The opioid crisis: why are painkillers so dangerous?

Veröffentlicht am: August 01, 2024
Dr. med. Wolfgang Bachmann
Dr. med. Wolfgang Bachmann

General practitioner

Opioid addiction is considered the "fastest growing drug problem" in the USA. Experts now believe that prescription opioids are the leading cause of death among Americans under the age of 50. The death toll is higher than when the HIV/AIDS epidemic was at its sad peak.

For many people, a certain image comes to mind as soon as they hear the word "drug addict". However, all sections of the population are equally affected by addiction to opioids. Opioids are substances with tremendous addictive potential. For this reason, addicts can be found in all ethnic groups, age groups and income brackets. It doesn't matter whether an older adult is taking opioids to relieve their chronic arthritis pain or a teenager is simply trying the drugs. Both are equally susceptible to the long-term damage caused by opioid use.

Most people agree that heroin - currently the most commonly used illegal opiate - is a very dangerous drug. However, many don't realize that legal prescription opiates for pain relief are just as dangerous and are an insidious problem. According to the 2015 National Survey on Drug Use and Health (NSUDH) results, about one in three Americans (about 38 percent) report using a prescription opioid drug at least once during some time within the past 12 months.

Whether hydrocodone, oxycodone, fentanyl, methadone or heroin - the use of opioid preparations and/or illegal drugs is increasingly becoming a serious problem not only in the USA, but all over the world.

Contents

The facts about the opioid crisis

  • In the U.S., about one in three adults (about 38 percent) report using a prescription opioid drug at least once for some time within the past 12 months. (National Survey on Drug Use and Health 2015)
  • 63 percent of patients who were prescribed opioid medications by their doctor, usually for the treatment of chronic pain, report abusing these medications. (New England Journal of Medicine)
  • Opioids are now responsible for more deaths in the USA each year than the HI virus was at the height of the AIDS epidemic.
  • Opioids are not only addictive to a certain group. Addicts can be found in all ethnic groups, age groups and income brackets.
  • Most people know that the opiate heroin is illegal and dangerous. Unfortunately, many people overlook the fact that legal prescription painkillers containing opiates also have enormous addictive potential.
  • Many people become addicted after legally obtaining the medication from their doctor or from a friend who had a legal prescription.
  • As little as 0.25 mg of fentanyl (the strongest opioid) can be fatal and is responsible for a large proportion of opioid overdose deaths.
  • In recent years, more than 52,000 people have died in the USA alone due to drug overdose, of which around 65 percent are attributable to the consumption of opioids.
  • Health authorities are very concerned because the use of prescription painkillers often serves as a gateway to the use of other highly addictive opioid drugs, particularly heroin.

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What is the opioid crisis?

The term "opioid crisis" refers to the growing battle in the US and Canada against addiction to opioid painkillers and illicit opioids such as heroin. The NSUDH study concluded that "the most common types of psychotherapeutic drugs abused (as of 2013) are painkillers, tranquilizers, stimulants, and sedatives - in that order. Painkillers are the most common cause of drug abuse in the prescription drug group."

According to a report published on the website of the New England Journal of Medicine, currently use:

  • Around 5% of adults who are not hospitalized or hospitalized in another facility abuse opioids;
  • Another one percent suffers from a very severe opioid addiction.
  • An almost unimaginable 63 percent of patients who have been prescribed opioid medications by their doctor, usually for the treatment of chronic pain, report abusing these medications.

In recent years, more than 52,000 people have died in the USA alone due to drug overdose, of which around 65 percent are attributable to the consumption of opioids.

The fact that many people become addicted after being legally prescribed the drugs by their doctor is a major cause for concern. Prescription opiate painkillers are responsible for 1.9 million Americans being addicted to drugs. This means that more people are addicted to these opioids than to cocaine and heroin combined. Many people who abuse opioid medications, whether illegal or legal, report that they regularly use multiple substances, especially alcohol, cocaine and prescription opioid painkillers.

Health officials are very concerned because the use of prescription painkillers often serves as a gateway to the use of other highly addictive opioid drugs, especially heroin. According to the Centers for Disease Control and Prevention (CDC), "Heroin abuse and addiction have increased in the United States in recent years across all demographics and age groups."

It is estimated that over 700,000 Americans begin using heroin each year. Many of these people struggle with addiction, depression and withdrawal symptoms. Research shows that nearly 25 percent of people who use heroin become addicted to the drug. White males and those of Hispanic origin between the ages of 18 and 25 who live in large cities are at the highest risk for heroin addiction.

In fact, in the metropolitan areas of 16 states, the rate for overdoses increased by 54 percent. In the Midwest, the rate for opioid overdose increased by 70 percent. The CDC released these troubling numbers in its March 2018 Vital Signs report, which found that from July 2016 to September 2017, emergency departments in 52 regions in 45 states saw a 30 percent increase in patients visiting the hospital due to overdoses. Overall, the rate for overdoses increased by at least 30 percent in all age groups and among both men and women. The report goes on to say that the likelihood of a repeat overdose is particularly high among those who have already overdosed on opioids. Repeat overdoses can be prevented through medication-assisted treatment during the emergency room visit, as well as coordinated efforts between first responders, law enforcement, community members, and pastoral care and drug counseling services.

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Opioids and opiates: What's the difference?

Opioids are drugs derived from opium, the active narcotic compounds of the opium poppy. According to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), "The term 'opioid' used to refer only to synthetic opiates (drugs intended to mimic natural opium but differing in chemical composition from real opium). Today, the term 'opioid' is used to refer to all opiates, including natural, synthetic and semi-synthetic drugs."

Similarly, most people mean one and the same thing when they talk about "opiates" or "opioids". However, a distinction is still sometimes made between "opiates" for drugs naturally derived from opium and "opioids" for synthetic and semi-synthetic drugs. However, both act in a very similar way in the brain.

Which drugs are considered opioids?

Opioids are either natural or synthetic chemicals that bind to receptors in the brain or body and alter thought processes, moods and motor control. The name is derived from the fact that the substances bind to opioid receptors (protein molecules on the membranes of some nerve cells). These receptors are located in the central nervous system and the gastrointestinal tract.

What legal opioid painkillers are currently available?

  • The most important and best known are prescription drugs such as oxycodone (e.g. known under the brand name OxyContin®), methadone, hydrocodone (known under the brand name Vicodin®), buprenorphine and the extremely strong drug fentanyl.
  • OxyContin, the most popular and well-known oxicodone-containing drug, was first introduced to the market in 1996 and is manufactured by Purdue Pharma. The active ingredient, oxycodone, is an opiate derived from morphine that is legally prescribed for pain relief, particularly for chronic pain that requires years of treatment. For example, it is often given to patients suffering from chronic bone loss, neurological degenerative diseases or terminal cancer. OxyContin has a high addictive potential and is considered a category II analgesic (= high abuse potential). It should therefore be prescribed with caution and only to a limited extent.
  • The strongest prescription painkiller currently available is fentanyl, a synthetic opioid painkiller that is significantly more potent than morphine. Fentanyl is known under the brand names Actiq®, Duragesic® and Sublimaze®, among others. Street drugs such as heroin and cocaine can be mixed with fentanyl, which significantly increases the risk of overdose or death. We must also mention carfentanil in this context. This is a powerful synthetic opioid that is legally used as a tranquilizer for large animals and is marketed under the brand name Wildnil®. It is a hundred times stronger than fentanyl - the chemical composition of both substances is very similar - and 10,000 times stronger than morphine.
  • Heroin is the most commonly used illegal street drug in the world that contains opioids. OxyContin and heroin are very similar. Both affect chemical signaling pathways in the brain, particularly dopamine, which leads to the familiar high and temporary feeling of well-being.

How does an opioid addiction develop? What are the risk factors?

Many people become addicted to opioids because of a prescription. Most of them have no intention of abusing the drug. However, as they become physically dependent on it, they find it difficult to stop taking the drug. After a certain time, the body's craving for the drug increases. However, those affected no longer have legal access to higher doses. Once those people have become addicted, many of them turn to other street drugs - fentanyl or other opioids such as heroin. Scientific research shows that the number of opioids dispensed from submitted prescriptions in the U.S. has increased significantly over the past 20 years. The dispensing of prescription painkillers more than quadrupled between 1999 and 2010. Whereas in 1991 there were still around 76 million prescriptions, 20 years later the figure was over 300 million. Every day in the US alone, more than 1,000 people are hospitalized to be treated for side effects due to the misuse of prescription opioids. Since 1999, deaths from prescription opioid overdose have quadrupled. One group of people stands out in particular: men between the ages of 25 and 52.

Drug addiction, whether to opioids or other substances, is influenced by several factors, including upbringing, genetics and environment. According to a report in the journal "Clinical Pharmacology & Therapeutics", drug addiction is influenced by genetics in about 50 percent of cases on average.

Some studies have shown that young patients with back pain or multiple pains are at high risk of abuse. Researchers suspect that a combination of four different variables is linked to the current opioid crisis:

  • Age
  • Depression
  • psychotropic medication
  • Pain impairment

Study results show that patients with these variables are at a higher risk of opioid dependence than those who are not.

The most common risk factors for opioid dependence are:

  • Taking prescription opioids over a long period of time: Many patients who misuse opioids report increased pain and severe pain-related limitations.
  • Drug abuse in the family
  • Abuse of other drugs or alcohol
  • First-time drug use at a young age: Scientists have found that abusing drugs or alcohol as an adolescent or young adult - before the brain is fully developed - increases the risk of addiction later in life. Drug use changes the development of the brain at an early age and can lead to the use of other substances.
  • Men between the ages of 18 and 55: Men are more likely than women to receive prescription opioids for free from family or friends and are also more likely to buy them from a street dealer.
  • Mental illnesses or mood disorders such as depression or anxiety
  • a criminal past or serving a prison sentence
  • forging prescriptions, stealing/scrounging drugs, frequent loss of prescriptions and resistance to changes in medication regardless of side effects occurring

Signs of opioid dependence

Addiction is defined as "a primary, chronic, neurobiological disorder with genetic, psychosocial and environmental factors influencing its development and manifestation. It is characterized by one or more of the following behaviors: impaired control over drug use, compulsive use, continued use despite recognizable harm, and intense craving for more." 

Drug addiction does not develop overnight. Rather, it is a process that is divided into different phases:

  1. First use
  2. improper use
  3. Increased tolerance
  4. Dependence
  5. Addiction

Relapses are also typical of the clinical picture.

Everyone who uses drugs and suffers from addiction has their own story to tell. The side effects associated with drug use, as well as one's risk of addiction and the symptoms associated with withdrawal, vary from one person to another. Nevertheless, some symptoms are more commonly observed in relation to opioid addiction. These include:

  • Severe constipation
  • Mood swings and changes, including anxiety, paranoia and depression, sometimes with a severe course
  • Lethargy, drowsiness and fatigue
  • Nausea and vomiting
  • Loss of appetite, reduced food intake and weight loss
  • Restlessness and insomnia
  • Muscle cramps and pain
  • Fertility problems and irregular menstruation in women
  • Decreased libido and testosterone deficiency in men
  • Exhaustion of the immune system and frequent illnesses
  • Intestinal damage
  • Liver damage
  • obsessive thoughts that revolve around obtaining more drugs: This leads to an inability to concentrate on other things or work.

Physical indications of heroin use include: the presence of pipes, aluminum foil, bags and syringes. Other signs include persistent lying and secrecy, missing valuables in the house and conflicts with the law.

How can an opioid addiction be overcome?

Breaking free from an opioid addiction is probably one of the most difficult experiences you will ever go through in your life. However, with the right treatment, many sufferers manage to successfully break free from their addiction. Many addicts report that they first had to hit rock bottom to realize that they could not go on like this and that fundamental changes were necessary.

The CDC advises authorities in the U.S. to take the following steps to combat the opioid crisis and treat those affected:

Recommended general measures:

  • First of all, the greatest risk factor must be addressed: the high number of prescriptions issued for opioid painkillers. Doctors should prescribe these drugs very carefully, very restrictively and with appropriate precautionary measures.
  • Improving access to treatment and prevention services: This includes medication-assisted treatment (MAT), which is often recommended for people with opioid addiction.
  • Professional training for therapists and healthcare providers in dealing with addiction and withdrawal
  • Increase access to naxolone and expand training on how to administer the drug: The drug can prevent death from overdose. These measures are particularly necessary in regions where drug addiction is a widespread problem.

How can an addict help themselves?

  • To get "clean", you must first cut all ties with people who support your addiction and supply you with the relevant drugs.
  • Seek professional help: a therapist, a doctor or a rehab clinic to stop your drug use and deal with the withdrawal symptoms.
  • Take part in an exit program. Many experts see this as the key to success. These programs usually begin with detoxification and then provide therapeutic treatment supported by a self-help group. Some programs emphasize "The 12 Steps Back to Life".
  • Focus on improving your mental and emotional health by setting goals, making a plan for your future and training for a career that interests you.
  • Find alternative ways to cope with stress and physical pain.
  • If you are suffering from severe physical pain, discuss with your doctor what other medication is available and try to relieve your pain naturally.
  • Symptoms such as discomfort and depression can be alleviated in the following ways: Changing dietary habits, exercise, getting more sleep, managing emotional stress, alternative healing methods such as acupuncture, massage, osteopathic manipulative therapy, and the use of supplements or essential oils.

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How can family and friends help an addict?

Some states in the USA have now passed laws that make involuntary withdrawal possible. This means that family members, with the support of a doctor, can file a petition in court to be allowed to treat an addict against their will. However, this is not always the best way. Concerned friends/relatives should therefore always seek professional help.

Sometimes certain measures help the addict to realize how much the drugs are affecting everyone's lives. Professional mentors try to work together with the family and the drug addict. The group confronts the addict with the situation and offers help, support and specific treatment measures.

Precautionary measures for opioid withdrawal

Many addicts suffer from withdrawal symptoms, which can be very unpleasant and sometimes last for weeks. Withdrawal symptoms can be

  • Abdominal pain, nausea, diarrhea and vomiting
  • Insomnia
  • Excessive sweating
  • Muscle pain
  • Anxiety and restlessness

Manage these symptoms with a doctor who specializes in treating withdrawal symptoms or attend a formal detox program that offers support and safety.

Summary at the end

  • The term "opioid crisis" refers to the growing fight against addiction to opioid painkillers and illegal opioids such as heroin.
  • Signs of addiction may include: Mood disorders such as anxiety and depression; sneaky, paranoid or aggressive behavior; insomnia and restlessness; changes in appetite, weight and digestion; complaints of pain and discomfort.
  • Measures to combat the opioid crisis include: Cutting off contact with people who supply you with the substances, joining a support group, seeing a therapist, attending detox, getting support from family and friends, treating pain naturally, and improving mental/emotional health.

 

Sources (in English):

Squeglia, L. M., Jacobus, J. & Tapert, S. F. (2010, February). The Influence of Substance Use on Adolescent Brain Development. Clinical Electroencephalography and Neuroscience, 40(1): 31–38, doi: 10.1177/155005940904000110

Al-Tayyib, A. A., Koester, S. & Riggs, P. (2017, February). Prescription opioids prior to injection drug use: Comparisons and public health implications. Addictive Behaviors, 65:224-228, doi: 10.1016/j.addbeh.2016.08.016

U.S. Department of Health and Human Services. (2014, September). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-48, HHS Publication No. (SMA) 14-4863, Rockville, MD: Substance Abuse and Mental Health Services Administration, Verfügbar unter: [https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf]

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