- More than 130 people died every day in 2017
- Role of Safe Injections
- Steps taken towards countering Opioid
- Various programs by Government of United States of America
Covid 19 has been part of every news these days, the speed at which this infection is spreading its wings makes it more dreadful. Amidst the corona issues, the attention over Opioid crisis somehow seems to be diverted. Since year 1999, the opioid crisis has become one of the United States most talked about medical issue, the reason behind this being the death of over 399,000 people due to this drug over dose epidemic.
The term ‘Opioid’ comes from excessive use of opioid drugs from both the sources medically prescribed or through illegal sources. This epidemic broke in late nineties due to increased prescription of Opioid drugs for better pain management and have continued till date. The number of women getting addicted towards these drugs are higher as compared to males. Most of the population comes from rural areas, where there has been significant increase in drugs abuse by the youngsters as these opioid drugs are seemed as better replacement for traditional drugs like Marijuana, Heroin and Cocaine which are costly in monetary terms
As compared with other countries, the percentage of prescriptions of these drugs is higher by staggering 40 %. History states that opiates such as Morphine were used for instant pain relief since 18th century and immediately became part of everyone’s life as miraculous drug which relieved every small ailment. In the year 1898, the pharmaceutical giant Bayer pioneered marketing the drugs made from Heroin, until they were banned in the year 1924. The country of United States of America has faced Heroin addiction in mid nineteenth century as majority of musicians were addicted to it. Before these Opioid epidemic, there was Heroin epidemic in the year 1970, when the US servicemen brought Heroin extensively from Vietnam.
The current day opiates consists of ‘Vicodin’ and ‘Percocet’, which came into market in the decade of seventies and were not positively received by the doctors and practicing physicians as they were not keen to prescribe them. Physicians were refrained from prescribing them because of their nature of turning addictive, but things soon changed after a letter published in New England Journal of Medicine (NEJM), which dealt with addiction related to drug based medicines
As per survey by Country’s leading Organisation regarding Drug Use and Health stated that in year 2016 over 11 million Americans misused prescription opioids, nearly 1 million used heroin, and almost 2.1 million are addictive to prescription opioids or heroin.
The US Drug Enforcement Administration stated in one of its report published in year 2015, that almost half of the people died with opioid overdose were taking prescribed opioids. The deaths caused by opioid overdose are large in number as compared to guns or road accidents.
There are various opioids available in the market but the most used are ‘Oxycodone’, ‘Hydrocodone’, ‘Fentanyl’ and ‘Codeine’. As per data published by US Department of Health and Human Services said that around 11 million people in the country consume oxycodone annually. Oxycodone exists in U.S market since year 1939 and was used extensively until year 1970, when the Food and Drugs Administration identified and classified oxycodone as Schedule II drug, which indicates it as highly addictive in nature. Companies like Purdue Pharma have been instrumental in utilizing oxycodone in the country in most subtle form, eventually ending up paying huge fines
Second in the list of top prescribed opioid pain relief medications come Hydrocodone. Hydrocodone is available in the market under various names, it is mainly used in tackling chronic pain and have side effects as dizziness and respiratory issues. Stats said that Hydrocodone is the number one reason behind 40% more medical emergencies than any other prescribed opioid drug.
Other opioid painkillers codeine and fentanyl are said to be more than stronger than morphine. While codeine is already a controlled substance in majority of countries and is available in syrup and cough syrup, the fentanyl is most lethal opioid drug and comes as odourless and tasteless form. In last 2 years over fentanyl pills of worth $800 million were sold illegally in United States.
As per survey conducted by The Associated Press-NORC Center for Public Affairs Research in the year 2018, stated that the number of Americans who sight opioid addiction as a significant issue for their community had immensely grown since year 2016.
Awareness regarding this issue has been very low, as majority of people are not aware about its danger and the solution to this problem and this can also be termed as American government’s failure along with failure of Internet and news agencies, as these platforms are mainly concerned to showcase topic which are interesting in term of controversies.
Various studies and researches have been made relating to this opioid crisis, major studies reveal the data regarding the deaths and faculties but very few providing the solutions and steps taken by the government to take down this epidemic.
The place known as ‘Supervised injection facilities’, or SIFs is where People who inject drugs (PWID) inject previously obtained drugs in the presence of trained medical professionals under more hygienic and better environment. These centers are equipped with counselling programs along with other medical services. These sites or centres are existing in country since many years, although first open safe center was proposed for opening in year 2019, the legality of status depends on the area of jurisdiction.
In many cities, the overdose rate is because of various factors including an increase in prescription opioid abuse and the rise of synthetic opioids like fentanyl, which is tremendously potent as compared to other drugs.
The city of Baltimore has largest number of deaths by opioid overdose as compared to other cities. Last year almost 496 people died from fentanyl overdose.
Report made by Maryland’s Opioid Operational Command Center in the year 2018, found that 800 people out of 2,114 people that died from opioid overdoses were from city of Baltimore. This report makes it clear, that more number of SIF’s are required throughout the country.
A study by Amos Irwin and colleagues who published their cost-benefit analysis of a practically supervised injection facility by the name of “Mitigating the heroin crisis in Baltimore, MD, USA” to the Harm Reduction Journal in 2017 brought forward the benefits by utilizing local health data and data on the impact of existing SIFs as the current SIFs that have been studied include the Insite SIF in Vancouver, Canada and the Medically Supervised Injecting Centre (MSIC) in Sydney, Australia, which were established way back in 2003.
It also stated that SIFs help prevent disease and infection by providing clean needles and safe injecting education to reduce bacterial infections, which will automatically reduce the number of blood-borne disease transmission. Alongside, the medical people at SIFs are instrumental in bringing many of the additional benefits provided by the sites as the staff reduces bacterial infections by cleaning wounds and identifying serious infections at the initial stage and also identifying people who injected drugs and helping them get the treatment.
This study also revealed some economic aspects forward as it outlines the cost of a single SIF as the study says for the annual cost of $1.8 million, a single SIF will generate almost $7.8 million just by savings, which prevents 3.7 HIV infections, 21 Hepatitis C infections, 374 days in the hospital for skin and soft-tissue infection, 5.9 overdose deaths, 108 overdose-related ambulance calls, 78 emergency room visits and 27 hospitalizations, while bringing 121 additional people into treatment, clearly proving that SIFs are not only cost-effective, but also produce significant public health benefits along with its ulterior aim of saving lives. The reason behind no rise in number of SIF’s remaining low irrespective of its numerous benefits is both public and political concerns. While opponents argue that SIFs will promote drug use and will bring people who inject drugs to neighbor hoods in the areas where there are such establishments and also question the legality of SIF’s under federal Controlled Substances Act.
After studying carefully, two sections of the Controlled Substances Act could be interpreted to prohibit the establishment of a SIF: Section 844, which prohibits drug possession, and Section 858, which prohibits knowingly maintaining a place for the purpose of unlawfully using a controlled substance. The President Trump’s administration have made it clear that they would pursue legal action against cities or states that allow SIFs.
Irrespective of above mentioned interpretations of the law, both states and local governments still are capable of setting up an authorize SIF, as the state government has all the necessary powers to stand against the federal government.
While SIF remains the questionable part, in the year 2010, Federal government of United States began tracking down the physicians and doctor who prescribed opioid painkillers on extensive level. Which resulted into rise of Heroin based drugs, as they were cheap in terms of cost. Controlled Substances Act was amended in year 2010 with Responsible Drug Disposal Act, which allowed pharmacies to accept controlled substances from household and long term care facilities under take back programs.
A white paper related to administration plan to face the crisis was released in the year 2011. In month of July 2016, President Barrack Obama signed a law named as Comprehensive Addiction and Recovery Act, which resulted into expansion of opioid addiction treatment with the help of buprenorphine and authorizing millions of dollar towards opioid research and treatment. Same year the U.S. Surgeon General enlisted statistics which described the extent of problem. Ensuring Patient Access and Effective Drugs Enforcement Act was passed by the House and Senate, which was result of law signed by President Barrack Obama. This act reduced DEA’s intervention in opioid epidemic. In 2016 itself in the month December, came 21st Century Cures Act, which aided opioid crisis in the form of $1 Billion in terms of State grants.
Under the committee set in 2017, by the current President Donald Trump termed opioid crisis as ‘National Emergency’. As per strategy to fight opioid crisis was given by Department of Health and Human Services stated that there should be improved access to prevention, treatment, and recovery of support services will prevent the health, social, and economic consequences which are related with opioid addiction and will enable individuals to achieve long-term recovery, also targeting the availability and distribution of anti-overdose drugs which will ensure the broad provision of these drugs to people who are likely to experience or respond to an overdose, also with a particular focus on targeting high-risk populations. These strategy further states that it is extremely important to strengthen public health data reporting and collection in order to improve the timeliness and specificity of data and to inform a real-time public health response whenever such crisis or epidemic arises.
The authority should provide an updated research that leads to understanding of pain and addiction, also helping in development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms. It will also aid in the practice of pain management which will enable access to high-quality, evidence-based pain care that decreases the pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.
Centers for Disease Control and Prevention state that an average of 130 Americans die every day from opioid overdose.
Extra efforts and research is required in order to prove that addiction is a complex disease and it is high time that people look into the issue of drug abuse seriously. Just by making drugs abuse a severe offence won’t work as awareness needs to done in people, especially in rural areas. Not just awareness solutions should be given in order to overcome this opioid crisis. SIF’s properly monitored by the government can be an excellent solution as it will definitely bring in some progress towards this Epidemic and most importantly many lives will be saved.