Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic

2018 ◽  
Vol 1 (21;1) ◽  
pp. 309-326 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Electronic Reporting ◽  
Number Of Patients ◽  
Overdose Deaths

The opioid epidemic has been called the “most consequential preventable public health problem in the United States.” Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semisynthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidencebased medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids. This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. Key words: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs)

scholarly journals Using Twitter to Surveil the Opioid Epidemic in North Carolina: An Exploratory Study (Preprint)

2019 ◽  
Author(s):  
Mohd Anwar ◽  
Dalia Khoury ◽  
Arnie P Aldridge ◽  
Stephanie J Parker ◽  
Kevin P Conway
Keyword(s):  
North Carolina ◽  
Language Processing ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Least Squares Regression ◽  
Online Data ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Twitter Data

BACKGROUND Over the last two decades, deaths associated with opioids have escalated in number and geographic spread, impacting more and more individuals, families, and communities. Reflecting on the shifting nature of the opioid overdose crisis, Dasgupta, Beletsky, and Ciccarone offer a triphasic framework to explain that opioid overdose deaths (OODs) shifted from prescription opioids for pain (beginning in 2000), to heroin (2010 to 2015), and then to synthetic opioids (beginning in 2013). Given the rapidly shifting nature of OODs, timelier surveillance data are critical to inform strategies that combat the opioid crisis. Using easily accessible and near real-time social media data to improve public health surveillance efforts related to the opioid crisis is a promising area of research. OBJECTIVE This study explored the potential of using Twitter data to monitor the opioid epidemic. Specifically, this study investigated the extent to which the content of opioid-related tweets corresponds with the triphasic nature of the opioid crisis and correlates with OODs in North Carolina between 2009 and 2017. METHODS Opioid-related Twitter posts were obtained using Crimson Hexagon, and were classified as relating to prescription opioids, heroin, and synthetic opioids using natural language processing. This process resulted in a corpus of 100,777 posts consisting of tweets, retweets, mentions, and replies. Using a random sample of 10,000 posts from the corpus, we identified opioid-related terms by analyzing word frequency for each year. OODs were obtained from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Least squares regression and Granger tests compared patterns of opioid-related posts with OODs. RESULTS The pattern of tweets related to prescription opioids, heroin, and synthetic opioids resembled the triphasic nature of OODs. For prescription opioids, tweet counts and OODs were statistically unrelated. Tweets mentioning heroin and synthetic opioids were significantly associated with heroin OODs and synthetic OODs in the same year (<i>P</i>=.01 and <i>P</i>&lt;.001, respectively), as well as in the following year (<i>P</i>=.03 and <i>P</i>=.01, respectively). Moreover, heroin tweets in a given year predicted heroin deaths better than lagged heroin OODs alone (<i>P</i>=.03). CONCLUSIONS Findings support using Twitter data as a timely indicator of opioid overdose mortality, especially for heroin.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

scholarly journals The Opioid Epidemic and Nonmarital Childbearing in the United States, 2000–2016

Demography ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 345-378
Author(s):  
Mónica L. Caudillo ◽  
Andrés Villarreal
Keyword(s):  
United States ◽  
Local Level ◽  
The United States ◽  
Unaffected Individual ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
Nonmarital Birth ◽  
Birth Rates ◽  
Individual Level ◽  
Overdose Deaths

Abstract The United States has experienced a dramatic rise in opioid addiction and opioid overdose deaths in recent years. We investigate the effect of the opioid epidemic at the local level on nonmarital fertility using aggregate- and individual-level analyses. Opioid overdose death rates and prescriptions per capita are used as indicators of the intensity of the opioid epidemic. We estimate area fixed-effects models to test the effect of the opioid epidemic on nonmarital birth rates obtained from vital statistics for 2000–2016. We find an increase in nonmarital birth rates in communities that experienced a rise in opioid overdose deaths and higher prescription rates. Our analyses also show that the local effect of the opioid epidemic is not driven by a reduction in marriage rates and that marital birth rates are unaffected. Individual-level data from the ACS 2008–2016 are then used to further assess the potential causal mechanisms and to test heterogeneous effects by education and race/ethnicity. Our findings suggest that the opioid epidemic increased nonmarital birth rates through social disruptions primarily affecting unmarried women but not through changes in their economic condition.

scholarly journals Using Twitter to Surveil the Opioid Epidemic in North Carolina: An Exploratory Study

10.2196/17574 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e17574
Author(s):  
Mohd Anwar ◽  
Dalia Khoury ◽  
Arnie P Aldridge ◽  
Stephanie J Parker ◽  
Kevin P Conway
Keyword(s):  
North Carolina ◽  
Language Processing ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Least Squares Regression ◽  
Online Data ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Twitter Data

Background Over the last two decades, deaths associated with opioids have escalated in number and geographic spread, impacting more and more individuals, families, and communities. Reflecting on the shifting nature of the opioid overdose crisis, Dasgupta, Beletsky, and Ciccarone offer a triphasic framework to explain that opioid overdose deaths (OODs) shifted from prescription opioids for pain (beginning in 2000), to heroin (2010 to 2015), and then to synthetic opioids (beginning in 2013). Given the rapidly shifting nature of OODs, timelier surveillance data are critical to inform strategies that combat the opioid crisis. Using easily accessible and near real-time social media data to improve public health surveillance efforts related to the opioid crisis is a promising area of research. Objective This study explored the potential of using Twitter data to monitor the opioid epidemic. Specifically, this study investigated the extent to which the content of opioid-related tweets corresponds with the triphasic nature of the opioid crisis and correlates with OODs in North Carolina between 2009 and 2017. Methods Opioid-related Twitter posts were obtained using Crimson Hexagon, and were classified as relating to prescription opioids, heroin, and synthetic opioids using natural language processing. This process resulted in a corpus of 100,777 posts consisting of tweets, retweets, mentions, and replies. Using a random sample of 10,000 posts from the corpus, we identified opioid-related terms by analyzing word frequency for each year. OODs were obtained from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Least squares regression and Granger tests compared patterns of opioid-related posts with OODs. Results The pattern of tweets related to prescription opioids, heroin, and synthetic opioids resembled the triphasic nature of OODs. For prescription opioids, tweet counts and OODs were statistically unrelated. Tweets mentioning heroin and synthetic opioids were significantly associated with heroin OODs and synthetic OODs in the same year (P=.01 and P<.001, respectively), as well as in the following year (P=.03 and P=.01, respectively). Moreover, heroin tweets in a given year predicted heroin deaths better than lagged heroin OODs alone (P=.03). Conclusions Findings support using Twitter data as a timely indicator of opioid overdose mortality, especially for heroin.

Commercial Fishing as an Occupational Determinant of Opioid Overdoses and Deaths of Despair in Two Massachusetts Fishing Ports, 2000–2014

2021 ◽  
pp. 104829112110234
Author(s):  
Scott Fulmer ◽  
Shruti Jain ◽  
David Kriebel
Keyword(s):  
United States ◽  
Cause Of Death ◽  
Death Certificate ◽  
The United States ◽  
Opioid Overdose ◽  
Commercial Fishing ◽  
Opioid Epidemic ◽  
Death Certificate Data ◽  
Deaths Of Despair

The opioid epidemic has had disproportionate effects across various sectors of the population, differentially impacting various occupations. Commercial fishing has among the highest rates of occupational fatalities in the United States. This study used death certificate data from two Massachusetts fishing ports to calculate proportionate mortality ratios of fatal opioid overdose as a cause of death in commercial fishing. Statistically significant proportionate mortality ratios revealed that commercial fishermen were greater than four times more likely to die from opioid poisoning than nonfishermen living in the same fishing ports. These important quantitative findings suggest opioid overdoses, and deaths to diseases of despair in general, deserve further study in prevention, particularly among those employed in commercial fishing.

“A Life Lived”: Collective Memory and White Racial Framing in Digital Opioid Overdose Obituaries

2020 ◽  
Vol 47 (4) ◽  
pp. 320-337
Author(s):  
Kevin Revier
Keyword(s):  
Predominantly White ◽  
Collective Memory ◽  
News Media ◽  
Qualitative Content Analysis ◽  
The United States ◽  
Opioid Overdose ◽  
Digital Platforms ◽  
Opioid Crisis ◽  
Overdose Deaths ◽  
Racial Framing

With a rise in overdose deaths in the United States, opioid awareness has come in a variety of ways. One of these, as reporters suggest, is obituary writing. Obituaries are considered in news media as offering “brutally frank” depictions of addiction that “chronicle the toll of heroin.” Moreover, obituary sharing by parents and loved ones has increasingly taken place on digital platforms, memorial websites expanding the visibility of overdose death while facilitating the building of virtual grief communities. Not solely commemorating individual loss, obituaries thus contain symbolic power—they reflect dominant social values and shape collective memory. As such, overdose obituaries inform how opioid crisis is framed, represented, and addressed. From a qualitative content analysis of 533 opioid-related U.S. obituaries published on Legacy.com and ObitTree.com , I find that while obituaries reduce stigma associated with drug use, addiction, and overdose, they primarily tell white tales of addiction. In affording a white racial framing of drug addiction, obituary writing corresponds with a larger whitewashing of the opioid crisis while implicitly constructing symbolic boundaries between those memorialized, who are predominantly white and middle-class, and those who are deemed as raced and classed Others. Such storytelling, particularly when popularized in news media and made visible on digital platforms, contributes to ongoing systemic inequality in the prevailing drug war.

Accidental Overdose Deaths in Oklahoma, 2002–2017: Opioid and Methamphetamine Trends

2020 ◽  
Vol 44 (7) ◽  
pp. 672-678
Author(s):  
Rachel Bonk ◽  
Ross J Miller ◽  
Joshua Lanter ◽  
Cheryl Niblo ◽  
Jesse Kemp ◽  
...  
Keyword(s):  
Drug Overdose ◽  
Sharp Increase ◽  
The State ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Death Rates ◽  
Synthetic Opioids ◽  
Accidental Overdose ◽  
Overdose Deaths

Abstract To evaluate trends related to accidental overdose deaths in Oklahoma, with a focus on opioids and methamphetamine. All accidental drug overdose deaths in the state of Oklahoma from 2002 to 2017 were reviewed. Opioids were grouped into the following categories: all opioids, prescription opioids, synthetic opioids and heroin. Age-adjusted death rates for methamphetamine and each opioid category were calculated and analyzed. Accidental overdoses accounted for 9,936 deaths during the study period. Of these, opioids were seen in 62.9%, with prescription opioids comprising 53.8%, synthetic opioids 10.3% and heroin 2.8%. Synthetic opioids, despite a recent upward nationwide trend, showed a slight overall decrease (−6.8%) from 2009 to 2017. In contrast, methamphetamine showed a 402.2% increase from 2009 to 2017 and an overall increase of 1,526.7%. Methamphetamine was involved in the most overdoses (1,963), followed by oxycodone (1,724). Opioid-related deaths were most common among white individuals (90.3%) and showed a slight male predilection (56.9%). With the intent of assessing the opioid epidemic as it relates to accidental overdoses in Oklahoma, this study suggests that opioid-related overdoses have slowed in recent years amidst a sharp increase in methamphetamine deaths.

scholarly journals Addressing the Opioid Epidemic: Recommended Solutions from Physicians

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Jessica Cataldo ◽  
Sandra Collins ◽  
Richard C Mckinnies ◽  
Jane Nichols ◽  
Thomas A Shaw
Keyword(s):  
United States ◽  
Active Role ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Multifaceted Approach ◽  
Improve Treatment ◽  
Opioid Crisis ◽  
A Current

The purpose of this study was to assess physicians’ accounts related to the current opioid epidemic and to identify solutions that they feel would be most successful in addressing opioid misuse and overuse. A survey was administered a group of physicians obtained from a nationwide database. Nearly all physicians surveyed believed there was a current opioid crisis in the United States and that physicians should take an active role in addressing opioid use in patients. Four key themes emerged regarding solutions to the opioid crisis: i) policy change, ii) improve treatment, iii) education, and iv) alternative treatment. The diversity of responses highlighted the need for a multifaceted approach to address opioid misuse and abuse.

scholarly journals Public health strategies to combat opioid epidemic in the United States: A systematic review

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
F Balidemaj
Keyword(s):  
Public Health ◽  
United States ◽  
Systematic Review ◽  
The United States ◽  
Opioid Abuse ◽  
Opioid Epidemic ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Opioid Crisis ◽  
Public Health Strategies

Abstract Background The opioid epidemic in the United States is a national public health crisis. Driven by an increase in availability of pharmaceutical opioids and by an increase in their consumption, specifically, for pain treatment, more so in the past twenty years, it has led to an economic cost of prescription opioid abuse, overdose, and dependence in the United States estimated to be 78.5 billion USD. The purpose of this systematic review was to identify and evaluate public health strategies that contribute towards combatting the opioid crisis. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for articles in English language that analyzed the most effective ways to regulate health markets to decrease the opioid crisis in the United States. Results The initial search yielded 2397 titles, of which 15 full-text articles were ultimately selected for inclusion in this systematic review. The review identified four categories in overcoming this epidemic nationwide, including required improvement in patient utilization of and access to safe and effective treatment options for opioid abuse and overdose, addressing the stigma correlated with opioid use, considering appropriate use of abuse deterrent formulations (ADF) along with patient education, and improving prescribing practices via utilization of drug monitoring programs, CDC opioid prescribing guidelines and provider continuing education. Conclusions Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. While the methods with promising improvement of the situation have been identified, implementing them has shown to be a challenge. Continued application is needed, while considering possible new steps that could help reinforce their utilization further. Key messages Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. The methods with promising improvement of the opioid crisis situation have been identified, however utilizing and implementing the existing public health strategies has shown to be a challenge.

scholarly journals Exploring the impact of the opioid epidemic in Black and Hispanic communities in the United States

2020 ◽  
Vol 6 ◽  
pp. 205032452094042 ◽  
Author(s):  
Jasmine Drake ◽  
Creaque Charles ◽  
Jennifer W Bourgeois ◽  
Elycia S Daniel ◽  
Melissa Kwende
Keyword(s):  
United States ◽  
Disease Control ◽  
Cause Of Death ◽  
The United States ◽  
Opioid Epidemic ◽  
Minority Communities ◽  
Urban Minority ◽  
The Impact ◽  
Overdose Deaths ◽  
The U.S

Context: In recent years, due to an alarming increase in the number of opioid-related overdose fatalities for White, Non-Hispanics in rural and suburban communities across the United States, they have been considered as the face of this epidemic. However, there has also been a staggering rise in the number of opioid overdoses in urban, minority communities, which have not been thoroughly addressed by the literature. Methods We reviewed deaths where opioid-related substances were reported as the leading cause of death to the Centers of Disease Control Multiple Cause of Death database from 1999 to 2017. Deaths were analyzed by year, State, drug type, and race and ethnicity. Results There were 399,230 total opioid-related deaths from 1999 to 2017 amongst all ethnic groups in the U.S. During this timeframe, approximately 323,939 total deaths were attributed to White, Non-Hispanics, while 75,291 were attributed to all other ethnicities. Examination of opioid-related overdose death data by ethnicity reveals that while White, Non-Hispanics have experienced the largest numbers of opioid-related overdose deaths in the U.S with up to 37,113 deaths occurring during 2017, there has also been a sharp rise in the number of opioid-related overdose deaths for minorities. opioid-related overdose deaths for Black, Non-Hispanics climbed from 1130 deaths in 1999 to 5513 deaths in 2017, while opioid-related overdose deaths for Hispanics climbed from 1058 in 1999 to 3932 in 2017. According to the Centers for Disease Control and Prevention, over the past 19 years, age-adjusted opioid-related deaths for Hispanics have climbed from 3.5 overdoses per 100,000 in 1999 to 6.8 overdoses per 100,000 in 2017. However, greater increases have been reported for Blacks during the same 19-year timeframe with age-adjusted rates of 3.5 overdoses per population of 100,000 in 1999 to 12.9 overdoses per population of 100,000 in 2017. Conclusion While Opioid-related overdoses have overwhelmingly plagued rural and suburban White, Non-Hispanic communities, there has been a surge in the number of deaths in Black and Hispanic Minority communities in recent years. Although there have been significant increases in the number of opioid-related overdose deaths in Black and Hispanic communities, the media narrative for this epidemic is often portrayed as a White, Non-Hispanic rural and suburban crisis. As a result, intervention strategies and policies have failed, both, to assess the severity of the problem in minority communities and to offer culturally sensitive preventative and treatment solutions. In this paper, the impact of the opioid epidemic on Black and Hispanic minority communities will be presented. Racial disparities in the U.S. Government’s current approach to an epidemic, which plagues rural and suburban White America, will be compared to its past criminal justice response to drug pandemics in urban minority communities. Culturally sensitive policy considerations and recommendations that can be used to, both, mitigate and offer treatment options for the opioid epidemic in these minority communities will also be addressed.

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