The Nation’s Opioid Epidemic Keeps Death Toll Rising, Experts Say

Daniel Ciccarone, Wilson Compton and David Matia participate in a AAAS Science & Technology Policy Forum panel on the opioid epidemic. | Mark F. Jones/CJVISIONS.com

Deaths by accidental overdose of opioids are rising sharply, due to a new source of more potent, readily available synthetic opioid drugs. Opioid overdoses have already caused the country’s overall death rate to increase in 2015, the first time since 1993, when the country was coming to grips with AIDS. And, “the worst is yet to come,” a drug court judge said during a panel at the 2017 AAAS Science & Technology Policy Forum, which was held March 27-28 in Washington.

The issue may soon get more attention. President Donald Trump appointed New Jersey Gov. Chris Christie on Wednesday to head a new drug addiction commission as part of Trump’s new Office of American Innovation. Christie has been active in addressing opioid addiction in his state and New Jersey now has some of the toughest prescribing restrictions for opioids.

Many people become addicted to prescription opioids and later transition to heroin. While the number of opioid pill overdoses began to decline after 2011, the number of heroin overdoses is increasing in the United States, especially for those aged 20 to 34.

One urgent problem is the increased availability of synthetic opioids called fentanyl, which is being used to increase the potency of heroin and cocaine or, more rarely, is used on its own. Fentanyl is about 80 times more potent than morphine or 30 to 40 times more potent than heroin. The problem is that users do not know how much fentanyl has been mixed into the heroin or other drugs they buy, said Daniel Ciccarone, professor of family and community medicine at the University of California, San Francisco. As a result, they don’t have a good way of knowing how potent the drugs they are taking, which leads to accidental overdoses.

“Supply control is not the only answer. If we stopped looking at this as an illicit drug epidemic and looked at it more as a poisoning epidemic, we would address it differently,” Ciccarone said.

Another problem is the continued stigmatization of addiction, which contributes to lawmakers, criminal justice system officials and insurers underfunding and underutilizing prevention and medical treatment programs.

“Dependency is a disease — it’s a brain disease,” said David Matia, a drug court judge from Cuyahoga County, Ohio. Yet only about one in 10 hospitals have detox centers, he said, and many insurance policies do not cover long-term drug treatment. Exceptions are plans created under the Affordable Care Act and Medicaid, he noted.

Wilson Compton, deputy director at the National Institute on Drug Abuse, said the agency and other federal and state groups are working on ways to make medications for treating opioid addiction more available. First, they are making naloxone, a prescription medication for accidental overdoses, available as needed from pharmacies. Second, the agency is working to increase access to long-term treatments.

There are three approved medications for treating opioid addictions, with more in development. However, only a quarter of people with addictions were even offered them as part of a treatment program in 2014, despite overwhelming evidence of their success, Compton said. Other panelists pointed out that regulations that limit the number of patients a doctor can treat with anti-opioid medications also restrict patients’ access.

“The data is quite clear. People who were started on [an opioid treatment medication] were much more likely to remain in treatment, and those who were not relapsed quickly,” Compton said. “We need to be thinking of how we can change treatment practices.” 

[Associated image: frankieleon/Flickr CC BY 2.0]