The number of deaths due to the opioid crisis in America are rising faster than ever.
Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.
The death count is the latest consequence of an escalating public health crisis: opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs. Drug overdoses are now the leading cause of death among Americans under 50.
Ohio, which many believe to be the epicenter of the crisis has a number of true horror stories like this.
In 2016, Summit County had 312 drug deaths, according to Gary Guenther, the county medical examiner’s chief investigator — a 46 percent increase from 2015 and more than triple the 99 cases that went through the medical examiner’s office just two years before.
There were so many last year, Mr. Guenther said, that on three separate occasions the county had to request refrigerated trailers to store the bodies because they’d run out of space in the morgue.It’s not unique to Akron. Coroners’ offices throughout the state are being overwhelmed.
These estimated deaths for 2016 alone exceed the total number of American deaths from the entire Vietnam and Iraq Wars.
And unlike previous drug epidemics that affected poor residents of big cities, the carnage has spread to both suburban and rural America, affecting both the rich and poor.
It is fair to say that the magnitude of this crisis has been underreported in favor of other stories like those about the daily exploits of the Tweeter-in-Chief. That’s shameful.
For us to try to come up with solutions to this crisis, we need to have an understanding of how we arrived at this desperate time in our history.
I believe the definitive book on this subject is Dreamland: The True Tale of America's Opiate Epidemic which I highly recommend to the reader who wants to learn more about this issue. Most interesting is the story the author conveys about a cottage industry based in Xalisco, Mexico which grew to serve many small to mid-sized American cities by selling heroin employing a business model similar to pizza delivery!
But in the meantime, here is an abridged history of how this all came about:
A number of years ago back in the 90s, strong opioids were seldom prescribed – even for those with acute pain due to the fear of addiction.
Then the pendulum swung violently the other way when Purdue Pharma started an advertising campaign to convince doctors that their new product, OxyContin was suitable to prescribe for any general pain complaints a patient might have. And best of all, they said the worries about addiction were greatly exaggerated. If you’re going to tell a lie, tell the big lie! Purdue knew these pills were addictive but lied about it. In May 2007 the company pleaded guilty to misleading the public about OxyContin’s risk of addiction and agreed to pay $600 million in fines. Its president, top lawyer and former chief medical officer also pleaded guilty as individuals.
Doctors with a newfound religion to dutifully treat pain prescribed 'Oxys' to just about anybody who complained about pain. Many became hooked. Others took advantage of the plentiful pills stored in medicine cabinets everywhere to get high. Some doctors started what were known as ‘pill mills’ which served wholesale numbers of patients complaining of pain in order to get a prescription. The opioid epidemic was on!
Then the Law of Unintended Consequences took over. With all of these people addicted to prescription painkillers, the powers that be tried to solve this problem in the only way they knew how – make it much harder and more expensive to get these pills. But just making something illegal doesn’t make the problem go away. Instead, these addicts discovered that a closely related drug, heroin was freely available and relatively cheap. So instead of being hooked on prescription drugs whose content was strictly regulated, users were turning to street heroin with questionable strength and ingredients.
One of those ingredients that crept into the heroin supply was fentanyl, a synthetic opioid that is many times more powerful than heroin. This has led to a huge spike in overdose deaths in the last year or two.
Now more desperate, public officials are pledging more money to fight this crisis. But just throwing money at the problem doesn’t solve anything. And the so-called War on Drugs which relies on law enforcement as the solution has done little more than give America the highest incarceration rate in the world.
Based on recent experiences to fight all of this addiction or at least mitigate the harm, it appears that there is good news and bad news. The good news is that while there is no panacea, there are some promising solutions to at least make some headway to help dig us out of the hole we are in. The bad news is that these solutions are being held back due to ingrained attitudes and prejudices along with (surprise) a lack of money to pay for it all.
Of immediate help is a drug called naloxone, aka Narcan that a policeman, firefighter, or paramedic can use to save the life of someone who has overdosed on heroin. Unfortunately, if the overdose is due to the much more powerful fentanyl, the lifesaving drug may be overmatched. And as an example of the above mentioned ingrained attitudes is an Ohio sheriff who incredibly, refuses to have his deputies carry Narcan.
Most promising is what is known as Medication Assisted Treatment (MAT). In conjunction with therapy, a substitute opioid is administered that relieves the withdrawal symptoms but without the addict getting high. This allows the addict to function normally and perhaps even work until someday, hopefully kicking the addiction.
The most well known drug is methadone which has been around since the 1940s. Although it is effective, it must be administered daily at a certified distribution center which often, nobody wants near where they live.
A better alternative is Suboxone (buprenorphine and naloxone) which has a great advantage in being able to be prescribed and then picked up at the pharmacy. However, Suboxone can be difficult to obtain because it can only be had from a limited number of federally certified doctors who in turn are limited by law to how many patients each can treat. It is ironic that while the addiction treatment is so controlled, OxyContin, the source of much of the addiction has no such controls.
Unfortunately, there is still stubborn cultural resistance to MAT because some still erroneously see it as nothing more than substituting one addictive opioid for another.
To ultimately make headway against the opioid crisis we have to reduce the demand that is driving everything.
To help prevent more accidental addiction as a result of legitimate pain treatment, comprehensive plans for treating the pain need to be used instead of just bringing out the prescription pad to prescribe an opioid. In addition, there is ample anecdotal evidence that medical marijuana may be able to more safely take the place of prescription opioids in many instances.
More importantly, we need to find out why so many Americans feel a need to get high. Many blue collar workers devastated by the loss of jobs and whole industries have suffered "deaths of despair." But why are so many more affluent Americans also falling into the trap of addiction? Is something missing in their lives too? Maybe we need to acknowledge that this opioid crisis in America may not be the disease but is in fact a symptom of underlying social and economic problems that make America not such a happy place to live in for all too many. How else do we explain why America leads the world in drug overdose deaths - by a lot.
There is this observation on Page 330 of Dreamland that all too many Americans may well be suffering due to increasing isolation from one other.
The most selfish drug fed on atomized communities. Isolation was now as endemic to wealthy suburbs as to the Rust Belt, and had been building for years. It was true about much of a country where the streets were barren on summer evenings and kids no longer played Kick the Can as parents watched from porches. That dreamland had been lost and replaced, all too often, finally, by empty streets of bigger, nicer houses hiding addiction that each family kept secret.
…the antidote to heroin wasn’t so much naloxone; it was community.
Nobody can do it on their own. But no drug dealer, nor drug cartel, can stand against families, schools, churches, and communities united together.