With drug overdose being considered the leading cause of accidental deaths in the US with an estimated 91 people dying every day from opioid use disorder, it is no wonder why we are in an opioid crisis. In 2015, 2 million Americans 12 or older had a substance use disorder involving prescription pain relievers and over 20,000 overdose deaths were related to prescription pain relievers (American Society of Addiction Medicine, 2016). This paper takes a look at why more people have access to legal opioids, the implications on having this access, and why the opioid epidemic is targeting primarily young white Americans.
This epidemic is partially due to the fact that the number of written opioid prescriptions has skyrocketed. In 2012 alone, 259 million prescriptions were written for opioids (American Society of Addiction Medicine, 2016). This incredible number includes an estimated 60% of patients with nonmalignant pain being prescribed opioids; 20% of which are considered long term users (Tripp, Rak & Burker, 2017). Looking at the history of opioids being prescribed shows even scarier facts. The prescribing rates of opioids to adolescents and young adults has nearly doubled from 1994-2007 (American Society of Addiction Medicine, 2016); the amount of prescription opioids sold and the amount of deaths due to prescription opioids have more than quadrupled since 1999 (American Counseling Association, n.d.). With so many prescriptions being written, it is important to look into why they are being written.
Chronic pain and the use of opioids have gone hand in hand for many years. The experience of chronic pain is subjective and is shaped by numerous factors, including biomedical, psychological, and behavioral. Due to this, it is difficult to diagnose an opioid use disorder for those who have used opioids long term for chronic pain since addiction criteria cannot be applied to them. Previous to the late 1990’s, opioids were rarely used as treatment for chronic pain. When physicians started prescribing opioids for acute pain in cancer patients, pharmacological manufactures started advocating for the use of opioids in non-cancer patients for treatment of chronic pain. From then, the use of opioids for chronic nonmalignant pain greatly increased in which 21-29% of those prescribed opioids for chronic pain long term were considered as misusing opioids and 8-12% of those are experiencing addiction (Tripp, Rak & Burker, 2017). According to Kirk Bowden, an American Counseling Association member who chairs the addiction and substance use disorder program at Rio Salado College in Arizona, opioids should not be used for chronic pain, instead they are more suitable for acute pain. Long term use of opioids can exacerbate pain as shown by neurobiological studies (Bray, 2017).
With opioid dependence having the possibility of beginning as early as 5 days, it is a serious question on why doctors typically prescribe 30 day supplies (Bray, 2017) following a surgery, trauma, or an exacerbating health condition and usually increased in dosage until the opioid reaches effectiveness (Tripp, Rak & Burker, 2017). “By the end of 30 days, the opioid is not addressing their pain anymore” (Bray, 2017). There are many contributing factors for the rise of opioid use disorder. One of the biggest contributing factors has to do with the prescribing doctors. Nearly 99% of opioid prescribing physicians going beyond the recommended 3 day dosage limit with a quarter of them writing 30 day supplies instead. Dr. Vivek Murthy, a US Surgeon General, stated that most of the opioid abuse are “coming from legally written prescriptions” (American Counseling Association, n.d.). With the focus of opioid addictions coming from those legally written prescriptions, race becomes another contributing factor.
An article written by the American Public Health Association in 2016 called “Is the Prescription Opioid Epidemic a White Problem?” touched on this subject. According to the article, there are a few reasons why opioid addiction has targeted majority of white individuals; marketing, the FDA’s classification of OxyContin, access to insurance coverage and treatment, and the changes in drug policies.
The marketing of buprenorphine, the “office-based opioid maintenance” treatment, is one of the main focuses in the article. Marketing is becoming primarily internet based with this rise of technology, which obviously caters to the computer literate. This in turn caters more towards middle to upper class SES; hence primarily white. These internet service announcements are sponsored by the buprenorphine manufacturers primarily included images of “white professionals” (Hansen & Netherland, 2016). When all demographics are not included, individuals might not feel as if they fit into that category and do not pursue these lines of treatment.
Additionally, the US FDA changed the classification of OxyContin (an opioid) in 1996 to a “minimally addictive pain reliever”. This, in turn, gave the manufacturers of OxyContin, Purdue Pharma, the ability to approach physicians with their medication to treat pain; promotion which was in primarily white states like Maine, Kentucky, and Virginia (Hansen & Netherland, 2016). With this lessened classification, physicians have fewer restrictions and qualifications that need to be met in order to prescribe the medication.
An individual’s access to insurance coverage and treatment are also huge components of why whites seem to be the target of the opioid epidemic. The United States Census Bureau reported in their 2016 “Health Insurance Coverage in the United States” report that 93.7% of non-Hispanic Whites had health coverage as compared to 89.5% Black, 92.4% Asian, and 84% Hispanic (Barnett & Berchick, 2017). Hansen and Netherland (2016) stated that “opioid prescriptions disproportionately went to White patients… which increased racial differences in opioid use”. This, coupled with changes in drug policies when it comes to opioid drug offenses and their sentencing, can lead to a racially motivated epidemic.
Instead of arresting consumers of nonmedical opioids, policymakers are requesting “reduced sentencing for nonviolent illicit drug offenses” (Hansen & Netherland, 2016). Physicians are being mandated more frequently to use Prescription Drug Monitoring Programs, voluntary take-back programs for unused medication, and Good Samaritan laws that protect individuals who are calling for emergency medication attention from attaining drug charges as well. This does not carry over to Blacks and Latino communities; “many drug addicted [Black and Latino] individuals continue to be incarcerated rather than treated for their addiction” (Hansen & Netherland, 2016). While the use of these programs could be helpful, they need to be applied to all communities and therefore to all races/populations. Another important topic to touch on is why the opioid epidemic seems to be targeting young adults.
According to Substance Abuse and Mental Health Services Administration’s (SAMHSA) report on the 2016 National Survey on Drug Use and Health (2017), 4.4% of the population (approximately 11.8 million) aged 12 or older have misused opioids within the past year. The main reason reported as to why they misused opioids was to relieve pain (62.3%) but other reasons were also included: to feel good or get high (12.9%), to relax or relieve tension (10.8%), to help with feelings or emotions (3.9%), to help with sleep (3.3%), to experiment or see what it’s like (3%), because they are hooked or have to have the drug (2.1%), to increase or decrease the effects of other drugs (0.9%), or some other reason (0.9%). While the majority of participants reported it was for some sort of pain relief, how they obtained the drug could also be considered misuse. Participants reported to SAMHSA that they attained the opioids in the following ways: given to them from a friend or relative for free (40.4%), a prescription from one doctor (35.4%), bought from a friend or relative (8.9%), bought from a drug dealer or other stranger (6%), took from a friend or relative without asking (3.7%), prescriptions from more than one doctor (1.4%), stolen from a doctor’s office, clinic, hospital, or pharmacy (0.7%), or some other way (3.4%) (Substance Abuse and Mental Health Services Administration, 2017). Within these statistics, it is shown how many different ways young adults are getting their hands on opioids and why they are using them. The trend for continued use is also prevalent; “It is known that youth who use opioids, whether prescribed by a medical practitioner or used non-medically, are likely to continue opioid use in the future” (Osborne, Serdarevic, Crooke, Striley, & Cottler, 2017). The younger an addict starts, the more likely they are to continue use and the more time they have to become addicted. With generations starting earlier and earlier, other societal issues can start to worsen for the future like life expectancies, the quality of the economy, overall public health, etc.
The opioid epidemic is being more popularized with the news and media in order to promote treatment but we need to look at more than just possible treatments. Why are more people getting legal access to opioids, what are the implications on having this access, and why the opioid epidemic is targeting primarily young white Americans are major topics to be studied. This paper took a brief look at these topics in order to better understand what we are dealing with when it comes to the opioid epidemic we have on our hands.
Christina D. Eubanks M.S.
Primary Therapist/Spark of Hope
American Counseling Association (n.d.). What are opioids? Retrieved from: https://www.counseling.org/images/default-source/cam2017/opiods_cam.jpg?sfvrsn=2
American Society of Addiction Medicine (2016). Opioid Addiction: 2016 Facts and Figures. Retrieved from: https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
Barnett, J. and Berchick, E. (2017). Health insurance coverage in the United States: 2016. Retrieved from: https://www.census.gov/content/dam/Census/library/publications/2017/demo/p60-260.pdf
Bray, B. (2017). We’re in danger of losing a generation. Retrieved from: https://ct.counseling.org/2017/04/danger-losing-generation/
Hansen, H. and Netherland, J. (2016). Is the prescription opioid epidemic a white problem? Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5105018/
Osborne, V., Serdarevic, M., Crooke, H., Striley, C., and Cottler, L. (2017). Non-medical opioid use in youth: Gender differences in risk factors and prevalence. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0306460317301351
Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www. samhsa.gov/data/
Tripp, C., Rak, E., and Burker, E. (2017). A review of effective treatments for patients with co-occurring chronic pain and opioid addiction. Retrieved from: https://www.counseling.org/docs/default-source/vistas/article_437fce2bf16116603abcacff0000bee5e7.pdf?sfvrsn=e1d84b2c_4