The U.S. government reported that 130 Americans die every day from an opioid overdose, and the growing crisis is costing the country approximately $75.8 billion a year in lost productivity, criminal justice intervention, and healthcare. Those costs are expected to keep rising in the coming years, according to a January 2019 U.S. News & World Report article.
That expectation reflects an element of insanity underscoring the gravity of this crisis: If policymakers, doctors, public health officials and others keep trying to tackle the opioid crisis with the same methods that have been failing, then yes, the crisis will continue to escalate. Already one-third of Americans know someone who is or was dependent on opioids, according to the American Psychiatric Association. Changes in how opioid use disorder is identified and treated — or better yet, prevented — will be key to turning the tide of the epidemic.
Labeling vs. Understanding: The Zero-Sum Game of Substance Abuse Stigma
People living with opioid dependence or addiction are often simply labeled as “addicts,” carrying the connotation that their opioid abuse is a personal failure or some untenable character flaw. The mental health conditions or other underlying causes that led them to develop substance abuse disorders are minimized, disregarded or overlooked.
Oversimplifying opioid use disorder by labeling people with the condition “addicts” can make them feel isolated and hopeless. A person living with an opioid dependence doesn’t need to be shamed, shunned or ignored. They don’t need to be abandoned in an attempt at “tough love.” They need to be heard, seen and understood by the medical community and their own community.
These Unaddressed Factors Keep Driving the Opioid Epidemic
About 80 percent of people using heroin first misused prescription opioids, according to the National Institute on Drug Abuse. Opioid dependence and addiction — including use of heroin, fentanyl and prescription painkillers — has steadily increased since the 1990s when oxycodone, brand-name OxyContin, was introduced to the market.
At the time, physicians and researchers said this powerful new class of painkillers was safe and non-addictive, which has led to rampant over-prescribing; medication abuse at a rate of nearly 30 percent by those prescribed the drugs; and people turning to cheaper, more accessible, and more powerful illicit street varieties. Not much has changed to slow these trends. In 2012, doctors wrote 259 million prescriptions for opioid painkillers — enough for one prescription for every single American adult, according to the American Society of Addiction Medicine.
This opioid crisis isn’t just a consequence of a lack of oversight by the medical community. Emotional and psychosocial factors are at play, too. America is rife with heated political and social disputes, strained economic conditions, and a culture that rewards instant gratification. Individuals are facing loss, trauma, chronic stress, and emotional as well as physical pain, with 59 percent of Americans saying they consider this to the lowest point in U.S. history that they can remember, according to a 2017 American Psychological Associate report that surveyed multiple generations
Self-medication has become a common response. Yet the despair fueling the need to self-medicate continues to go unaddressed. Instead, treating the symptom — addiction — has become the standard.
Treating Addiction with More Drugs Isn’t Helping
People with opioid dependence and addiction are being offered socially acceptable and legal ways to feed their addiction under the guise of help or treatment. These substitute opioids — such as methadone, naloxone, and other pharmacological interventions — can mitigate the disruptive effects of opioid withdrawal, but they don’t end the dependence.
These replacement opioids end up propagating the very cycle they claim to try to address. People who are off heroin but reliant on Suboxone to survive the day are not free of their addiction.
Replacement opioids extend the sense of numbness and escapism that originally led the person to develop opioid use disorder. This numbness keeps people from seeking clarity about their underlying feelings — and often removes the incentive to do so. These drugs aren’t coping mechanisms or crutches; they become chains with a different name keeping the person in bondage to the substance dependence.
Without detoxing from the substance to get free of the dependence, the person cannot get the much-needed clarity to discuss an accurate diagnosis of the underlying cause of the dependence with their doctors. And without accurate diagnoses of and treatment for those issues – whether mental health conditions, unresolved trauma, underdeveloped coping skills, anxiety or other struggles — successful treatment and lasting solutions will continue to elude the individual and the country.
Patient-First Approaches Can Help End the Opioid Crisis
Opioid addiction affects every aspect of the socioeconomic scale. Drugs do not discriminate — but healthcare providers and members of society have. Instead of labeling all people struggling with opioid dependence as addicts and funneling them into a cycle of failed treatment method, communities, doctors and policymakers need to consider a more effective person-first approach.
The person-first approach to addressing the opioid crisis requires a significant reprioritization in treatment, starting with the following:
- Place a higher value on the individual’s and community’s healing.
- Utilize treatments such as medical detox to help a person eliminate physical dependence to opioids.
- Leverage the clarity gained from detox to treat the real causes of the person’s drug use.
- Evaluate other methods of treating long-term pain.
- Provide the support systems necessary to help a person maintain treatment for those underlying causes of dependence so that they can stay opioid-free.
The in-depth, state-by-state analyses that provide the devastating statistics used to illustrate the gravity of the opioid epidemic are helpful to an extent. They capture mass attention to increase awareness. But they shouldn’t be accepted as signs the problem is unfixable. The crisis doesn’t not need to continue to escalate for years to come if new approaches to finding real solutions are employed and failing methods are cast aside.
Published February 7, 2019