use, including opioid use, and the busy physicians do not have the time to deal with this complicated and difficult health problem. Worse yet, too many physicians falsely
believe that intervention and treatment of addiction do not work—that addiction is hopeless. Te reality is otherwise. Addicted patients are good people with serious and challenging health problems. Physicians need to provide care to their addicted patients, not by prescribing more opioids or other controlled substances, but by helping them recognize their disease and to find help overcoming it, as they would with any other serious, chronic disease. Physicians can help their addicted patients enter treatment and, because addiction is a chronic and even a life-long disease, physicians can play an essential role in helping to manage their long-term recovery. Physicians can also refer addicted patients to recovery support programs in the community, including Alcoholics Anonymous and Narcotics Anonymous.
Correcting Misconceptions about Opioid Addiction, Overdose Death and Drug Supply One common misconception about opioid (and other drug) addiction is that treatments that aim to stop drug use “fix” addicted
patients. Treatment can be, and oſten is, a solid first step on the road to lasting recovery but, for most opioid-addicted patients, recovery requires extensive recovery support and years of work from patients and oſten from families. While stopping opioid use is difficult for addicted people, a large majority of individuals addicted to opioids have stopped using these drugs many times, both for voluntary and involuntary reasons. Te real question is not “why can’t they stop using drugs?” but rather, “why can’t they stay stopped?”. Te biggest challenge in the journey to achieving lasting recovery is remaining abstinent from all drugs, including alcohol. Treatment is almost always short-term while addiction changes the brain while using, even aſter stopping, these changes may persist for a long time or forever. Another misconception is that opioid
addiction is a quick death sentence. In fact, for an active heroin user, the estimated annual risk for overdose is an estimated 1.6% and 2.5% and for all opioids, about 2% (see Table 1). Tis translates to between about one in 40 to one in 60 active opioid users dying of an overdose each year of opioid use; however, the lifetime risk of premature death is higher, with death rates ranging between 25–50% higher than for non-addicted people 20 years aſter addiction sets in.
Table 1. Estimates of the Risk of Opioid Overdose Death Drug Overdose Deaths
Use in the Past Year
Heroin—15,469a (2016) All opioids—42,429a a b
/ /
(2016) / 948,000b 626,000b 2.1 millionb
Substance Use Disorder in the Past Year
= =
=
Many opioid-addicted people are
unmoved by the risk of overdose death because such a small percentage of their opioid-using friends die each year. Overdose deaths oſten occur at a crucial time in which a person who has not been using opioids suddenly resumes using at the same dose level used previously and/or when other drugs, such as benzodiazepines or alcohol, are added to the opioids. Opioid doses that were tolerated during active addiction are oſten lethal to the same individual who has not been using at all for weeks or longer or who starts taking other sedative-type drugs. A third misconception is that the opioid
overdose epidemic is limited to opioids. Glaringly overlooked is the fact that there are few people addicted to opioids that do not also, and usually simultaneously, use other drugs. Te national data on opioid overdose deaths provided by the CDC is limited because it is based on routine death reports from medical examiners which substantially underreport the presence of additional drugs. Tis is because many death investigations do not include full (if any) toxicological testing and some medical examiners do not report more than a single drug, or they use vague language like “drug death” rather than specifying the drug(s) identified at autopsy. In contrast, the Florida Drug-Related Outcomes Surveillance and
Estimated Annual Risk of Overdose
1.6% 2.5%
2.0%
Thielking, M. (2017, December 21). Life expectancy in the US is falling—and drug overdose deaths are soaring. STAT. The opioids most commonly involved in overdose deaths. Data from National Center for Health Statistics. Available:
https://www.statnews.com/2017/12/21/life-expectancy-drug-overdose/
Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available:
https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.htm
*Note: Tese are crude estimates. Prevalence rates of drug use and substance use disorders are based on self-report, with some high-risk populations underrepresented. Past year users are diverse in many ways including how oſten they use opioids, by what routes of administration they use the opioids and by which individual opioids they use. Past year users include people who used once in the year and people who used opioids a thousand times in that year. Further, national overdose death data rely on state toxicological testing and reporting to the Centers for Disease Control and Prevention which vary dramatically. Additionally, among opioid overdose deaths, seldom are opioids used alone.
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