The opioid epidemic is a growing public health emergency impacting people of all ages in all communities. The number of drug overdose deaths has quadrupled since 1999, it is estimated 136 people die of opioid overdose everyday, and this epidemic only continues to worsen as the COVID-19 pandemic has intensified the crisis.
Timeline of the opioid crisis
The 1990s marked a rise in prescription related opioid overdose deaths and the first wave of the opioid epidemic. Pharmaceutical companies began prescribing opioid pain relievers at a higher rate. Despite pharmaceutical companies reassuring that patients would not become addicted, this eventually led to a more widespread misuse of these prescription drugs. Their ease of access and addictive qualities proved to be a dangerous combination. In 2010 the number of deaths related to heroin began to rise, and in 2013 significant increases were seen in deaths involving fentanyl. In 2017 the US Department of Health and Human Services declared the opioid crisis a public health emergency.
The impact of the COVID-19 pandemic
In 2020, as the COVID-19 pandemic became the #1 public health crisis in the world, the opioid epidemic continued to intensify. Challenges experienced from the COVID-19 pandemic such as unemployment, social isolation, and financial hardship led many individuals to feeling heightened experiences of anxiety or depression. In times of hardship, increased stress, or depression individuals may find themselves turning to alternative ways to manage their pain and overall situation such as medication. Increased isolation created new challenges for those in recovery working to manage their addiction because they found themselves unable to interact with support groups or their counselors the way they once could due to social distancing. The number of opioid related deaths from September 2019 to August 2020 was 27% higher than the previous 12 month period, illustrating that the COVID-19 pandemic escalated an already serious problem.
Overprescribing and drug modification
From 1999-2019, 500,000 people died from an opioid overdose, but what exactly is causing these overdoses?
In the 1990’s, the over-prescribing of opioid drugs became an issue that we are still facing the consequences of today. Lynn Clark, Director of Advanced Practice for Anesthesiology for Children at Children’s Health, notes from personal experience that after a surgical procedure she was “sent home with 90 tablets and took maybe 10”, illustrating that providers prescribed an excessive amount of pain relievers for her post-op treatment. More than 50% of teens who abuse prescription opioids get them from a friend or relative. As an expert in pain management, Clark works to educate providers on prescribing a more practical number of drugs to patients because “if you don't take all of the drugs prescribed, they end up sitting in grandma's medicine cabinet or mom's medicine cabinet”, says Clark and can easily end up in the wrong hands.
Shawna Bacon, Nurse Manager at Nexus Recovery Center, works with clients facing opioid use disorder. She notes the modification of drugs to be another major culprit for the increase in opioid related overdoses. Bacon has seen a “large increase in the pressed pills where people are thinking they are taking percocets, but it's fentanyl and they don't realize it and then they overdose''.
The common stigma of opioid users
“It’s the common stigma that most people think it’s the homeless population, but it's everyone. It's someone's kid, it's someone's mom, grandma, grandparents”, says Bacon. Opioid addiction is present in individuals of all ages from all communities. Many people associate opioid addiction with only the homeless population, however that is not the case. Some individuals “may have gotten addicted because of the fact that they went to the doctor to treat a broken leg, and they couldn’t get off of (the opioid pain reliever)”, says Bacon. The negative stigma created around opioid addiction has even caused some people to avoid seeking help for fear of being associated with a population perceived as negative by the general public. This negative stigma also deters people from receiving the help they need, because many people do not want to see treatment centers in their neighborhood.
Barriers to finding a solution
Communication between sober living and treatment centers is a major barrier in addressing the opioid epidemic. Bacon notes that it is difficult for individuals to find the help they need because “there is always constant change”. Information regarding what treatment centers offer or accept is not always centralized, causing networking to be the primary route of finding the right solution. Clark echoes the importance of centralized communication noting that “there are so many different people that have a piece of this pie and are invested in getting (someone) help, but are they really talking to each other and making sure the resources are being utilized and consistently done?”. Without communication, collaboration is not possible.
Education is a factor that has the ability to break down barriers. However, there is progress to be made when it comes to education. Many barriers such as communication gaps, access to care, or costs can be attributed to a gap in education. Education takes all forms from individual education to family education to provider education. Lynn Clark works with the pediatric population and stresses the importance of “getting the parents on board (and) getting them to understand what the barriers are”. Shawna Bacon also emphasizes how critical family education is because “the family may not have as much support because they don’t understand it”. There is also work to be done in educating providers in both learning to prescribe a reasonable amount of prescription medicine and understanding options as far as treatment centers and where to send people to.
State funding and patient costs
Cost related barriers prove to be a big obstacle when it comes to the treatment of individuals facing opioid use disorder. While there may be some level of state funding or support, people and treatment programs “can always use more support” says Shawna Bacon at Nexus Recovery Center. For opioid users on medication assisted treatment also referred to as maintenance, it can be difficult finding providers that offer that treatment and even more difficult to find payment options. Bacon expressed that “we need more providers to actually give maintenance” and that “there's plenty of doctors that may take cash payment, but there's very few that will take the state funding.” This is a major obstacle for individuals seeking help but are unable to afford the care on their own.
Access to care in rural communities
Living in rural areas is another obstacle for individuals seeking care due to a limited number of resources available to them. Long distances to reach the right doctor or a lack of transportation creates a challenge for individuals trying to access the proper care. Bacon notes that “it's hard for someone to really say ‘yes, I want a commitment to helping myself, but I have to drive an hour and a half just to go see the doctor’”. Not only does visiting a doctor pose a challenge in rural environments, but “trying to find a pharmacy that (has their maintenance medication) in stock is even a hindrance”, says Bacon.
Stigma deters progress
The common stigma surrounding opioid addiction seems to be deterring progress when it comes to increasing the number of treatment or rehab facilities availability. Clark observes that people are likely to be hesitant to have treatment centers built in their neighborhood. “If someone is building an addiction rehab center, in your backyard is that something you want? I think there's a lot of stigma around what happens with these folks”, says Clark. Progress needs to be made when it comes to reducing this stigma, but Clark mentions that “until it’s your mother or sister who needs treatment, it’s a different story”.
Addressing mental health and multimodal treatment
Understanding the role that mental health plays in opioid addiction is important to reaching a solution and treatment plan. Clark emphasizes the role that chemical coping plays in addiction and drug overdoses. “People are doing chemical coping. They’re taking a medicine to make them feel better, and if whatever they were taking isn't helping they're going to either find something else either more addictive or more problematic for them or they're going to take more of it, which leads to those overdoses” stresses Clark. Clark is hopeful that addressing mental health can help get ahead of the problem. “Let’s get you in earlier when you’re having issues with your anxiety and your depression so that we can handle that before you even turn to coping with drugs or alcohol.”, says Clark.
Clark also mentions that a multimodal treatment plan is important to reaching the best results. “I think that’s the other part, the multimodal part, making sure we aren’t just focused on medicine. Let’s use other things, let’s use ice and heat and physical therapy and behavioral health to treat your pain in addition to medications.”, says Clark.
About Children’s Health
Children’s Health is committed to making life better for children. As one of the largest and most prestigious pediatric health care providers in the country and the leading pediatric health care system in North Texas, Children’s Health cares for children through more than 750,000 patient visits annually. The Children’s Health system includes its flagship hospital, Children’s Medical Center Dallas, as well as Children’s Medical Center Plano, Our Children’s House inpatient rehabilitation hospital, the Children’s Health Care Network, specialty centers, rehabilitation facilities, and physician services. Children’s Medical Center Dallas continues to be the only North Texas hospital to be ranked in 10 out of 10 pediatric specialties by U.S. News & World Report. Through its academic affiliation with UT Southwestern Medical Center, Children’s Health is a leader in life-changing treatments, innovative technology, and ground-breaking research. Children’s Health has the only disease specific certification from the joint commission for pediatric chronic pain.
About Nexus Recovery Center
Nexus Recovery Center is a nonprofit organization dedicated to breaking the cycle of addiction. Since 1971, Nexus has helped thousands of people overcome substance and alcohol abuse in order to lead healthy, productive, and rewarding lives. They are committed to supporting individuals and families by providing a wide range of services, from residential and outpatient treatment to continuing care and recovery support. Their specialized services include treatment for adult women, adolescent girls and their accompanying children.