Understanding the Opioid Crisis in 2019

Opioids have made headlines recently with a number of cities and counties across North America taking legal action against drugmakers and distributors in federal courts for the widespread damages caused by opioid addiction.

What are Opioids?

Opioids include the entire family of opiates (derived from the natural ingredients of opium). This includes synthetic and semi-synthetic substances (Gowan 2019).

Opioids include strong prescription pain relievers. It has been shown that a significant number of patients who use opioids for longer than the recommended period will develop a dependency (Medline Plus 2019; Charumilind 2018).

The Four Main Types of Opioids

1. Endogenous opioids (produced by the body)
   1. Endorphins
   2. Enkephalins
   3. Dynorphins
   4. Endomorphins

1. Opium alkaloids (natural opiates)
   1. Morphine
   2. Codeine
   3. Thebaine

1. Semi-synthetic opioids
   1. Diamorphine (heroin)
   2. Hydromorphone
   3. Oxycodone
   4. Buprenorphine

1. Fully synthetic opioids
   1. Fentanyl
   2. Pethidine
   3. Methadone
   4. Tramadol
   5. Tapentadol

(Gowan 2019)

Why Do People Use Opioids?

A person might be prescribed opioids when they are experiencing acute or chronic pain and their current pain management - using non-drug treatment and non-opioids - is inadequate (Gowan 2019).

Opioid-Use Disorder

‘Opioid-use disorder’ is the clinical term for opioid addiction. Opioids are highly addictive because they trigger the release of endorphins in the brain. A person may feel compelled to increase their dosage or seek out illegal means of obtaining opioids, such as heroin, in response to a developed tolerance (Mayo Clinic 2018; Medline Plus 2019; CNN Library 2019).

The Opioid Crisis in America

The unfathomably-large scale of prescription opioid shipments from 2006 to 2012 sits at an estimated 76 billion opioid painkillers. Low-income, rural areas have been hit the hardest, including Wise County Kentucky and Norton, Virginia (Terry 2019).

Fatal overdoses occurred in great numbers across Appalachia and other ‘hotspots’. Generally considered to be a Midwest problem, the rate of opioid overdoses rose in all eastern US states (George 2019).

The national death toll as a result of drug overdose was 70,200 in 2017, with an estimated 47,600 of those being opioid-related (CNN Library 2019). It is commonly accepted that opioid abuse rates are underdiagnosed and underreported (Kiang 2019; Charumilind 2018).

Synthetic opioid deaths now outnumber heroin deaths in the USA, indicating the production of drugs including methamphetamines and cocaine are now contaminated with opioids such as fentanyl (George 2019).

It is estimated that in North America a staggering 400,000 people have died as a result of opioid addiction since 1999. The cost of the epidemic on the American economy is estimated at $179 billion in 2018 (Simmons-Duffin 2019).

The effect of opioid addiction spreads wider than measurable overdoses and deaths: it also influences unemployment, loss in productivity and exacerbations of behavioural health conditions (Charumilind 2018).

One pharmaceutical giant has been fined $572 million (USD) by a US court in August for being found responsible for fuelling the opioid crisis (Hayes 2019).

District Court Judge Thad Balkman, who determined the pharmaceutical company’s role in the epidemic, also made mention of Tasmania due to its link to the highly addictive oxycodone family of painkillers (Hayes 2019).

Tasmanian Poppy Farmers

Tasmania is implicated in recent opioid scandals as it is the world’s largest producer of legal alkaloids. Alkaloids are the raw materials from poppies that form powerful opioid painkillers (Hayes 2019).

Tasmania’s poppy-farming industry supplies 50 per cent of the raw materials that make up the world’s opioid painkillers (Kastelloriou 2019; Hayes 2019).

In response to allegations that they are part of the problem, poppy farmers are claiming to have complied with international and US federal regulations and cannot be held responsible for the crisis.

One farmer in an ABC interview stated blaming poppy growers for opioid addiction is comparable to blaming wheat growers for the obesity epidemic (Edgell as quoted by Hayes 2019).

Opioid Use in Australia

Australia is one of the many countries to see significant growth in the use of pharmaceutical opioids over the past 20 years. In 2015 it was estimated that nearly 15 million opioid prescriptions were dispensed in Australia (Campbell 2019).

Similar to the USA, Australia also saw a shift towards a higher rate of casualties relating to pharmaceutical opioids rather than as a result of heroin. In 2017, it was estimated that 1,600 Australians died from drug overdoses related to opioids (Campbell 2019; Hayes 2019).

Strategies were put into place by the National Pharmaceutical Drug Misuse Framework for Action (2012-2015) such as coordinated medication management systems, increased access to pain and addiction services, development of resources, and workforce development. Few of these strategies have been carried out (Campbell 2019).

Looking Forward

To address the opioid problem in Australia, Dr Gabrielle Campbell (2019) suggests that we need to implement the following strategies:

• Improving opioid education for both health provider and consumers;
• Improving communication between providers; and
• Widening the availability of specialist pain and addiction services that work alongside primary care providers.

(Campbell 2019)

Stigma likely plays a large role in the hesitation patients and health professionals have toward addressing the opioid epidemic, locally and abroad. It is also necessary to attempt to reverse the over-reliance on medicines as solutions for chronic health issues (Cambell 2019).

Additional Resources

• National Institute on Drug Abuse: https://www.drugabuse.gov/drugs-abuse/opioids

References

• Campbell, G 2019, ‘How is Australia Responding to the pharmaceutical Opioid Problem?’, National Drug and Alcohol Research Centre, Sydney, viewed 31 October 2019, https://ndarc.med.unsw.edu.au/blog/how-australia-responding-pharmaceutical-opioid-problemhttps://ndarc.med.unsw.edu.au/blog/how-australia-responding-pharmaceutical-opioid-problem
• Charumilind, S, Latkovic, T, Lewis, R and Mendez-Escobar, E 2018, ‘Why We Need Bolder Action to Combat the Opioid Epidemic’, McKinsey and Company, viewed 31 October 2019, https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/why-we-need-bolder-action-to-combat-the-opioid-epidemic
• CNN Library, ‘Opioid Crisis Fast Facts’, CNN, viewed 31 October 2019, https://edition.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html
• George J 2019, ‘New Opioid Epidemic “Hot Spots” Emerge in U.S.’, Medpage Today, viewed 31 October 2019, https://www.medpagetoday.com/neurology/opioids/78170
• Gowan, J 2019, ‘Pain, Opioids and Other Analgesics: Part 2’, Ausmed, Melbourne, viewed 31 October 2019, https://www.ausmed.com.au/cpd/courses/opioids-and-analgesics
• Hayes, J 2019, ‘Tasmanian Poppy Farmers are at the Centre of the US Opioid Crisis, But They Say They’re Not to Blame’, ABC News, Sydney, viewed 31 October 2019, https://www.abc.net.au/news/2019-10-13/tasmania-poppy-farmers-in-crosshairs-of-us-opioid-crisis/11588766
• Kastelloriou, S 2019, ‘Tasmanian Poppy Farmers Are at the Centre of the Opioid Crisis in USA’, SBS Greek, viewed 31 October 2019, https://www.sbs.com.au/language/english/audio/tasmanian-poppy-farmers-are-at-the-centre-of-the-opioid-crisis-in-usa
• Mayo Clinic 2018, How Opioid Addiction Occurs, Mayo Clinic, viewed 31 October 2019, https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-opioid-addiction-occurs/art-20360372
• Medline Plus 2019, Opioid Misuse and Addiction, Medline Plus, viewed 31 October 2019, https://medlineplus.gov/opioidmisuseandaddiction.html
• Simmons-Duffin, S 2019, ‘The Real Cost Of The Opioid Epidemic: An Estimated $179 Billion In Just 1 Year’, NPR, viewed 31 October 2019, https://www.npr.org/sections/health-shots/2019/10/24/773148861/calculating-the-real-costs-of-the-opioid-epidemic
• Terry, NP 2019, ‘Shouldn’t There Be a Law Against Reckless Opioid Sales? Turns Out, There Is’, The Conversation, viewed 31 October 2019, https://theconversation.com/shouldnt-there-be-a-law-against-reckless-opioid-sales-turns-out-there-is-121021