Are We Finally Getting Serious About Our Deadly Drug Trends?
Is there anyone left in our nation who can say they personally know no one touched by problem drug or alcohol use?
Judging by a flurry of studies released in 2016, including the first-ever report on alcohol, drugs and health by the Surgeon General, the answer is a resounding no. The new data makes clear that more and more Americans are using drugs and alcohol in ways that are hurting them and those around them, and experiencing record levels of addiction.
Yet amid all the discouraging findings, there are signs of hope. It is now up to us to find ways to use this new knowledge and build upon it so we can stop the downhill slide and maybe even reverse it.
First the bad news:
- Drug overdoses killed a record 50,000 people in 2015.
- Deaths from opioids such as heroin and prescription painkillers have quadrupled since 1999, breaking down to 91 deaths for every day in 2015.
- Heroin-related deaths now surpass gun homicides. As recently as 2007, gun homicides outnumbered heroin deaths more than 5 to 1.
- Almost 1 out of 12 people in the U.S. has substance use disorder, but only about 10% of that group receives any kind of treatment. Complicating the picture, nearly half of those with a substance use disorder also have a mental disorder but less than half are treated for either condition.
- Each year, alcohol misuse contributes to 88,000 U.S. deaths.
- Substance misuse costs society an estimated $442 billion annually in health care, lost productivity and criminal justice costs.
- Since 1980, the combined death rate from drugs, alcohol and mental disorders has almost tripled. And some areas have seen astonishing jumps. Clermont County, Ohio, for instance, which has been hit hard by the opioid epidemic, saw a 2,206% increase.
- A third of long-term prescription opioid painkiller users surveyed said they are addicted to the drugs. One in 5 said their doctor didn’t give them enough information about the addiction risks, and 6 in 10 said they weren’t advised about when and how to stop taking the drugs.
Put it all together and there is no question that ours in a nation in the throes of a drug crisis unlike anything we’ve seen before.
Now, some good news:
We are finally waking up to that trouble and the need to address it aggressively before it snowballs further out of control. For example:
- In December, Congress approved the 21st Century Cures Act, which includes $1 billion in state grants to help tackle the opioid crisis.
- Overdose deaths involving prescription opioids (such as OxyContin and Vicodin) are now rising only slightly after years of galloping to record highs, a sign that efforts to educate the public about their dangers are starting to have an effect.
- The CDC’s “Guideline for Prescribing Opioids for Chronic Pain” has begun to be implemented by the medical community, resulting in less prescribing of the drugs that have proven so addictive.
- Naloxone, a medication that can reverse the toxic effects of an opioid overdose, has become more widely distributed, is now standard equipment for most emergency responders, and is saving lives daily.
- Medication-assisted treatment, such as with buprenorphine, which blocks painful withdrawal symptoms and diminishes cravings, is becoming more accepted and more available. Recent rule changes have allowed qualified doctors to prescribe the drug to more patients than in the past (up to 275 in some cases).
- Prescription drug monitoring programs, which seek to keep patients from shopping around for doctors willing to prescribe to them as well as oversee doctors who might be tempted to operate a “pill mill” for profit, are being ramped up.
- The Affordable Care Act and parity laws have created new opportunities to receive treatment by requiring insurers to cover substance use disorders and addiction issues at the same levels as traditional medical services.
- Through drug courts and other efforts, the criminal justice system has taken steps to put non-violent drug offenders in treatment rather than behind bars. And more of those who are already behind bars are getting access to evidence-based treatment.
In the big picture, research has helped us better understand that a substance use disorder is an illness, one that changes brain circuitry and disrupts functions such as decision-making and self-control. That knowledge is slowly helping to lessen the stigma surrounding addiction.
We still need “a cultural shift in how we think about addiction,” as Surgeon General Vivek H. Murthy, MD, MBA, noted in his agency’s report, so that we can move past the old idea of addicts being simply immoral or weak-willed. But progress is being made, and that means people who are struggling with drugs or alcohol may be more willing to admit they have a problem and seek treatment. And the sooner a person gets help, the less likely they are to show up one day as a statistic.
Perhaps most crucially, the Surgeon General’s report notes that recovery from addiction is possible along a variety of paths and it is much more common than many realize. It may take time, multiple episodes of treatment, and a long-term commitment but “approximately 50 percent of adults who once met diagnostic criteria for a substance use disorder — or about 25 million people — are currently in stable remission (1 year or longer),” the report noted.
It’s a reality that we shouldn’t forget when the bad news about our nation’s substance use starts to seem overwhelming, and it’s one that I can attest to as an addiction psychiatrist. No matter the substance, the person, the circumstances, or the depth of the drug or alcohol use, there is hope.