An estimated 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain medicines in 2016.1 Treatment admissions linked to these medications more than quadrupled between 2002 and 2012, although only a fraction of people with prescription opioid use disorders receive specialty treatment (18 percent in 2015).1 Overdose deaths linked to these medicines nearly quadrupled (from 4,400 to nearly 19,000, or 1.5 to 5.9 per 100,000 persons) from 2000 to 2014.2 There is now also a rise in heroin use and heroin addiction as some people shift from prescription opioids to their cheaper street relative; 626,000 people had a heroin use disorder in 2016, and nearly 13,000 Americans died of a heroin overdose in 2015.1,3 Besides overdose, consequences of the opioid crisis include a rising incidence of infants born dependent on opioids because their mothers used these substances during pregnancy4,5 and increased spread of infectious diseases, including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.6
Effective prevention and treatment strategies exist for opioid misuse and addiction but are highly underutilized across the United States. An initiative of the Secretary of Health and Human Services7 began in 2015 to address the complex problem of prescription opioid and heroin use. This initiative emphasizes improved education of healthcare providers in managing pain and prescribing opioids appropriately; wider availability and adoption of the effective overdose-reversing drug naloxone, which research has shown to be a lifesaver in communities where it has been distributed to people who use opioids, their families, and potential bystanders;8 and wider implementation of evidence-based treatment strategies.
Effective medications exist to treat opioid use disorders: methadone, buprenorphine, and naltrexone. These medications could help many people recover from opioid addiction, but they remain highly underutilized. Fewer than half of private-sector treatment programs offer medications for opioid use disorders, and of patients in those programs who might benefit, only a third actually receive it.9 Overcoming the misunderstandings and other barriers that prevent wider adoption of these treatments is crucial for tackling the problem of opioid addiction and the epidemic of opioid overdose in the United States.
All opioids are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to addiction, overdose incidents, and deaths.
An opioid overdose can be reversed with the drug naloxone when given right away. Improvements have been seen in some regions of the country in the form of decreasing availability of prescription opioid pain relievers and decreasing misuse among the Nation’s teens. However, since 2007, overdose deaths related to heroin have been increasing. Fortunately, effective medications exist to treat opioid use disorders including methadone, buprenorphine, and naltrexone.
A NIDA study found that once treatment is initiated, both a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid addiction. However, naltrexone requires full detoxification, so initiating treatment among active users was more difficult. These medications help many people recover from opioid addiction.