The opioid crisis explained
Professor Tim Classen unpacked the opioid crisis at the inaugural Q Talks: Live! event in November.
Classen was one of three featured speakers at Q Talks, which also featured Professor Jenna Drenten on how visual social media is changing communication and Professor Al Gini on the importance of humor. Q Talks is part of the Dean’s Alumni Series.
What are opioids?
Vicodin, Percocet, Norco, and OxyContin are examples of prescription opioid painkillers. Vicodin was released 40 years ago, and OxyContin came to market in 1996. Heroin, morphine, and fentanyl are also examples of opioids.
Origins of the opioid crisis
In 2001, the Joint Commission on Accreditation of Healthcare Organizations identified pain as the fifth vital sign along with blood pressure, heart rate, respiratory rate, and temperature.
The commission argued that “we need to treat pain in a better way to reduce patients’ pain and to deal with problems stemming from patients’ pain,” said Classen. But “that really was I think in some ways a jumping-off point for the use of painkillers.”
According to Classen, between 1998 and 2010, the number of prescriptions for opioid painkillers doubled. In 2015, doctors wrote 250 million prescriptions for opioid painkillers – or one for every adult in the U.S.
Scope of the opioid crisis
- Number of fatal overdoses: Between 1999 and 2016, approximately 150,000 people suffered fatal overdoses from prescription opioids, with 40,000 deaths from all opioids in 2016 alone.
- Fatal overdoses by gender/race: White males from 18 to 40 years old and white females from 18 to 40 years old have seen the greatest increase of overdoses since 1999 compared to older white males/females and non-white males/females.
- Heroin substitution: In 2010, OxyContin was reformulated so make it harder to crush and insufflate. Many people with opioid additions transitioned to heroin, and heroin overdoses subsequently increased rapidly in 2011.
- Fentanyl effect: In recent years, fentanyl has become widely available and inexpensive relative to other opioids. This has led to higher rates of overdose overall. In 2016, 10% of all deaths among young white males and young white women were fentanyl overdoses.
- Geography: The opioid crisis affects the entire U.S., but it is particularly acute in West Virginia, Ohio, Utah, New Hampshire, Maine, and Massachusetts. Illinois has a high heroin overdose rate, while the northeast has suffered the most from the fentanyl epidemic.
Several policies have been introduced to respond to the crisis, including:
- Prescription drug monitoring programs: All states have created prescription databases to make it harder for patients to fill more than one opioid prescription a month, said Classen. This has helped reduce prescription opioid abuse, but some people have moved on to using heroin and other opioids such as non-prescription fentanyl.
- Medication-assisted treatment: Medication-assisted treatment is the use of medication such as buprenorphine or methadone to reduce opioid cravings and withdrawal. “This has been identified as an essential remedy for those with opioid problems,” said Classen.
“We have about 2 million opioid addicts in this country, and about 10 million people have misused opioids,” he continued. “The number of people suffering from these disorders necessitates some sort of remedy.”
Naloxone is now available to reverse opioid overdose and is carried by some police forces.
Classen closed his presentation with a series of questions. “At Quinlan, we do focus on ethical business behavior, and here are some things to ponder,” he said.
- How do we treat addiction and the enormous number of opioid addicts?
- How do we respond to the role of doctors’ prescribing behavior of opioids that exacerbated this crisis?
- How do we best treat people with chronic pain?
- What can we learn to avoid massive unintended consequences of healthcare innovations?
To learn more about the opioid crisis, Classen recommends these resources:
- Public Health Reports: A Public Health Strategy for the Opioid Crisis →
- Centers for Disease Control: Opioid Overdose →
- U.S. Surgeon General: Advisory on Naloxone and Opioid Overdose →
View Q Talks photos in the gallery below or on Quinlan’s Flickr page.