Prescription Opioid Abuse Causes

Understanding Opioid Addiction

The rise in opioid misuse and addiction is a growing concern in public health, with prescription opioids often playing a central role. Understanding the scale of this issue, and the impact of prescription opioids, is crucial in addressing the factors that contribute to prescription opioid abuse causes and devising effective strategies to combat it.

Opioid Epidemic Statistics

The opioid epidemic has seen a significant increase in the number of overdose deaths in the last few decades. According to the CDC, the number of people who died from a drug overdose in 2021 was over six times the number in 1999. Furthermore, the number of drug overdose deaths increased more than 16% from 2020 to 2021. Over 75% of the nearly 107,000 drug overdose deaths in 2021 involved an opioid. In the period from 1999 to 2021, nearly 645,000 people died from an overdose involving any opioid, including prescription and illicit opioids.

Moreover, in 2017, approximately 12 million Americans misused opioids and more than 47,000 people died of opioid overdose, reflecting a 345% increase in overdose fatality rates between 2001 and 2016.

Impact of Prescription Opioids

Prescription opioids have a significant role in the opioid crisis. According to the NCBI, they contribute to 40% of opioid overdose deaths in the United States. In 2018, an average of 41 people died each day from overdoses involving prescription opioids, totaling nearly 15,000 deaths, and opioids were involved in 32% of all opioid overdose deaths.

Furthermore, the misuse of opioids — legal, illegal, stolen, or shared — is the reason 90 people die in the U.S. every day on average, according to the American Society of Anesthesiologists.

These statistics highlight the pressing need to address the issue of prescription opioid misuse and addiction, and underline the importance of investigating the causes and potential solutions to this public health crisis.

Factors Influencing Opioid Misuse

Understanding the factors that contribute to prescription opioid abuse is essential in preventing and addressing the opioid crisis. The misuse of opioids is influenced by a multitude of factors ranging from individual traits to larger environmental influences.

Individual-Level Factors

Several individual-level factors contribute to the misuse of opioids, including sociodemographic characteristics, health and mental health factors, biological factors, and psychosocial factors. Sociodemographic factors include age, race, gender, ethnicity, education, income, and employment status. For example, being unmarried or divorced is associated with an increased risk of opioid dependence(Source). Health and mental health factors include personal health status and any mental health conditions that may predispose an individual to substance misuse. Biological factors include genetic predispositions that may make some individuals more susceptible to opioid misuse than others [1].

Influence of Family and Social Circles

The behavior and attitudes of family, friends, and co-workers significantly influence opioid misuse. A family history of substance use disorder, accessibility to opioids from family and friends, and workplace environments can all contribute to opioid misuse. For example, if opioids are readily available in a household, an individual may be more likely to misuse them. Similarly, if substance misuse is normalized or encouraged in a particular social circle or workplace, this could also increase an individual's likelihood of misusing opioids [1].

Community and Environmental Factors

The community and immediate context in which individuals live can affect opioid-related risks. Factors such as geographic conditions, treatment accessibility, pain management practices, prescription opioid formulations available, community norms, and access to legal and illegal opioids can perpetuate opioid misuse. For instance, if an individual lives in a community where opioid misuse is common, they may be more likely to engage in similar behaviors. Additionally, if access to treatment for opioid misuse is limited in their community, they may have a harder time ceasing misuse.

Beyond these immediate influences, the larger social context, including government regulations, economic conditions, social stigma, advertising campaigns, educational campaigns, and law enforcement, shapes the risk factors of opioid misuse. Factors such as the opioid market economy, government programs and regulations, access to treatment, social stigma, economic conditions, and law enforcement and criminal justice systems all contribute to the opioid crisis. For example, overprescribing opiates and opioids, lack of education and opportunity, and economic hardships can all lead to an increased risk of opioid dependence [1].

In conclusion, the causes of prescription opioid abuse are complex and multifaceted, requiring comprehensive and multi-pronged solutions to address them effectively.

Risks and Consequences of Opioid Misuse

The misuse of prescription opioids continues to be a serious public health issue with far-reaching consequences. These range from the genetic predisposition to addiction, through numerous health risks, to significant social and economic implications.

Genetic Factors in Addiction

Research indicates that the risk for opioid addiction can be influenced by genetic factors. Twin studies suggest that 50% of the risk for opioid addiction is genetic. Several genome-wide association studies (GWAS) have identified genetic risk factors for opioid addiction, including alleles in potassium-ion-channel genes (KCNC1 and KCNG2) and a glutamate receptor auxiliary protein (CNIH3). Additionally, a variant in the µ-opioid receptor gene (OPRM1) that regulates OPRM1 expression appears promising. In pharmacogenetics of opioid addiction, methadone dose may be regulated by variants in the cytochrome P450 2B6 (CYP2B6) gene and a locus 300 kb 5' to OPRM1. A single-nucleotide polymorphism in the δ-opioid-receptor gene may predict treatment response to methadone versus buprenorphine.

Health Risks Associated with Opioid Misuse

Opioid misuse poses a variety of health risks. Opioids have highly-addictive properties, posing a substantial risk of addiction and overuse [4]. Individuals with certain healthcare conditions or characteristics may be more sensitive to opioid effects, which may lead to overdose.

Opioids may interact with other medications that can increase the risk of overdose, arrhythmias, or seizures, so it is crucial to consult healthcare providers and pharmacists and read information from the Food and Drug Administration (FDA) before taking other medications concurrently with opioids [4].

People addicted to an opioid medication who stop using the drug can have severe withdrawal symptoms that begin as early as a few hours after the drug was last taken. Symptoms of withdrawal include drug craving, irritability, yawning, severe sweating, restlessness, anxiety, depression, dilated pupils, watery eyes, runny nose, hot and cold flashes, muscle aches, insomnia, and other symptoms [5].

Yes, a person can overdose on prescription opioids. An opioid overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death. When people overdose on an opioid medication, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, which can result in coma, permanent brain damage, or death [5].

Social and Economic Implications

Prescription opioid misuse has far-reaching social and economic implications. Overprescribing opiates and opioids, lack of education and opportunity, and being unmarried or divorced were identified as contributing factors to dependence on opioids. The opioid epidemic has led to increased access to opioids for vulnerable populations, resulting in accidental death among men and the degradation of rural community health services [6].

Overprescription of opioids has significantly contributed to the opioid crisis, with a fourfold increase in prescription opioid sales associated with a fourfold increase in deaths attributed to prescription opioids from 1999 to 2008 [6].

Rural communities have been the epicenter of the opioid epidemic, with the strain of treating opioid use disorder (OUD) putting rural hospitals in a precarious position due to the lack of experienced professionals, expensive treatment materials, and lack of reimbursement from government benefactors.

The prevalence of opioid use and misuse has led to a staggering number of deaths over the past two and a half decades. In 2017, approximately 12 million Americans misused opioids and more than 47,000 people died of opioid overdose, reflecting a 345% increase in overdose fatality rates between 2001 and 2016 [1].

In conclusion, the risks and consequences of prescription opioid misuse are numerous and complex. It is therefore essential to continue research into the causes of misuse, and to develop effective prevention and treatment strategies.

Preventing Opioid Misuse

Preventing prescription opioid misuse is a complex challenge that requires a multi-pronged approach. Collaborative efforts and education and awareness initiatives are two key strategies for preventing opioid abuse.

Collaborative Efforts for Prevention

Collaboration is essential for success in preventing opioid overdose deaths. Medical personnel, emergency departments, first responders, public safety officials, mental health and substance use treatment providers, community-based organizations, public health, and members of the community all bring awareness, resources, and expertise to address this complex and fast-moving epidemic.

The CDC's efforts include timely tracking of nonfatal and fatal drug overdoses, improving toxicology to better track polysubstance-involved deaths, enhancing linkage to care for people with opioid use disorder and risk for opioid overdose, improving prescription drug monitoring programs, implementing health systems interventions, partnering with public safety, and implementing other innovative surveillance and prevention activities [7].

Collaboration among medical personnel, public safety officials, mental health and substance use treatment providers, community-based organizations, and public health is crucial in addressing the opioid epidemic [1]. This collaborative approach involving various stakeholders, including healthcare providers, community organizations, and government agencies, is essential for preventing opioid misuse. By working together, these stakeholders can develop comprehensive strategies, share resources, and implement effective prevention measures.

Education and Awareness Initiatives

Education and awareness initiatives play a vital role in preventing opioid misuse. By providing accurate information about the risks and consequences of opioid use, these initiatives can help individuals make informed decisions and seek appropriate support [1].

However, education about the use of naloxone and opioid tapering, when appropriate, was not consistently discussed with patients during opioid medication counseling. Pharmacists perceived themselves to be responsible for medication safety, yet were uncomfortable dispensing opioids, in part due to the perception of “policing” opioid prescriptions. Pharmacists desired training about communication techniques to facilitate conversations with patients regarding opioids.

Several studies found that healthcare professionals (HCPs) discussed drug name, purpose, administration, and side effects when counseling patients about opioid medications. However, risks associated with opioid medication use were not as frequently discussed as side effects.

Education and awareness initiatives should focus on providing accurate information about the risks and consequences of opioid misuse. By increasing knowledge and understanding, these initiatives can empower individuals to make informed decisions and take steps to prevent opioid misuse.

Treatment and Recovery Options

Addressing the complex issue of prescription opioid abuse involves understanding the various treatment and recovery options available. It is vital to understand that recovery is a long-term process, often requiring medical treatment, psychological therapy, and strong social support.

Withdrawal Symptoms and Treatment

People addicted to an opioid medication who stop using the drug can have severe withdrawal symptoms. These symptoms can begin as early as a few hours after the drug was last taken and can include drug craving, irritability, yawning, severe sweating, restlessness, anxiety, depression, dilated pupils, watery eyes, runny nose, hot and cold flashes, muscle aches, insomnia, and other symptoms [5].

It's important to note that withdrawal should be managed under medical supervision. Sudden cessation can lead to severe and potentially life-threatening withdrawal symptoms. Treatment can include a combination of medications, counseling, and social support to help manage symptoms and reduce the risk of relapse.

Addressing Opioid Dependence

Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects. As a result, dependence on the drug can develop.

The process of addressing opioid dependence often involves a combination of medication and behavioral therapy. Medication-assisted treatment (MAT) is a comprehensive way to address the needs of individuals that combines FDA-approved medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies. This approach has been shown to be effective in reducing illicit opioid use compared to non-drug approaches, and more individuals stay in treatment compared to non-drug approaches.

Support for Recovery Efforts

Support during the recovery process is crucial. This can come in various forms, including family and friends, recovery programs, counseling, and support groups. These resources provide a network of support, understanding, and advice that can significantly aid in the recovery process.

Furthermore, recovery from opioid dependence is not a short-term goal; it's a long-term commitment. Therefore, ongoing support is often necessary to help individuals maintain their recovery and prevent relapse. This might include continued participation in treatment programs, regular check-ins with healthcare providers, and ongoing participation in support groups.

Understanding the treatment and recovery options available for prescription opioid abuse is a crucial step towards addressing this pervasive issue. With the right support and resources, recovery is definitely possible, and individuals can regain control over their lives.

References

[1]: https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-00596-8

‍[2]: https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372

‍[3]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741106/

‍[4]: https://www.dol.gov/agencies/owcp/opioids/riskfactors

‍[5]: https://nida.nih.gov/publications/drugfacts/prescription-opioids

‍[6]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410480/

‍[7]: https://www.cdc.gov/opioids/basics/epidemic.html

‍[8]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9030717/