Americans have experienced substance abuse issues throughout the nation’s history, whether it be alcohol, marijuana, cocaine, or some kind of narcotic. But federal officials say the wave of opioid and heroin addiction that has swept the United States in the last 15 years is the country’s worst drug crisis ever.
“There aren’t more people who are abusing drugs than there have been historically,” says Kimberly Johnson, PhD., director of the federal Center for Substance Abuse Treatment (CSAT) for the federal Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Md. “But the drugs that they’re using are more fatal, so more people are dying.”
In 2014 alone, opioid-related overdoses killed some 28,000 Americans.
Johnson and her agency are fighting the current drug crisis by promoting community-based addiction and mental health treatment services for individuals and families across the nation. She appeared on KET’s Connections with Renee Shaw to discuss the latest on substance use disorders. The conversation is part of KET’s Inside Opioid Addiction initiative.
For years, doctors have treated patient pain by prescribing medications like Vicodin or Percocet. The common belief at the time, according to Johnson, was that legitimate patients wouldn’t become addicted to these painkillers.
But things started to change in 1996 when OxyContin went on the market. The powerful opioid-based pharmaceutical led to a wave of addiction issues for patients and abuse among those without underlying pain issues.
“Because it had so much medication in one pill… it gave a much stronger high than something like a Vicodin would,” Johnson says.
State and federal officials have taken steps to better track prescriptions that physicians write for opiates. Johnson says 49 states have some form of mandated or voluntary prescription drug monitoring database, but she acknowledges that not all doctors use that information to help them spot patients with an opioid abuse issue. For example, a recent article in U.S. News and World Report indicates that 20 percent of individuals who have been hospitalized for an overdose or substance abuse problem were able to get a new prescription for opioids within a month of their release.
Johnson says CSAT is trying to develop protocols for doctors and their staffs to make checking the prescription databases as routine as their washing hands before seeing a patient. Health officials are also encouraging doctors to find other ways to relieve patient pain without resorting to opioid-based medications.
Between 2013 and 2015, health care providers did write fewer prescriptions for opiate painkillers, yet that hasn’t translated into a reduction in opioid-related deaths. Johnson says that’s because while there are fewer people showing signs of prescription opioid abuse, many addicts are now turning to heroin and Fentanyl to get high. And those drugs can be even more addictive and more deadly.
Drug Scourge Even Touches Newborns
Because the current epidemic is rooted in part in well-meaning efforts to treat legitimate pain, the resulting abuse problems have touched a wide range of Americas, young and old, rich and poor. Of particular concern for some health officials is substance abuse among pregnant women.
Infants exposed to addictive opiate drugs while in their mother’s womb can develop neonatal abstinence syndrome (NAS). After they are born, these babies go through withdrawal similar to what adult addicts in recovery can experience. Johnson says the withdrawal process, which can take about a week, is painful for the infants, and difficult for doctors and nurses treating those babies to watch. Plus those children can be at greater risk for substance abuse themselves as they grow older.
To help address NAS, Johnson advocates treatment options specifically geared for pregnant addicts.
“We know that there’s medication that works and that stabilizes women and can help their babies have a lower likelihood of having the neonatal abstinence syndrome,” Johnson says.
Those medications – methadone and buprenorphine – are opioid-based and can cause NAS in babies, but Johnson says the symptoms aren’t as severe as for infants exposed to heroin or other opiates while in the womb.
The Chronic Disease of Addiction
Johnson says effective treatment for any substance abuse disorder should combine medications to alleviate the physical symptoms of addiction and withdrawal along with mental health counseling to address the thoughts and behaviors that can facilitate an addiction. She says treatment specialists know what to do to help those with a substance abuse disorder, they just need more resources to be able to meet the demand for recovery services.
“We really do need to think about addiction as a chronic condition and something that people need to manage over the course of their life,” says Johnson.
She says individuals don’t leave a 30- or 90-day treatment program and find themselves miraculously cured of their addiction. Instead Johnson likens a person in recovery to someone with diabetes or heart disease in that they have to continually monitor their behaviors to ensure that they remain healthy.
Despite the ongoing increase in drug overdose deaths, Johnson says she is optimistic that the trend can be reversed eventually. She says abuse and addiction have been reduced for other substances in the past, so she believes the same can be done for heroin and opioids.
“The most common outcome to addiction is recovery,” Johnson says. “We forget that sometimes.”