The U.S. opioid crisis continues to unfold as a massive health crisis with soaring costs in care, treatment, and lives. According to the U.S. Dept. of Health and Human Services and the U.S. Centers for Disease Control (CDC), opioids were involved in 47,600 of the 70,237 drug overdose deaths in 2017, or 67.8 percent, an uptick of 9.6 percent from 2016. It’s thought that around 2.1 million Americans are currently living with opioid use disorder. According to the National Institute for Drug Abuse, the epidemic kills an average of 130 people each day and costs the U.S. economy an estimated $78 billion a year.
The epidemic also continues to rage across state lines. Again from the HHS, in 2017 the states with the highest rates of death due to drug overdose were:
Alongside those, the states with statistically significant increases in drug overdose death rates from 2016 to 2017 included: Alabama, Arizona, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, West Virginia, and Wisconsin.
Age, race and gender are no barrier, as drug-overdose deaths, both with and not involving opioids, continues to rise across the United States in adults of nearly all ages.
The numbers are stark, and much work remains to be done both in terms of diagnosis and treatment as well as education. Even so, there are signs of hope. The CDC reports that opioid prescribing has declined since 2012, and July 2019 data showed a 5.1 percent decline in overdose deaths for the first time since 1990. It’s thought that decline comes from increased awareness, new and targeted education regarding opioid risks and benefits, as well as education on non-pharmacologic and non-opioid alternatives both to prescribers and to patients.
Access to opioids is slowly becoming more restricted, as both the U.S. Drug Enforcement Administration (DEA) and Food & Drug Administration (FDA) put new practices into place. The FDA in particular says it is focused on securing the legitimate supply chain and doing more to hold distributors responsible. Under the Drug Supply Chain Security Act (DSCSA), manufacturers, re-packagers, wholesale distributors, and dispensers (mainly pharmacies) are all required to have systems and processes in place to quarantine and investigate suspect and illegitimate medications. And states have beefed up their own laws regarding drug access and supply, with such measures as:
Heightened regulation and stopgap measures at the pharmacy counter cannot do it alone. Awareness and avoidance are key, certainly, but so is treatment and education for those already struggling with addiction. According to statistics from a National Survey on Drug Use and Health, 11.4 million Americans misused opioids in 2017, and 2.1 million had an opioid-use disorder. Government data further shows that the number of people seeking treatment for opioid addiction now outweighs alcohol abuse at facilities which provide data.
Given the high cost, both in economic and human terms, more attention is likely to focus on treatment, and the outcomes from medical intervention. The costs of treatment vary from state to state, but a benchmark can be found from preliminary cost estimates from a U.S. Department of Defense certified opioid treatment program, which offered methadone treatment, medication and integrated psychosocial and medical support services. Depending on the services involved, that ran from $115 per week to $1,117.50 per month to between $6,552 and $14,112 per year. (For context, the Agency for Healthcare Research and Quality lists expenditures for individuals who received health care for diabetes mellitus at $3,560 $5,624 for those with kidney disease.)
The opioid crisis is a swift and agile foe. The effort to curtail it must continue across all the current lines of attack, and healthcare providers must stay on top of any and all efforts being made so that they can fulfill their role in awareness and treatment, and also in safe opioid use among their patient population.
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