This is a guest post by Kristen Nichols Heitman, MPH, an epidemiologist in the Rickettsial Zoonoses Branch in the Division of Vector-Borne Diseases in the National Center for Emerging Zoonotic and Infectious Diseases at the Centers for Disease Control and Prevention (CDC). She received a Master of Public Health (MPH) with a concentration in epidemiology from Georgia State University.
In April, singer-songwriter and cultural icon Prince was found dead in his Minnesota home. In June, a medical examination concluded that the entertainer died of an accidental overdose of a pain medication called fentanyl – an opioid and one of the strongest painkillers available. There are still unanswered questions about the circumstances leading up to his death but it now appears that like millions of Americans, Prince was taking opioids to manage chronic pain.
According to the National Institute of Drug Abuse, opioids reduce the intensity of pain signals reaching the brain and affect the areas controlling emotion, which diminishes the effects of a painful stimulus. Medications that fall within this class include hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine and related drugs. Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injury-related pain. Morphine is often used before and after surgical procedures to alleviate severe pain.
The Origins of an Epidemic
The rise of the global prescription opioid epidemic started in the 1990s when pain specialists and advocacy groups in the U.S. began to argue that the nation faced an epidemic of untreated pain. A growing number of professional and consumer groups pushed for the increased use of opioids for pain management. In the U.S., the number of prescriptions written for opioids increased by 300 percent between 1991 and 2009. In 2009, Americans consumed 99 percent of the world’s hydrocodone, 60 percent of the world’s hydromorphone, and 81 percent of the world’s oxycodone.
In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness. In 2013, providers in the United States wrote nearly a quarter of a billion opioid prescriptions. This is enough for every American adult to have their own bottle of pills.
Addiction and Overdose: Who’s at Risk?
With the increase in providers prescribing opioids came an uptick in abuse, addiction and overdoses. Risk factors for abuse and overdose include:
- Obtaining overlapping prescriptions from multiple providers and pharmacies.
- Taking high daily dosages of prescription pain relievers.
- Having mental illness or a history of alcohol or other substance abuse.
- Living in rural areas and having low income.
While these risk factors help identify those at a higher risk for opioid abuse and overdose, anyone who takes prescription opioids can become addicted to them. In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with addiction to these powerful drugs. In 2014, nearly two million Americans either abused or were dependent on prescription opioid pain relievers.
Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids. Taking too many prescription opioids can lead to an overdose and stop a person’s breathing—leading to death. The most common drugs involved in prescription opioid overdose deaths include:
- Oxycodone (such as OxyContin®)
- Hydrocodone (such as Vicodin®)
Prescription opioid overdose deaths also often involve benzodiazepines. Benzodiazepines are central nervous system depressants used to sedate, induce sleep, prevent seizures and relieve anxiety. Examples include alprazolam (Xanax®), diazepam (Valium®), and lorazepam (Ativan®). While taking prescription opioid, benzodiazepines should be avoided.
Take a look at these statistics related to overdose deaths involving prescription opioids from 1999–2014:
- Overdose deaths involving prescription opioids have quadrupled since 1999, and so have sales of these prescription drugs.
- From 1999 to 2014, more than 165,000 people died in the United States from overdoses related to prescription opioids.
- In 2014 alone, more than 14,000 people died from overdoses involving prescription opioids.
- Opioid prescribing continues to fuel the epidemic. Today, at 50 percent all U.S. opioid overdose deaths involve a prescription.
- Among those who died from prescription opioid overdose between 1999 and 2014
- Overdose rates were highest among people aged 25 to 54 years.
- Overdose rates were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics.
- Men were more likely to die from overdose, but this gap between men and women is closing.
If you or someone you know suffers from prescription drug abuse, here are some helpful resources for finding treatment:
The conclusions, findings, and opinions expressed by the author do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.