The opioid crisis is everywhere!

At least once a week something shows up in the news relating to the opioid crisis. President Trump not too long ago declared it a national health emergency.

How did it come to this? And what are we going to do about it?

Those are the big questions, aren’t they?

To be honest, we don’t think it will be solved overnight, but there are many people attempting to apply their solution to the problem. We have government agencies doing what they think is right and health professionals doing what they think is right. Unfortunately, they don’t always agree on what is right.

Another component is the issue is relatively new in the eye of the public. If we look back into U.S. history regarding substance use, alcohol was the big thing in the 1920’s with the prohibition act, then it was marijuana with the release of the movie reefer madness, followed by cocaine use in the 70’s and 80’s all of which during that time opioids were seen as “ok” because they came from a doctor. Take a look at That 70’s Show with Kitty making comedic allusions to the use of her “happy pill”. Many women used it and it was not seen as a real issue.

Now today, it’s a different story. It has gotten way out of hand for thousands of people. And what are we going to do to stop it?

Let’s start off this subject with the facts to better understand how bad it really is.

The Facts

In the U.S. the opioid crisis is getting a lot more recognition due to the high overdose deaths. In 2017, according to the NIH (National Institute on Drug Abuse), there was an estimate of 72,000 drug-related overdose deaths. That number is higher than deaths related to pneumonia, nephritis, and self-harm (suicide).

Utah alone is ranked 7th for the highest opioid deaths in the U.S. In the most recent report released by the NIH, Utah had approximately 466 opioid-related deaths which equates to 16.4 deaths per 100,000 people. The national average is 13.3 deaths per 100,000 people. The number of opioid prescriptions written was 73.1 per 100 people…that is crazy! And to think it keeps increasing year after year.

What is the U.S. government going to do?

After the announcement by President Trump in 2017 about the opioid epidemic being a public health emergency the white house in conjunction with the HHS (Human Health Services) created a 5 prong approach to combating the epidemic. The 5 points are as follows:

  • Improving access to treatment and recovery services;
  • Promoting the use of overdose-reversing drugs;
  • Strengthening our understanding of the epidemic through better public health surveillance;
  • Providing support for cutting-edge research on pain and addiction; and
  • Advancing better practices for pain management.

Since the day of the announcement, there have been several things done to move this plan forward. Some great and positive changes were enacted recently which provided the grounds for combating the opioid epidemic. In 2018, the house passed the H6 opioid epidemic bill which sets the ground rules for combating the opioid epidemic and pledges the federal governments support. Here is an overview of that bill.

H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, is a bipartisan bill that will help in our overall efforts to combat the opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting our communities, and bolstering our efforts to fight deadly illicit synthetic drugs like fentanyl.

The federal government has continued to increase its efforts in combating the opioid epidemic. Another example was the grant awarded to the state of Utah after President Trump’s announcement in 2017. The government awarded Utah $1.7 million dollars in order to help fund the efforts done by the Utah state government in combating the opioid crisis. The $1.7 million was dispersed between 11 Utah rehab centers which allowed the funds to be immediately utilized by the health professionals. For many, this was seen as a great act in an effort to support the states, especially the states who rank high in overdose deaths (Utah being 7th).

However, not all government efforts have a positive outcome. With the 5th point “advancing better practices for pain management” (from their 5 prong approach to combating the opioid crisis) the government’s solution was to increase the scrutiny on opioid dispensing pharmacies. Pharmacies now push back much harder on PCP’s (Primary Care Physicians) when they submit an opioid prescription to be filled. In many cases, the pharmacy will not fill the prescription.

This has created a situation where many PCP’s have discontinued prescribing opioids to chronic pain patients. Because of this many people suffer due to their lack of pain relievers. Here in Utah at White Tree Medical, we have seen an increase in our heroin user-patient base. Heroin is easily found on the street and has a much lower cost than opioid pain pills. Heroin is the drug many chronic pain patients have begun using.

What are the health professionals saying?

Let’s approach this question with a lighter tone. In Netflix’s series Bill Nye Saves The World Bill invites Dr. Carl Hart as a guest in his episode relating to addiction. Dr. Hart is a professor of Psychology at the University of Columbia. He specializes in addiction-related topics and provides many people with a better understanding of addiction.

In the episode, Dr. Hart addresses the government involvement in the opioid epidemic by stating that there needs to be less hysteria surrounding the talk of addiction. He believes that the government should stay out of it and leave it up to the health professionals, those who are trained in the field, to find a solution to the issue. Dr. Hart believes that addiction can be reversed.

In the article by Helaina Hovitz she recaps the key takeaways of the episode very clearly. She states,

“The episode goes on to differentiate between addiction to substances and behavioral addictions such as shopping and gambling. A cutaway segment features an in-person visit to a lab in St. Louis set up to look like a casino, complete with clock-less walls and a cold temperature. In this lab, researchers conduct MRI’s in order to study the brain’s response to certain stimuli and activities related to the act of gambling.

The big takeaway: Change is possible. The same way the brain changed when it became addicted, it can change back.

Nye also hosts a panel discussion about addiction treatment featuring Cara Santa Maria, neuroscientist Dr. Carl Hart, and an officer of the law in Ohio who says that in his precinct, they help people get sober rather than just locking them up, and out of 2,400 “clients” who are part of that program, there is an 81% success rate of people now living clean. Among many other salient points, Cara Santa Maria emphasized the necessity for individualized treatment options above and beyond 12-step, which doesn’t have a great success rate; and Dr. Carl Hart advocated for less hysteria and moralizing and more comprehensive assessments, pointing out that the majority of people who use drugs—including so-called “hard drugs” like heroin and methamphetamine—do not become addicted.”

Many health professionals (like Dr. Hart) believe the same thing. However, wouldn’t it be best if the government supported the health professionals with money and left the science up to them?

What can I do about it?

Our suggestion to you is to educate yourself. Learn about the advantages and disadvantages of opioids. Teach your friends, kids, parents, whoever will listen to you and make sure they understand how to make an informed healthy choice when it comes to utilizing opioids.