment will be erected. Lastly, the Journal of Policy

Analysis and Management had another strategy to combat the crisis. Their plan focuses primarily

on the treatment of people who have already developed an OUD. They suggest that there should

be more access to the opioid antagonist, naltrexone, to repel opioids from the brain’s opioid

receptors (Saloner & Barry, 2018). The overall plan focuses on the use of other medications to

help reverse the overdose and to lose their addiction.

After analyzing the different strategies suggested by experts, a plan that combines all the

strategies to combat the opioid crisis should work efficiently. The main part of the strategy

should coincide with the statement from Health Policy$ense, that we need to address both the

supply side as well as the demand side of the crisis (Glickman & Weiner, 2018). For the supply

side, the number of opioids distributed to the populations must be reduced. It also needs to be

ensured that pharmaceutical companies are providing proper warning on labels on any opioids

they do prescribe. This will be made possible by laws being enforced throughout the nation. As

seen in the lawsuit of Purdue Pharma, after having to pay a fee for the erroneous portrayal of the

addiction risk, their sales in opioids went down significantly (Jones et al., 2018). Secondly, to

address the demand, proper treatment needs to be available. It was found that residential

treatments without medication and other behavioral therapies had poor success rates (Saloner &

Barry, 2018). Therefore, it will be more beneficial to use medication such as Naltrexone which is

a known opioid antagonist with high success rates. By simultaneously using these tactics, the

number of opioids in circulation will decrease significantly, bringing the opioid crisis to an end.
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References

Ghertner, R., & Groves, L., (2018). The opioid crisis and economic opportunity: geographic and

economic trends. ASPE Research Brief. Retrieved from

https://aspe.hhs.gov/system/files/pdf/259261/ASPEEconomicOpportunityOpioidCrisis.pd

Glickman, A., & Weiner, J. (2019). Why deaths continue to rise in the opioid epidemic. Health

Policy$ense. Retrieved from https://ldi.upenn.edu/healthpolicysense/why-deaths-

continue-rise-opioid-epidemic

Hamm, S. (2018). New strategies for combating the opioid epidemic. Yale Medicine. Retrieved

from https://medicine.yale.edu/news/yale-medicine-magazine/new-strategies-for-

combating-the-opioid-epidemic/

Jones, G.H., Bruera, E., Abdi, S., & Kantarjian, H. M. (2018). The opioid epidemic in the United

States-overview, origins, and potential solutions. Cancer, 124(22), 4279-4286. doi:

10.1002/cncr.31713

Konschak C. (2018). The evolving roles of health IT in fighting the opioid crisis. Divurgent.

Retrieved from https://www.divurgent.com/knowledge-center/health-it-opioid-crisis/

Opioid Overdose: Data Analysis and Resources. (2019). Center for Disease Control and

Prevention. Retrieved from https://www.cdc.gov/drugoverdose/data/analysis.html

Opioid overdose: Understanding the epidemic. (2018). Center for Disease Control and

Prevention. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html

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Saloner, B., & Barry, L. C. (2018). Ending the opioid epidemic requires a historic investment in

medication-assisted treatment. Journal of Policy Analysis & Management, 37(2), 431-

438. doi:10.1002/pam.22047

Uhl, M.X. (2017). Who Is Using Opioids and Opiates? Available from

https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1930387&site=eds-

live&scope=site