In 2017, there were over 70,000 drug overdose deaths in the U.S. Around two-thirds of those deaths involved an opioid – including legally prescribed and illegal substances.
It’s unfortunately common to read or hear about heroin related overdoses in the news. Some of us may even have a friend or loved one who has struggled or is currently struggling with opioid addiction.
It’s understandable, then, that heroin is often the first thing that comes to mind when hearing terms like “opioid abuse” or “the opioid epidemic.” However, illicit drug use is only one part of opioid addiction and the current opioid crisis afflicting the U.S. For example, opioid abuse often begins with prescription painkillers.
It’s important to fully understand the extent of opioid addiction in order to have a clearer picture of both substance use disorder and the larger, nationwide opioid epidemic we currently face.
In this article we’ll explain what opioid addiction is, what can cause it, and how it’s treated, and attempt to answer any other questions you may have about opiates.
Common opioid drugs
While heroin was responsible for about 15,400 overdose deaths in 2017, this number accounts for less than one-third of all opioid-related overdoses. In fact, prescription opioid overdose accounted for around 17,000 deaths in 2017. Meanwhile, fentanyl – a synthetic opioid – accounted for an additional 28,400 deaths according to data collected by the CDC.
Common opioids include:
Opioids are often prescribed to patients by their primary care physician as a pain management treatment – often after a surgery or injury. However, opioid prescription has been on the rise in the U.S. since the 1990’s. More than 191 million opioid prescriptions were filled in 2017 alone. This includes generic and name brand drugs like Vicodin (hydrocodone) and OxyContin (oxycodone).
Despite being legally prescribed, these medications can be highly addictive. According to the CDC, as many as twenty-five percent of patients receiving long-term opioid therapy eventually struggle with opioid addiction.
Prescription opioid abuse can lead to illicit drug use – the CDC says about three out of four new heroin users reported misusing prescription opioids prior to heroin.
Heroin, also known as diamorphine, is a semi-synthetic drug that is derived from morphine. Some countries still administer diamorphine for medical purposes; however, in the U.S. it is not accepted as medically useful and its manufacture, distribution, and sale has been illegal since 1924.
Heroin comes in several forms, most often:
- A fine white powder
- Rough, off-white granules
- Larger, light brown “rocks”
Heroin use has increased sharply over the past decade, with 494,000 Americans reporting heroin use at least once in the past year.
In recent years, synthetic opioids, namely illicitly manufactured fentanyl, have rapidly risen as the leading cause of overdose deaths.
Fentanyl is a synthetically produced opioid that, when manufactured and prescribed legally, is used to treat severe pain, most often in cancer patients. The drug is typically administered as a transdermal patch or lozenge. However, recently, fentanyl has seen a sharp increase in illegal production and sale for use as a recreational drug. This has resulted in a sharp increase in opioid overdose.
The CDC reports 28,400 Americans died from overdoses involving synthetic opioids other than methadone – in most cases fentanyl. This drug is particularly dangerous as it’s considered 50-100 times more powerful than morphine.
To make matters worse, illegally produced fentanyl is often mixed with heroin, cocaine, or other substances to increase its effect. This can be done without the user knowing. As a result, overdose deaths from synthetic opioids have increased by 264% between 2012 and 2015, according to the CDC.
Signs and symptoms of opioid abuse
The signs of opioid abuse will vary from person to person. These signs will also vary in whether they are physical or psychological. Below are some common examples of both types of signs.
Physical signs of opioid use can include:
- Slowed or shallow breathing
- Loss of coordination
- Slurred speech
- Intense nausea or vomiting
Opioids can have profound effects on the brain, which often cause psychological and behavioral signs, such as:
- Drastic mood swings
- Changes in sleeping patterns
- Lowered motivation
- Abandoning responsibilities and relationships
The number of opioid overdose deaths has steadily increased for over a decade, resulting in more than 400,000 deaths in the U.S. If you believe someone has overdosed on an opioid, it is a medical emergency. Contact 911 immediately if they show one or more of the following symptoms:
- Loss of consciousness
- Irregular breathing or no breathing
- Slow and erratic pulse or no pulse
- Unresponsive to outside stimulation
- Limp, unresponsive body
When a person stops using an opioid after regular or heavy use, withdrawal symptoms often occur. Someone experiencing opioid withdrawal may suffer a number of undesired physical and mental effects as their body filters out the drug. Withdrawal symptoms will typically increase in intensity over time until the process is complete.
Initial symptoms of opioid withdrawal – beginning within 24 hours:
- Muscle aches and pain
- Restlessness and inability to sleep
- Heavy sweating
Later symptoms of opioid withdrawal – beginning after the first day:
- Abdominal cramps
- Intense nausea and vomiting
- Rapid heartbeat
- High blood pressure
Withdrawal is difficult and can often result in relapse and, commonly, overdose. After a user stops taking an opioid, their tolerance level lowers. If they return to opioid use during or immediately following withdrawal, they may use the same amount of the drug as they did before, resulting in an overdose.
This is why it’s important to seek treatment, especially when going through withdrawal. Treatment can involve medicines, counseling, and support.
Causes and risks of opioid addiction
Substance use disorders, including opioid addiction, can have a variety of causes. These causes range from environmental to behavioral or genetic.
According to the National Institute on Drug Abuse, as much as half of a person’s risk of becoming addicted to a substance may be dependent on their genetic makeup. Several genetic factors of opioid addiction can include:
- Family history of addiction or substance misuse
- Co-occurring mental health disorders (depression, anxiety, etc.)
- Risk-taking or thrill-seeking personality
In some ways related to a person’s genetic factors are their behavioral factors. Certain behavioral traits can increase an individual’s risk of opioid addiction, including:
- Personal experience with drug use or experimentation
- Previous criminal activity
- Regular or heavy tobacco use
Equally as powerful as genetic and behavioral factors are the environmental and social risk factors. These can include:
- Poverty or unemployment
- Stressful life or family situations
- Severe pressures at home or at work
Lastly, it’s important to understand that one of the leading causes of opioid addiction is prescription misuse. Be certain to closely adhere to prescription instructions as set by your physician or primary care provider. If you have a personal or family history of substance use disorder or mental illness, be sure to talk to your doctor about whether opioid painkillers are right for you.
The national opioid epidemic
The national opioid epidemic has been labeled as a public health emergency by the United States Department of Health and Human Services. According to the Department of Health, over 130 Americans die each day from opioid overdoses. Additionally, the CDC has confirmed that opioids account for two-thirds of all overdose deaths.
The opioid crisis began in the early 1990s. Since the beginning of the crisis, the CDC has identified three distinct waves of opioid-related deaths. These waves include:
- The first wave: beginning in the 90s with an increase in prescription of opioids to patients.
- The second wave: beginning around 2010 with a sharp increase in heroin overdose deaths.
- The third wave: beginning around 2013 with an even sharper increase of opioid deaths as a result of the production of illicit synthetic opioids, namely fentanyl.
As a result, between 1999 and 2017, over 400,000 people died as a result of opioid abuse. To put it another way, in 2017, the number of opioid overdose deaths was six times higher than in 1999.
The opioid crisis in Philadelphia
Urban areas are particularly susceptible to the opioid epidemic, and Philadelphia has been no exception. Since 2010, opioid related deaths have increased each year. However, overdose deaths did begin to slow in 2018. Despite this, opioid related deaths are still high and the city has begun taking measures to fight opioid abuse and save lives.
Part of the city’s response includes educating the public on the realities and dangers of the opioid crisis, expanding access to treatment, and increasing law enforcement resources.
Another growing concern is the sharp increase of methamphetamine use throughout Philly. According to The Philadelphia Inquirer, an increase in the supply of methamphetamine in the city has driven down its price, leading many opioid users to cut the substance in with opioids like heroin and fentanyl. As a result, Temple University’s Episcopal Hospital saw a 33% increase in the amount of patients testing positive for meth in 2018 over 2017.
In order to curb the number of overdoses, the Mayor’s Taskforce recommends taking three actions:
- Call 911 – If you believe someone is overdosing, you should immediately call 911. The Good Samaritan Law protects individuals who report overdoses.
- Get naloxone – Also known as the brand name Narcan, naloxone blocks the effects of opioids and helps a person to start breathing. It is used to treat opioid overdose in emergency situations.
- Seek treatment – Whether you or someone that you know has overdosed, it’s crucial to seek treatment to help prevent another overdose from occurring.
Treatment for opioid use disorder
It’s important to seek treatment for yourself or someone you know who is suffering from opioid use disorder. There are several types of treatment available for opioid abuse. We will outline them below.
Outpatient programs are designed for individuals using drugs or alcohol and who are in need of frequent sessions to maintain abstinence. Common features of outpatient rehab include:
- Patients do not have to stay at the facility for the duration of treatment.
- Treatment programs are run during the day.
- Typical programs are 10-12 hours throughout the week.
- Often an opportunity to gain control over substance use before beginning further inpatient treatment.
Rehab After Work offers multiple outpatient rehab and therapy programs across all 12 of our Pennsylvania locations.
Inpatient rehab treatment is more intensive than outpatient programs. In general, common inpatient features include:
- Program lengths between four weeks to several months.
- During the program, patients remain in the facility.
- Access to around the clock support.
- Allow for focus solely on recovery, while cutting out the distractions of daily life.
- Can take place in a hospital or in a more homelike environment at a residential treatment center.
Medication assisted treatment
Medicated-Assisted Treatment (MAT) combines counseling and behavioral therapy with FDA-approved medications to treat substance use disorders. A commonly used medication is Vivitrol, a non-addictive, non-narcotic extended release medication approved by the FDA for the treatment of opioid dependence.
Addiction counseling typically occurs one-on-one with a licensed therapist. Counseling can take place as part of a treatment facility program or as a standalone service offered by private therapists. Addiction counseling often utilizes cognitive behavioral therapy (CBT) and other techniques to help patients change existing behavioral and psychological patterns.
Reach out to us to discuss which treatment option may be best for you.