The opioid epidemic is one of the most devastating public health crises of our time.
- Overdose deaths, which had already been rapidly increasing since the late 1990s, skyrocketed to over 100,000 deaths a year during the pandemic.
- Increases in substance use disorders are particularly alarming in one specific group: pregnant people and their newborns.
- Overdose is now the leading cause of pregnancy associated deaths in many states.
Opioids are a class of drugs that interact with the opioid receptors in the nerves and brain and can reduce the intensity of pain signals.
- They can be naturally occurring, like products found in certain poppy plants or morphine, semisynthetic, like heroin or oxycodone, or fully synthetic like fentanyl.
- Opioid overdoses occur when someone takes an amount of an opioid, alone or in combination with other substances, that impairs the body’s ability to function.
- Because opioids interact with receptors in the brain and nerves, they can interfere with the heart and lungs, slowing the heart rate and respiratory rate and depriving the brain of oxygen.
The reason that some people become dependent on opioids and others do not isn’t fully understood.
- It’s likely a combination of the way the drugs affect the emotion centers in the brain, family history, and environmental and lifestyle factors.
- For some people, the drugs not only relieve pain, but trigger a pleasure response. As tolerance to the drug increases, some people are driven to take more or stronger doses to continue feeling the effects.
- Substance use disorder, or in this case opioid use disorder, is the term we use to describe a person who continues to use opioids even in the face of negative consequences. It’s a more compassionate and less stigmatizing term than “addict.”
The opioid epidemic began in the late 1990s.
- The opioid epidemic first began in the late 1990s when prescriptions for opioid pain medications quadrupled between 1999 and 2009.
- Many attribute this rise to improper rules around drug labeling and marketing.
- In 1995, the drug manufacturer Purdue Pharma submitted a new drug application to the FDA for its extended-release oxycodone.
- The labeling of the drug allowed Purdue to market it for the treatment of chronic pain, rather than for limited duration or to treat life-limiting debilitating pain only, despite the risks of dependency outweighing the benefits.
- With the less restrictive labeling, Purdue was able to aggressively market the drug for things like lower back pain and fibromyalgia, and doctors who previously understood opioids to be habit-forming were told by sales people the drug has a low risk of dependency and that it was safe to use.
From 1999 to 2010 the amount of opioid prescribed not only increased…
- …but also the dose and duration—indicating the patient population was beginning to experience opioid use disorders.
- A review in 2014 found insufficient evidence to support the benefits of long term opioid use, and that chronic use of opioids was associated with a higher risk of overdose.
- But by then, the opioid crisis had already firmly established itself in the population.
As the share of people suffering from opioid use disorder grew, a second wave began in the 2010s with increased use of heroin.
- At this time, the predominant source of heroin changed from South America to Mexico, which created a steady, and cheap, supply into the U.S.
- As guidelines for opioid prescribing changed and the number of prescriptions decreased, easy-to-access and affordable heroin began to outpace other semisynthetic opioids when it came to overdose deaths.
- The third, and current, wave started in 2013 with a rapid increase in use of the synthetic opioid fentanyl.
Fentanyl is a man-made opioid, that has been used to treat pain in surgery since the 1960s.
- It’s up to 50 times stronger than heroin, cheap to produce, and easy to ship around the country.
- It only takes a small amount to reach the same feeling that comes from heroin or other opioids, but this means it’s easy to take too much, and the risk for overdose is higher as well.
- While fentanyl has contributed to overdoses via contaminated drug supplies, many people are now seeking out the drug itself as their preferred substance.
- Since 2021, over 100,000 people have died of an overdose each year, and since the epidemic began in 1999, over half a million people have died from opioid overdoses alone.
The crisis truly spares no one, including pregnant and postpartum people.
- Opioid overdose is now a leading cause of death associated with pregnancy and the postpartum period.
- From 2017-2020, pregnancy-associated overdose deaths (which are overdose deaths that happen within the first year of giving birth) increased by 81%.
- Despite the fact that treatments for substance use disorders are available to pregnant people and have been shown to improve the health outcomes of the babies, many people face difficulties accessing them.
Stigma, clinic location, ability to access services, income, and fear of punishment all act as barriers to accessing care.
- One study found that pregnant people were significantly less likely to be granted an appointment with an opioid use disorder clinician compared to non-pregnant people.
- And if people cannot get care for substance use disorders in pregnancy, then they are likely to have babies that experience neonatal abstinence syndrome.
- Neonatal abstinence syndrome, or NAS, is the term that’s used when newborns experience a group of conditions caused by withdrawal from certain drugs, usually opioids, that they are exposed to in the womb.
- Often, these infants are put into the foster care system. Infants are actually the fastest growing age group in foster care, accounting for 20% of placements, mostly because of parental substance use.
- But change may be coming. In 2023, overdose deaths declined for the first time in 5 years.
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