Since 1999, over 560,000 people in the United States have died from an opioid-related overdose, millions have faced addiction, and many more have misused opioids of various types. In fact, in 2017 alone, nearly 10 million people misused prescription opioids. The role of prescribed opioids in this crisis cannot be understated, but how did medications that were supposed to help people become such a problem?
The prevalence of opioid prescription misuse
What are opioids?
Opioids are a class of drugs that have pain-relieving and euphoria-inducing effects similar to those produced by the opium poppy. They bind to opioid receptors in the brain, which block the transmission of pain signals between the brain and the rest of the body. These drugs come in both illicit and prescription forms; this range includes heroin, morphine, and oxycodone. Most opioids are considered addictive and have a high potential for misuse.
Still, it’s important to note that opioids serve an important medical purpose, especially for easing the immediate agony from traumatic and severe pain. While doctors are much more cautious about prescribing opioids these days, it’s not black and white.
How are they used?
Opioids have been used in various forms for centuries, and they’ve been used in Western medicine to treat pain since the 1800s. Nowadays, they’re most often prescribed to treat pain and discomfort after surgery or an injury, to chronic pain patients who have struggled finding relief with less risky approaches, and during end of life care.
What led to prescription misuse?
There were many different villains and systematic failures that resulted in prescription misuse. It's hard to point to a single action or entity but beginning in the 1990s, health agencies encouraged doctors in the United States to see pain as a condition worthy of dedicated treatment, which led to increased use of opioid pain relievers. The practice of prescribing opioids for pain increased further after 1997 with the pharmaceutical development of new long-acting medications that were advertised as less addictive. For many people, prescription painkillers were their first introduction to opioid use, leading to rapid growth in the rates of prescription drug misuse. Overdose deaths decreased in the late 2010s but began shooting up again in 2020 in the wake of the COVID-19 pandemic.
How did prescription opioid misuse become so common?
While illicit opioids certainly exist, the evidence is very clear: prescription opioids remain a major risk factor for opioid use disorder. An epidemic of addiction and overdose doesn’t happen in a vacuum, however, and there are many factors that have contributed to the rise of the opioid epidemic and its sustained presence.
1. Aggressive marketing
In the 1990s, Purdue Pharma developed and released OxyContin®, a sustained-release formulation of oxycodone. They began aggressively marketing this new drug to doctors while lobbying lawmakers and emphasizing its safety and low potential for misuse and addiction. This led doctors to feel comfortable prescribing it frequently, even for minor problems that would not normally call for such strong painkillers. In 2020, the pharmaceutical company admitted to knowing as early as 2007 that the opioid was still addictive, despite their marketing.
Because doctors were led to believe that drugs like OxyContin were safe for many patients and could streamline their operations, opioid prescriptions quickly began growing until they reached a peak in 2010. In many cases, physicians were prescribing much higher doses than was necessary to treat acute pain, and they were recommending that these painkillers be taken for longer periods than is now recommended.
3. Structural support
It should also be noted that the structure of the American medical system also played a role in the proliferation of prescription opioid abuse. Many physicians run private practices that work primarily through insurance, and most insurance plans cover prescription pain relief more thoroughly than other time-consuming options, like physical therapy. This meant that patients would have to pay less out of pocket to receive pain relief after surgery, but it also put them at risk of drug misuse.
As the Purdue lawsuit shows, drug manufacturers also develop relationships with medical providers to encourage more aggressive prescribing practices and lobby the government with their internal safety and efficacy studies showing favorable results.
How prescriptions are obtained
To this day, doctor-prescribed opioids remain a primary avenue for those with opioid use disorder to gain access to drugs. There are many media narratives about stereotypical drug-seeking behavior, but studies have shown that those who misuse prescription opioids acquire them in fairly mundane ways.
According to the Substance Abuse and Mental Health Services Administration’s 2018 National Survey on Drug Use and Health, it was most common for respondents to receive prescription opioids for free from their friends and family. Over 40% of those surveyed obtained opioids in this way, and 37% reported receiving drugs legally from a physician’s prescription. Only 6% reported having obtained the drugs illicitly from a dealer or stranger.
The results of this survey make it obvious that the opioid epidemic is still propped up by a high volume of legal prescriptions and the overprescription of doses, a situation unique to the US.
Effective OUD treatment at your fingertips
The good news? With the right care and support, opioid misuse doesn’t have to control your life. Ophelia uses evidence-based medication treatments and a telehealth model to get people back on track.
For many who are unfamiliar with the science, it can be surprising to learn that the medications, such as Suboxone®, that are approved by the FDA to blunt the torturous withdrawal symptoms and cravings are opioids themselves. However there is substantial evidence backing this approach. When taken as prescribed and in appropriate doses, Suboxone does not produce euphoria.
But aren’t you then dependent on Suboxone? Yes. The problem is that many people confuse physical dependence with addiction. You are physically dependent on medication if you take it every day. But just like high blood pressure medication and antidepressants qualify as a dependence, that doesn’t mean you’re addicted.
Ophelia’s model is simple: Start with a consultation call to connect with a care team to determine whether you’re eligible for a buprenorphine-naloxone treatment and attend ongoing virtual meetings that fit into your schedule. Ophelia works with insurance providers, including Medicaid, in a number of states and offers a convenient self-pay option.