who are prescribed opioid medicines are on the path to addiction and overdose death. Importantly, the rise in heroin use in the last several years is commonly seen as having been caused by the advent of abuse-deterrent opioid drugs and the recent crackdown on the medical prescribing of opioids because physicians have become reluctant to prescribe these medicines. In this common narrative, opioid-addicted pain patients have turned to the illegal drug market for heroin because heroin is cheaper and more accessible. Every element of this concern is


Katz, J. (2017, April 14). You draw it: just how bad is the drug overdose epidemic? Te New York Times. Available: htps://www.nytimes.com/interactive/2017/04/14/upshot/drug-overdose-epidemic


Extending opioid prescribing to patients with chronic pain not only dramatically increased the number of Americans taking prescription opioids (97.5 million in 20152


and HIV (see figure above).7 ),


but it also massively increased access to and availability of prescribed opioids. For example, in 2012, 259 million prescriptions for opioids were dispensed in the US3


—


enough for one botle of opioids for each American adult.4 Tese factors combined to create a “perfect


storm” of serious negative consequences. Recently the Centers for Disease Control and Prevention announced that in 2016, overdose death in the US reached a record high of 63,600, two thirds of which were opioid overdoses.5


Reshaping the Current Opioid Epidemic Narrative Te drug overdose epidemic, fueled mainly by opioid use, is the defining public health epidemic in the United States in the 21st


Century. Te central In the same year, about 2.1


million Americans age 12 or older met criteria for an opioid use disorder (i.e., addiction)— with 1.8 million people with a prescription pain reliever use disorder and 0.6 million with a heroin use disorder.6 In just one year, from 2015 to 2016,


overdose deaths increased 21%. Before this increase, overdose deaths had already surpassed deaths from car crashes, guns


8 datia focus


role of prescription opioids has turned national atention to the roles played in the epidemic by pain medicines, the healthcare system and the pharmaceutical industry. Te current narrative about the role of opioid pain medicines in the opioid epidemic is that these medicines are highly addictive, are overprescribed and, as a result of their nonmedical use by patients, prescribed opioids are the primary driver of drug overdose deaths. In this narrative, many medical patients


Drug


overdose deaths are now the most common cause of death for Americans under the age of 50.8


Tese facts are


compelling but they do not tell the whole story and they can be misleading about today’s “public health emergency.”9


correct. Efforts to reshape the treatment of pain with less reliance on chronic opioid use are needed. Healthcare generally and the pharmaceutical industry particularly bear tragic responsibility for the prolonged underestimation of the risks of widespread, high-dose, long-term prescribing of opioids.10, 11 However, this current narrative is only


part of the story. It misses several essential elements of the larger picture of addiction that must be understood to turn back the overdose epidemic. First, it fails to specify how non-addicted opioid pain patients transition into opioid addiction and it ignores how the medical use of opioids differs distinctly from addictive use of the opioid medicines. Second, the current narrative fails to connect the role of opioids in overdose deaths to the wider patern of nonmedical, or recreational, drug use. Opioid overdose deaths, like other drug overdose deaths, usually involve the use of other addictive drugs, such as alcohol, marijuana, cocaine, and methamphetamine, among many others.12


Tird, the current overdose


narrative ignores the significant role of adolescent initiation to drug use in the opioid overdose epidemic at older ages. While it is important that for many opioid- addicted people their first use of an opioid was a prescribed opioid from a physician,


winter 2018


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