We see news updates about the opioid crisis almost daily: opioid deaths are at a higher rate than ever recorded, and it is receiving attention at every level of government. But what do you need to know about this topic? What are the many components to this crisis and why is it occurring? 

A national emergency
The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency in 2017. Here are some staggering facts on this issue:

• Deaths due to opioid overdose increased more than five-fold since 1999. (Source: Centers for Disease Control and Prevention)
• Reported opioid deaths exceeded the peak number of deaths due to guns, HIV, and motor vehicle accidents. (Source: The New York Times)
• Americans consume more opioids than any other country. (Source: The United Nations International Narcotics Control Board)

Substance use disorder is a disease
There are many known risk factors associated with developing a substance use disorder (SUD), the clinical term for “addiction.” Experts recognize substance use disorder as a disease that can affect anyone, regardless of age, profession, religion, gender or income. It is time to reconsider the stereotype that individuals suffering with SUDs are dirty, weak, rebellious and lack self-control. Many individuals who become dependent on these powerful substances are professionals and do not fit the media’s image of an addict. This disease often starts by using pain medications as prescribed by a doctor, and developing a dependence on the medication that spirals out of control. Children born to parents with SUDs have an increased risk of developing an addiction themselves compared to children born to parents without any SUDs.

Opioids affect the brain in a powerful way
Research has shown that opioids affect the pleasure center of the brain with a flush of dopamine. Although opioids cause physical dependence, this psychological dependence is what creates the long-term problem. An individual might experience physical withdrawal with discomfort lasting a few days. However, the psychological effects can last a lifetime. The brain hijacks the individual’s rational thinking, and the drive to receive those pleasurable jolts of dopamine overtake the person’s ability to resist. You might be surprised to learn that a similar process occurs when your phone dings to alert you of a text message, or when you score points in a video game.

Opioids include many types of drugs
Although originally intended to treat pain or provide relief from other addictions, opioids can be readily abused and lead a person down a seemingly never-ending cycle of abuse. Opioid prescription pain relievers include oxycodone (OxyContin, Percocet), hydrocodone (Vicodin, Norco), morphine (MS Contin), hydromorphone (Dilaudid), meperidine (Demerol), fentanyl (Fentora), methadone and codeine. 

Prescription opioids are becoming harder to get
The focus on the opioid crisis has resulted in a number of policy and rule changes, and physicians are under tremendous pressure to reduce the number of prescriptions they write for opioid pain relievers. Patients find themselves looking for other outlets for their pain medications, such as turning to friends, coworkers or strangers to get them. Strangers may sell counterfeit medications that look like the real thing. It is common for desperate individuals to look to heroin, which is cheaper and easier to get, even when they never would have considered using heroin before.

Fentanyl
Enter Fentanyl, a powerful opioid medication that is showing up as a component in counterfeit pills purchased on the street. Fentanyl is 100 times more powerful than morphine. Carfentanyl, a chemical cousin of fentanyl developed for large animal treatment, is 10,000 times more powerful than morphine. Fentanyl and its cousins are easy and cheap to obtain on the internet from overseas producers (mainly in China) and are being added to counterfeit medications to boost the potency at a lower cost. The trouble is that a buyer may have no idea they are buying “fake” Vicodin or Norco strengthened with fentanyl. The manufacturers of these counterfeit pills are not required to meet quality control standards. They may not thoroughly mix the concoction, leaving pockets of fentanyl not fully blended. This could result in a single pill containing large amounts of the drug and other pills with none. Additionally, scales and measuring tools may not be calibrated properly. These uncontrolled manufacturing methods could easily result in lethal doses of heroin, fentanyl and carfentanyl.

Additional complications
According to the National Alliance on Mental Illness, an estimated 7.9 million people have both a substance use disorder and a mental illness, which is referred to as a co-occurring disorder or comorbidity. Treating for each disorder is more difficult, because one medical condition may mask the other.

You probably know someone affected by this disease
In 2014, the Substance Abuse and Mental Health Services Administration reported that 20.2 million adults in the U.S. had a substance use disorder, affecting 10 to 14% of the population. That means at least one in ten of the people in your life are impacted.

Treatment is effective
A combination of medication and behavioral therapies is effective in the treatment of substance use disorders, and can help some people to sustain recovery. Overall, the appropriate choice of therapy will depend on several factors, including:

• Severity of the substance use problem
• Patient motivation to stop using
• Level of dysfunction in the patient’s environment
• Patient’s level of cognitive functioning and level of impulse control
• Presence of co-occurring mental illness in the patient 

Oftentimes, a mental health professional will incorporate feedback from the patient as well as individuals close to the patient, when developing a treatment plan. Research supports positive reinforcement over punishment for treating addiction, which reinforces the concept of the disease. 

You can find treatment referral and information for yourself or a loved one at the Substance Abuse and Mental Health Services Administration (SAMHSA) website: samhsa.gov, or by calling the National Helpline: 1-800-662-HELP (4357). The lines are open 24/7.