Sunday Article 09: Opioid Epidemic

The Opioid Epidemic

Opioids have been widely used around the world for severe and/or chronic pain. In an arsenal of painkillers, they are considered big guns. But if they’re so good at relieving pain, why is it not prescribed more?

Why can’t we simply take opioids for any pain?

The short answer to that is addiction. However, it’s worth checking out the long answer.

While America is known for many things, in healthcare they’re also known for the ongoing opioid crisis. Since the 1990s, at least 760 000 died due to drug overdose; in 2018, two out of three overdose deaths were related to opioids [1]. This is because the risk of addiction to opioids was underestimated.


How do opioids work?

Opioids derive from the opium poppy plant, Papaver somniferum [2].As some may know, the use of opioid has been used for centuries, where opium (extract of the juice from the flower) helped relieve pain, produce euphoria, induce sleep and combat diarrhoea [2].

Opioid agonists act on different opioid receptors, such as mu, kappa and delta (they’re also classed under G protein-coupled receptors) [2]. They are mostly expressed on neurones but can be found in other places around the body. Activation of these receptors in the central nervous system can cause analgesia, euphoria, cough suppression, nausea and vomiting and more [2]. Opioid receptor activation in the peripheral nervous system can cause constipation and/or histamine release from mast cells [2].

Opioids can be addictive because unlike paracetamol and ibuprofen, when opioids activate the opioid receptor, they can also lead to the release of dopamine [2]. Dopamine is a feel-good hormone, therefore it can encourage people to continue to take opioids for more dopamine release [2].


Figure 2 Intracellular changes after binding of opioid to a G-Protein. From: Pathan, H., & Williams, J. (2012). Basic opioid pharmacology: an update. British Journal Of Pain, 6(1), 11-16. doi: 10.1177/2049463712438493



Why was there an opioid epidemic? How bad was it?


The epidemic happened in three phases, where the first phase began in the early 1990s [4,5]. Around this time, there was an increase in patients being prescribed opioid or opioid-combination medications [4]. Pharmaceutical companies and medical societies believed that opioid medications had a low risk of addiction, hence encouraged doctors to prescribe them [4]. This led to more patients with non-cancer pain taking opioids, which snowballed into 86% of opioid patients taking them for non-cancer pain [4].

The second phase occurred in 2010 when there was an increased death in heroin overdose [4,5]. Efforts have been made to reduce prescribed opioids, thus making opioids harder to obtain [4]. Those who have become dependent on their prescribed opioids inevitably resorted to heroin, which was cheaper, abundant, and illegal [4]. Between 2002 and 2013, deaths by heroin overdose rose by 286% in the US[4]. Since heroin is injected, there was also a risk of transmitting bloodborne diseases around the community such as HIV and Hepatitis B and C.

The third phase is the most recent, starting around 2013 [4]. Fentanyl is a synthetic opioid and while it can be used medically, it was also manufactured illicitly [5]. Illicit fentanyl was used as alternatives to drugs of abuse, which ultimately caused the third wave of the epidemic [4]. In the US, there were over 20,000 deaths related to fentanyl and related drugs in 2016 [4].


How did they combat this?

To combat the epidemic, the CDC (Centers for Disease Control and Prevention) has funded health departments in line with the Overdose Data to Action cooperative agreement [5]. They aimed to track drug overdoses, enhance the care of users with opioid use disorder and those at risk of overdose, improving prescription monitoring, improving toxicology and more [5]. They also do this monitoring trends, supporting healthcare systems, increasing public awareness and various other methods. Fortunately, the CDC aren’t the only one coming up with interventions; the U.S Department of Health and Human Services are in it as well [6].

Want to learn more?

Patriot Act is a Netflix show that does political and social commentary with comedian Hasan Minhaj as the host. This show covers various world issues in hilarious ways, without diminishing the seriousness of the issue. In one of the episodes, Hasan focuses on how the pharmaceutical companies (wrongly) took part in the opioid epidemic. It’s eye-opening and informative – it’s worth watching!


You can catch the Fentanyl episode here:
https://www.youtube.com/watch?v=vkhMfgOT9Xs
P.S: He focused on Malaysia in a different episode too!

REFERENCES:

  1. Opioid Crisis Statistics. (2021). Retrieved 14 February 2021, from https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html#:~:text=In%202018%2C%20an%20estimated%2010.3,and%20808%2C000%20people%20used%20heroin.&text=Appropriate%20prescribing%20of%20opioids%20is,and%20safety%20of%20Medicare%20beneficiaries

  2. Pathan, H., & Williams, J. (2012). Basic opioid pharmacology: an update. British Journal Of Pain, 6(1), 11-16. doi: 10.1177/2049463712438493

  3. Prescription Opioids DrugFacts | National Institute on Drug Abuse. (2021). Retrieved 14 February 2021, from https://www.drugabuse.gov/publications/drugfacts/prescription-opioids

  4. History of the Opioid Epidemic. (2021). Retrieved 14 February 2021, from https://www.poison.org/articles/opioid-epidemic-history-and-prescribing-patterns-182

  5. Understanding the Epidemic | Drug Overdose | CDC Injury Center. (2021). Retrieved 14 February 2021, from https://www.cdc.gov/drugoverdose/epidemic/index.html

Opioid Overdose Crisis | National Institute on Drug Abuse. (2021). Retrieved 14 February 2021, from https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis

This article is prepared by Sarah Yasmin Sharuddin.

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