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Last week I attended an opioid conference to better understand the current crisis, though I haven’t had any clients at risk. As you may know, opioids are prescribed to manage pain. However, some 56,000 Americans died of overdose in 2015 and it is expected the number will increase in coming years. The cause of death is suppressed breathing, the major negative opioid side effect.
The consumption of opioids is greatest in West Virginia and the surrounding Appalachian area as well as a large swath of the southwest, around New Mexico. There are also major hotspots in the Northeast, Midwest, and far West.
Four perspectives were presented at the conference—the role of the National Institute of Mental Health (NIMH) in combating the epidemic, Pennsylvania’s challenge in its northern counties, behavioral health services provided in Philadelphia, and the University of Pennsylvania’s research into opioid addiction.
It turns out the opioid crisis lies solely within the United States. It’s a slight problem in Australia, and almost totally nonexistent in the E.U. The distribution suggests that profits are the driving force of our widespread addiction. Fentanyl, the chief synthetic opioid, is inexpensive to make relative to high profit margins. China mail orders fentanyl to customers in the U.S. and provides express shipment to wholesalers. Fentanyl also is smuggled in from Mexico and Canada as well as increasingly produced in small labs here at home.
NIMH is looking to minimize deaths by having first responders and emergency clinics equipped with naloxone, an opioid blocker delivered by nasal spray to help overcome suppressed breathing. NIMH also is using neuroimaging to identify the pathways affected by the drug, looking for other drugs that can manage pain without the negative side effects, and testing temporary (six month) implants to resist negative effects, among its other efforts.
Interestingly, the use of opioids in northern counties of Pennsylvania has skyrocketed, with males ages 24-29 the major users. In Philadelphia, however, the use of heroin tops opioids.
It appears that three distinct populations are at risk for addiction to opioids—those with severe pain; the self-medicators burdened with excessive stress, anxieties, and depression; and the recreational users, looking to get high. Yet, there seemed to be little distinction in targeting and treating addiction among these groups.
The auditorium was packed with psychiatrists, other physicians, and medical students, with standing room only in the rear, making it difficult to ask questions that came to mind. I would have liked to ask what age groups and possible geographical groupings account for the high death rate due to overdosing. Needless to say, to save lives, major targeting could be aimed at those within these groupings. Moreover, as a clinical psychologist, I am particularly interested in those looking for exciting sensations versus the self-medicators, some of whom may deliberately be overdosing as a death wish.
My colleagues tell me that use of opioids and heroin is much greater than recognized, that they attend social events where high-powered professionals regularly use the substances—but carry naloxone spray with them to avoid congested breathing.
Overall, it looks like we can expect the epidemic to become worse before it becomes better. We don’t have a national strategy to address the crisis, haven’t pinpointed the motives of those at risk, don’t have better controls on overprescribing pain medications among medical doctors, and allow profit-making to supersede our nation’s mental health.
I would welcome any comments or observations you may have that may shed more light on this spreading crisis, since in one way or another, we as a nation, are all in this together.
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This blog was co-published with PsychResilience.com
