How the U.S. Should Fight the Opioid Crisis

In the midst of the United States’ opioid epidemic, it is troubling to know that opioids are still one of the most commonly prescribed drugs. Taking opioids comes with many dangers, but there is a reason that doctors and patients are willing to take this potentially huge risk. Prescription opioid use is considered to be indisputable, due to its effectiveness against short-term and long-term pain. The risk clearly outweighs the reward, but opioid use prevails over all other types of pain medication. The reason for this is because opioids are in surplus supply, readily available, and heavily researched. The government’s efforts to decrease the use of opioids have become weaker in the past few years, and the opioid manufacturers are refusing to back down on excessive opioid development. There needs to be a drug with the benefit opioids have, without the high risk of addiction.

Few people seem to know exactly what opioids are, what they do, and how the opioid crisis should be handled. The natural chemical found in the opium poppy plant is called opiate, and this is what professionals use to make the type of drug known as opioids. Opioid is an umbrella term that identifies drugs that are used as painkillers, not including over-the-counter medications such as ibuprofen and tylenol, which don’t have any euphoric effects like opioids do. Opioids are able to ease varying degrees of pain, and are incredibly helpful when a patient is physically suffering from surgery, injury, or a chronic disease. When someone takes an opioid like OxyContin, the chemical interacts with pain receptors throughout the nervous system, lessening the intensity of pain. There is a high chance that a person will become addicted to opioids, and there are many other harmful side effects. Opioids can cause nausea, memory loss, and can decrease blood pressure and heart rate. This can be difficult for people who are taking other medications, who could benefit from the use of opioids but cannot take them due to the mixture of all the strong medications in their body.

The CDC has spent many years gathering information about the risks and benefits of opioids, and have published the Guideline for Prescribing Opioids for Chronic Pain which strongly suggests that “clinicians should prescribe immediate-release opioids instead of extended-release /long-acting (ER/LA) opioids.” These modifications allow doctors to use opioids for many types of situations. A patient suffering an injury from a car accident may be prescribed a short-term opioid medication, where the effects of the drug only last a few hours. On the other hand, a person with chronic pain who has tried every other treatment option may benefit from a long-acting opioid. 

It is bittersweet, but medical professionals have been able to gather so much research and data about opioid use and opioid addiction due to the opioid epidemic. The United States government is willing to put a lot of money and man-power into studying the effects of opioids and opioid addiction since it has been plaguing the country for many years. There is not much that researchers do not know about opioids, and scientists have found ways to change and manipulate the duration of opioids effects thanks to all the research the United States government has supported. 

Opioids can be modified to fit a person’s degree of pain, and they are widely available in the United States. In 2019 the CDC released the total number of opioids that were described in that year, and over 153 million were given to patients across the U.S.. Opioids sole purpose is to help people manage pain, so it makes sense that it would be used vastly. In the United States, accidents are incredibly common and thousands of people suffer from injuries daily. Opioids are very effective in treating short-term pain from things like accidents, but that is not exactly what makes people addicted to opioids.

Not only do opioids block pain receptors in the brain and spinal cord, they also create a feeling of euphoria in those taking it. This is the feeling that people are likely to succumb to when they take opioids. It does not matter if the treatment was meant to help with short-term or long-term pain, the combined power of not feeling pain and an overwhelming feeling of euphoria makes the risk of addiction incredibly high. The National Institute on Drug Abuse warns that “regular use- even as prescribed by a doctor- can lead to dependence and, when misused, can lead to addiction, overdose incidents, and deaths.” If this feeling of euphoria, or the “high” that people feel were nonexistent, no one would become addicted to opioid medications.

There is no doubt that opioid abuse is a huge problem in the United States. In order to lessen the damage of the opioid epidemic, there needs to be a safer alternative that can still help patients that are dealing with long-term or short-term pain. This drug would need to be able to block pain receptors in the brain and nervous system at the same, or at least a similar, level of strength as opioids. Not only does it have to be powerful, but it cannot give patients a sense of euphoria when they take it. Instead, that component should be replaced with something that makes people feel mildly uncomfortable. That way, opioid users do not feel compelled to continue taking the drug once they are no longer prescribed to it.

The United States of America heavily relies on prescription drug use. In fact, over 131 million adults take some type of prescription drug, which means that there is a high demand and high profit within the pharmaceutical industry. Opioids are a popular drug that makes pharmacies large sums of money, and even though the damage from the opioid crisis has been catastrophic, some doctors prescribe opioids irresponsibly because they are influenced by opioid manufacturers. The pharmaceutical industry believes that no alternative drug can compete with opioids, so for them, the benefits outweigh the deadly cost. The response from the government about the opioid epidemic has been ineffective, since the crisis has only worsened with the past three decades. With Big Pharma lobbyists within the government, no research is being funded by the government to find a solution. The pharmaceutical industry refuses to consider other types of pain medication and the government’s neglect towards medical research funding caused the opioid crisis.

Opioids are used as pain-relievers, and can be prescribed by doctors for many types of physical ailments. But the United States is facing an opioid epidemic, so the number of opioid prescriptions should be decreasing or at least be heavily discouraged, but that is not the case. In 2017, CNN and Harvard T.H. Chan  released a study titled Physicians’ opioid prescribing patterns linked to patient’s risk of long term drug use where they compared databases that tracked how much pharmaceutical companies paid doctors and the number of prescriptions doctors wrote, which revealed that, “among doctors in the top 25th percentile of opioid prescribers by volume, 72% received payments,” and that “among the very biggest prescribers — those in the top 10th of 1% — 95% received payments.” The article explained how drug manufacturers can pay doctors to consult and provide other services, but doctors cannot accept more payment for prescribing more. The loophole around this law is that opioid manufacturers will have doctors who are frequent prescribers consult with them rather than doctors that don’t prescribe opioids as frequently. The pharmaceutical industry believes that opioids are the most effective pain killer available, and manufacturers do anything to ensure that opioid use never ends. The doctors are just as corrupt in this situation, and are just as responsible as the opioid manufacturers for causing the opioid epidemic.

The government’s handle on the opioid epidemic has done little to help victims of reckless prescribing practices . In an article titled, Are Substance-Use Disorders in the USA a Crime or Crisis? Restorative Justice to Reclaim Voting Rights for Disenfranchised Nonviolent Offenders, writer Tyriesa Howell states that “while many states, cities, and counties are initiating lawsuits against prescription opioid producers for their roles in the opioid epidemic, a federally responsive war on pharmaceutical opioid sales has not been initiated and physicians have only been recommended to reduce overprescribing pain medication through the use of prescription drug monitoring programs.” The government has laws in place that punishes those in possession of illegal drugs and frequently acts on those laws, but legal drug dealers like doctors and opioid manufacturers are not being punished by the federal government. The government’s answer to fighting the opioid epidemic has been to put people in jail, but this does not help them with their addiction, and many people relapse once they are released. The opioid epidemic affects more than the health of opioid users, it affects their family, their job, and their reputation. If the government had supported research to find alternatives instead of criminalizing nonviolent drug users, then less people would be in those illegal situations in the first place.

Even though not every person prescribed an opioid becomes addicted, the increase in opioid use inevitably leads to an increased risk of a person succumbing to an opioid addiction. Harvard T.H. Chan’s study also revealed that, “one out of every 48 people newly prescribed an opioid will become a long term user.” Prescription opioid medications are commonly used by people who suffer from chronic pain. Manufacturers capitalize on this, and make opioid medications very expensive since people need it to function throughout the day without pain. The government only helps those who can be covered by medicaid, and has done very little to help the other thousands of people who cannot afford their medications. If people can no longer afford their medications, they might turn to more dangerous options.

The illegal drug market is equally as large as the United States’ pharmaceutical industry, and both profit off people that become addicted to opioids. People who can no longer afford a pharmaceutical medication often replace their medications with an illegal drug. The sole purpose of opioid use in medicine is to treat pain, and since it has shown to be the most effective in doing so, most illegal drugs won’t satisfy opioid users. Heroin is an opioid that is even stronger than prescription pills, so it is likely that people who can’t afford prescription medication will turn to heroin since it is even more effective than opioid pills. Heroin is the most dangerous type of opioid and is considered to be a Schedule I drug, meaning that it is not used in any type of medication and is considered highly addictive according to the DEA. Now these regular people who simply wanted to find affordable treatment are involving themselves in illegal activities with potentially dangerous drug dealers, putting themselves in more desperate situations. Even if opioid users do not turn to illegal drugs, there are other ways they can obtain the drug that will relieve their pain and cravings. Some people injure themselves enough to where they can be given pain relievers in the emergency room. A disturbing act like that shows how disorienting opioid use can be, and what lengths people will reach to relieve their cravings.

Instead of trying to find an alternative drug, the government continues to allow doctors and pharmacies to distribute drugs to people who could be using alternative pain therapy that has less damaging repercussions. Unfortunately, there is little research being done on possible alternatives. There is currently no drug within the pharmaceutical industry that has enough credibility to be a reliable source of profit, and if the industry cannot profit, then they will certainly have no interest in it.

The human species has been using opium as medical treatment for thousands of years, almost as far back as human existence itself. Countless medical practices and treatments have been discarded once better methods are discovered, yet very little has changed with opioid therapy in the thousands of years it has been used. Opioids are used in modern medical practice everyday and it is impossible to deny that their effectiveness in treating pain and the elated feeling people experience when taking opioids are what make this drug so valuable and dangerous. Regardless of the potential dangers, there are still many opioid advocates who claim that opioid use is too important to the treatment of certain medical conditions for it to be prohibited due to its lethal side effects. If opioids suddenly disappeared with no alternative, millions of people would die from withdrawal or overdose from another deadly drug. It is important to understand that opioids are a vital part of the medicinal world, and that they will never go away. But it is also important to realize that, though opioids prolong the absence of pain, they also shorten lifetimes. With so many advancements in medicine, there has never been a better time to start searching for an alternative. Opioids’ ability to withstand the test of time is impressive, but it is time to evolve from outdated and dangerous opioids.

In The Clinical Journal of Pain’s article titled, The Opioid Debate-Pro: Opioids Have an Important Role in Pain Management in Children, Dr. Elliot Krane suggests that the current guidelines to opioid prescribing are too strict, which means that some people who may need opioids are not getting them. He argues that those on the anti-opioid side believe that “all society must do is to restrict and curtail the availability of opioids to patients, beef up law enforcement, incarcerate over-prescribers and users, and the fire will be extinguished.” In a perfect world, this is all we would have to do, but experts know that this issue is too complicated for such a simple plan of action. It is extremely unreasonable to believe that the opioid crisis can be solved by prohibiting it, since it would be detrimental to those who are currently prescribed opioids. In the article, There’s Never Just One Side to the Story, Bioethicist Travis Rieder believes that the solution to the opioid epidemic is inevitably going to come to a compromise, though it won’t be easy. Rieder talks about how “the pendulum swing toward radical permissiveness was, undeniably, incredibly harmful—it helped launch today’s drug overdose crisis, and even as that crisis moves away from prescription opioids and toward illicit drugs, it continues to feed it. But a full-on swing back toward the prohibitionist attitude that led us to withhold opioids from desperate patients would also be a tragedy.” Those on the anti-opioid side are aware that, if opioids were abolished with no alternative, it would likely lead thousands of desperate people to use illegal and more dangerous drugs, which is the opposite of the goal both sides want to achieve. If people can no longer receive their treatment from a doctor, they will find another way to treat their pain. Both sides of the opioid argument want to see patients struggling with pain get the treatment they need, and both sides also wish to put an end to the opioid epidemic. But the anti-opioid side wants to take it a step further by advocating for pain relief options that do not have extreme risks.

 In cases where no other therapy or medication is able to soothe a patient’s pain, opioids have proven to be 100% effective. Opioids have played a large role in helping professionals make breakthroughs in medicine, and Dr. Elliot Krane is quick to point out that “opiates have brought relief to the suffering, made surgical procedures possible and routine, and have salvaged countless lives that otherwise would have been lost.” Opioids are especially helpful in surgeries, and without opioids to help patients handle their pain, none of them would not be able to withstand any surgery. Many patients who have struggled with their pain and have exhausted every other type of therapy have found that opioid medication will change their lives for the better.

In 2018, a randomized clinical trial launched by Dr. Erin Kreb et al to test the effectiveness of opioid vs. non-opioid pain treatment in patients with chronic back or hip pain. This trial lasted a year and had 240 participants, with one group receiving either an “immediate-release morphine, oxycodone, or hydrocodone/acetaminophen” and the second group receiving “acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug.” The results of their study found that “adverse medication-related symptoms were significantly more common in the opioid group over 12 months,” and concluded that opioid treatment “was not superior to treatment with nonopioid medications for improving pain-related function over 12 months.” This clinical trial shows that opioid use is not a reasonable treatment option for those with chronic pain, and that it is possible to tolerate pain with over the counter medication. The “adverse” side effects of opioids are life ruining, and opioids are only a temporary life saver. Opioids make the pain manageable, but daily use builds a tolerance that knows no limit. Eventually, even opioids will not be enough to tolerate the pain. 

A key difference between opioids and nonopioid treatments is that opioids bind to opioid receptors in the brain, releasing endorphins. Opioids not only make people feel great physically, but it also gives them a feeling of euphoria. This combination is what makes opioids a valuable pain reliever. The euphoric feeling is the reason thousands of people end up addicted to opioids. The National Institute on Drug Abuse advises that “the best way to avoid opioid addiction is to take opioid pain medications only as prescribed by a doctor, and only for as long as you need them.” Those in favor of opioids fail to mention the effects of opioid euphoria in pain management. There are safer alternatives that can have similar effects as opioids, but without the deadly consequences.

It may seem like an unhinged proposal, but medical marijuana has shown promising results in pain treatment, and has less severe side effects compared to opioids. Marijuana is also in surplus supply and readily available, but more research needs to be conducted in order for it to be approved by the federal government. Marijuana may not be the solution to the opioid crisis, but it would bring the United States one step closer to finding it by providing safer options for people suffering from pain. 

References

Krane, E. J. (2019). The Opioid Debate—PRO. The Clinical Journal of Pain, 35(6), 468–472. doi: 10.1097/AJP.0000000000000700.

Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018;319(9):872–882. doi:10.1001/jama.2018.0899

Physicians’ opioid prescribing patterns linked to patients’ risk for long-term drug use. (2018, June 22). Retrieved March 27, 2021, from https://www.hsph.harvard.edu/news/press-releases/opioids-addiction-physicians/

Rieder, T. N. (2018). There’s never just one side to the story: Why america must stop swinging the opioid pendulum. Narrative Inquiry in Bioethics, 8(3), 225-231. doi:http://dx.doi.org.ezproxy.rowan.edu/10.1353/nib.2018.0071

The more opioids doctors prescribe, the more they get paid. (2019, September 16). Retrieved March 27, 2021, from https://www.hsph.harvard.edu/news/hsph-in-the-news/opioids-doctors-prescriptions-payments/

Tyriesa, H. H. (2019). Are substance-use disorders in the USA a crime or crisis? restorative justice to reclaim voting rights for disenfranchised nonviolent offenders. Journal of Human Rights and Social Work, 4(2), 103-107. doi:http://dx.doi.org.ezproxy.rowan.edu/10.1007/s41134-018-0069-0

University, G. (2019, February 13). Prescription drugs. Retrieved March 28, 2021, from https://hpi.georgetown.edu/rxdrugs/#:~:text=More%20than%20131%20million%20people,and%20those%20with%20chronic%20conditions.

What is an opioid? (2016, May 25). Retrieved from https://archives.drugabuse.gov/blog/post/what-opioid