Deaths from opioid overdoses are skyrocketing across America.

An estimated 44 Americans die every day from prescription opioid and heroin overdoses, and at least two per day occur in Virginia.

The Centers for Disease Control and Prevention (CDC) has labeled prescription drug abuse an “epidemic” in America with prescription opioid overdoses more than quadrupling since 2000. Virginia has not escaped the opioid crisis. In 2014, for the first time, prescription opioid and heroin overdoses killed more Virginians than automobile accidents.

A Crisis Arises from Pain
An estimated 30 to 40 percent of Americans are reported to suffer from acute or chronic pain. A decade ago, the healthcare industry made a major effort to better manage chronic pain’s disabling effects, causing opioid analgesics, including oxycodone and hydrocodone, to become the most commonly prescribed class of medications in the U.S.

This increased availability of prescription opioids has been a contributing factor to today’s opioid epidemic. These pain relievers present an intrinsic abuse and addiction liability because they are similar to, and act on the same brain systems affected by, heroin and morphine. Well-intentioned treatment for pain has triggered addiction in people who may have been genetically disposed to dependency.

A second factor is the reintroduction of heroin in a different form—that which can be smoked or snorted. Two or three decades ago, heroin use was solely by intravenous injection. The easier administration of heroin has increased its use, more than doubling usage among young adults, ages 18-25, in the past decade.

A certain percentage of heroin abusers began with a legitimate prescription for painkillers, became addicted, but were no longer able to get opioids because their health was better, or they were abusing their prescriptions. They had to find another source for their addiction, and that source was heroin.

Overdose Deaths
Why are people dying? Opioids, when used repeatedly over time, induce tolerance—a physiological change that requires a higher dose of the same substance to achieve the same effect. With opioid dependency, the tolerance reverses very rapidly, contributing to a greater risk of an overdose death during a relapse to opioid use after a period of abstinence. Opioid users who do not realize they have lost their tolerance may use the same amount as they did before a recovery period, overdose and die.

Prevention and Treatment

Public health initiatives have been launched throughout Virginia and across the nation to educate, prevent and treat opioid addiction and curb the mounting number of overdose deaths.

Physicians across the country are working to manage patients’ pain with alternatives to oxycodone and hydrocodone. With the growing body of research supporting medication assisted treatment, Pathways and other treatment centers also have better ways to manage withdrawal and cravings from opioid dependence. Examples of medication-assisted treatment include suboxone, naltrexone and methodone (only in licensed opioid treatment programs). Methodone assisted treatment always includes counseling and support.

Friends and family members of opiate and heroin abusers also are being educated about the life-saving drug naloxone, which reverses the effects of opioid overdoses. The non-addictive medication is administered through nasal spray or auto-injector. Naloxone is becoming more readily available and can be purchased without a prescription in pharmacies such as CVS.
Communities across the country can have an impact on this epidemic by raising awareness, reducing the stigma associated with addiction, educating young people about the risks associated with opioid and heroin abuse and changing prescribing patterns to reduce the availability of pharmaceutical opioids.


BY BRENT MCCRAW, M.ED.
DIRECTOR, CENTRA ADDICTION & RECOVERY SERVICES

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