History of the Opioid Epidemic
The opioid epidemic has claimed the lives of more than 932,000 Americans since 1999. The opioid epidemic began with aggressive marketing of narcotic pain killers and a nation in pain. About 16 million Americans, or 8% of all adults live with persistent chronic back pain. This and other pain disorders were treated with opioids such as hydrocodone, oxycodone, morphine and sometimes fentanyl. This is called the “first wave” of the opioid epidemic and lasted eleven years. In 2010 the “second wave” began as prescribing rates decreased, a brand name medication was reformulated to be abuse resistant and first-time use of heroin soared. In 2013 fentanyl began circulating in the drug supply. By 2016 Fentanyl overdoses began exceeding heroin and prescription overdoses. In 2020 a fourth wave of the epidemic involved fentanyl and stimulants like cocaine and methamphetamine. 2021 alone resulted in 107,622 deaths from drug overdose. 2022 is predicted to have even more fatalities, that data won’t be available for many months.
Opioid Use Disorder Most Effective Treatments:
There are three medications approved by the FDA to treat Opioid Use Disorder:
- Methadone – A full opioid agonist methadone works by filling the opioid receptors drugs like heroin and fentanyl activate to create a high. When someone is taking an effective dose of methadone, they are not experiencing withdrawal or craving, and if they were to use an opioid, the methadone should block out or severely blunt the effects of that opioid. Methadone is the oldest medicine of the three and has been studied numerous times, determined to be safe and effective.Methadone in conjunction with counseling has repeatedly been identified as the golden standard for treatment of opioid use disorder. Due to the regulation of methadone, it can only be obtained for opioid use disorder at an Opioid Treatment Program where a nurse can observe the person taking the medication. When that person meets the requirements of that clinic, they can earn take home doses of medication. Programs typically offer detoxification (short term) and maintenance (long term) protocols. Typically, the longer someone is in treatment and abstinent, the more likely they are to stay sober at the conclusion of treatment.
- Buprenorphine/Buprenorphine with Naloxone – Buprenorphine is a partial opioid agonist/antagonist. This means that it bonds to some of the opioid receptor sites but blockades others. It works in the same way as methadone but is a weaker drug. Benefits of Buprenorphine are that it can be prescribed at a doctor’s office, although this may be a specialty doctor’s office. Before taking the first dose of Buprenorphine, the person needs to abstain from other opioids for 12-48 hours and be experiencing withdrawal prior to taking the first dose. If someone takes Buprenorphine too soon, they may experience precipitated withdrawal, which triggers a rapid onset of withdrawal symptoms, such as vomiting, diarrhea, dysphoria, and other uncomfortable symptoms. Again, like methadone a person can work with the prescribing physician on a detoxification protocol or choose to take it for maintenance dosing.
- Naltrexone– Naltrexone is a derivative of naloxone that binds to opioid receptor sites but produces no psychoactive effects. Naltrexone can be prescribed by any physician and doesn’t have special requirements to prescribe. People interested in naltrexone need to wait 7-14 days from their last use of opioids to take this medicine. Otherwise, precipitated withdrawal may occur resulting in symptoms consistent with opioid withdrawal.
Divine Right Transportation recognizes how important a community healing approach will be to the United States recovery from the opioid epidemic. If someone using opioids or other drugs wants to stop, our patient advocates will do everything they can to assist you with making an appointment to get treatment.