Preventing opioid overdoses and deaths might feel different from the previous prevention work you’ve done. People are dying fast. Compared to other substances the opioid crisis is a very public problem. Second, some opioids (prescription opioids) are legal and there is a legitimate medical need for some opioids (to treat pain associated with cancer, surgery, etc.).
There are a few trends that may play a role in the high rates of opioid overdose that we are seeing today.
The first cause is the widespread prescribing of prescription opioids to patients. Since 1999, the number of prescription opioids sold in the U.S. nearly quadrupled. In addition to the overall increase in the number of opioid prescriptions written, patients also received opioids for extended durations and in high doses. Overprescribing increases the volume of prescription opioids diverted for non-medical use.
Many prescribers and individuals taking opioids (either for medical or non-medical use) were unaware of the characteristics of opioid use disorders—such as the development of tolerance to the drug over time, and the high risk of overdose.
The increased availability, purity, and relatively low price (compared to diverted prescription opioids) of heroin also contributed to today’s opioid crisis. As the number of individuals with opioid use disorders increased, and new restrictions reduced the supply of diverted prescription opioids, many individuals began using heroin.
And finally, a study from the National Bureau of Economic Research published a study that proposed associations between macroeconomic conditions and opioid abuse. The found patterns between unemployment rates and opioid-related deaths and emergency department visits. This concept sometimes referred to “deaths of despair,” suggests that deindustrialization (decline in industrial activity in a region or economy) and unemployment has led to high rates of hopelessness and depression, disproportionally among white men and that these factors for individuals at increased risk for self-medication through painkillers including prescription opioids and heroin.
The role of prevention in addressing the opioid overdose crisis is two-fold: preventing opioid overdoses from occurring in the first place and prevent death from opioid overdoses when they do occur.
While many prevention practitioners focus on preventing health-related problems before they occur, working to prevent both a problem and its negative consequences isn’t entirely new territory.
Consider how we approach the problem of car accidents. We implement a variety of strategies to reduce risks for motor vehicle crashes in an effort to prevent them from occurring in the first place, including driver vision exams and education, vehicular maintenance and features like anti-lock brakes, and adequate roadway lighting and speed limits.
But we also recognize that some crashes will occur. And when that happens, it’s important to minimize the harm that may result. We also implement strategies to help people survive motor vehicle crashes, including features like seatbelts and airbags, roadway guardrails, and median barriers and making sure that well-trained EMTs are available to respond. These are like our strategies to prevent death in the event of an opioid overdose.
Just as we’re accustomed to working toward preventing both car accidents and their consequences, so too do we need to work toward preventing both opioid overdoses and overdose-related death and disability.
Sources: - CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov. - Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual Review Of Public Health, 36559-574 - Substance Abuse and Mental Health Services Administration (2015). Substance use disorders. Available at https://www.samhsa.gov/disorders/substance-use - Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M. (2016). Increases in Drug and Opioid Overdose Deaths--United States, 2000-2014. MMWR. Morbidity And Mortality Weekly Report, 64(50-51), 1378-1382. doi:10.15585/mmwr.mm6450a3 - Hollingsworth, Alex J. and Ruhm, Christopher J. and Simon, Kosali Ilayperuma, Macroeconomic Conditions and Opioid Abuse (February 2017). NBER Working Paper No. w23192. Available at SSRN: https://ssrn.com/abstract=2924282]