Understanding the Opioid Epidemic

For someone who doesn’t understand opioid addiction, when media report an epidemic and talk about opioids leading to heroin use, without lots of context and historical, factual information, it causes fear and misinformation. Understanding addiction is important to understanding the opioid epidemic. My fear is that well-meaning public officials will attempt to “fix” the problem and actually make it worse. One such “fix” has been to place too much blame on doctors and prescription use of opioids, which might lead to restrictions on access to opioids, which might lead to more people seeking drugs on the street. Also, demonization of heroin complicates the matter.

Heroin and opioids are powerful drugs, and they can be dangerous. However, opioids, when prescribed for pain, are very effective and useful. The problem is that a certain percentage of opioid users will become addicted. Those who become addicted to opioids have a predisposition to addiction, and there’s treatment for this. The main problem with the opioid epidemic and the use of heroin is when people purposefully seek the drugs to feed an addiction. The addict isn’t treating pain, but rather using opiate-like drugs because they’re physically addicted and have a psychological compulsion to use the drugs even after they’re physically withdrawn from opioids. It’s the mental and emotional obsession that creates the insane use despite severe consequences.

So, until addiction in general is understood, it’s not likely that good solutions will arise to deal with the specific problem of an opioid epidemic. To put all this in perspective, though, let’s imagine a new drug is discovered. Let’s say this new drug is so popular that it’s legalized, yet it becomes the cause of approximately 90,000 deaths a year. Let’s say that around 80% of the population over 18 use this drug. Let’s say that 10 to 13% of the people who use this drug develop a problem of addiction or serious misuse that meet treatment criteria. Let’s say that 30% of all driving fatalities are related to the use of this drug. Let’s say that the consequences of the drug cost the US 250 million dollars a year. Let’s say the following are true:

• Around 1,825 college students between the ages of 18 and 24 die from causes related to this drug.

• 696,000 students between the ages of 18 and 24 are assaulted by another student who has been using this drug.

• 97,000 students between the ages of 18 and 24 report experiencing sexual assault or date rape related to the use of this drug.

• Roughly 20 percent of college students meet the criteria for treatment for addiction to this drug.

• About 1 in 4 college students report academic consequences from using this drug, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall.

This drug, of course, exists. It’s alcohol. So, while opioid addiction is a serious problem, it’s best understood in the context of addiction in general. It’s strange to demonize a drug like heroin, or emphasize the addiction epidemic to opioids, and to focus most addiction-related resources toward a war to eradicate the demon heroin and restrict pain medication, when alcohol presents a larger problem than heroin, opioids, cocaine, pot and all drugs combined. I understand alcohol is a socially accepted and regulated drug, and I’m not a prohibitionist, but it helps to think about alcohol as just another potentially-addictive drug. The point is to focus attention on treatment. To understand addiction is the key to understanding the opioid epidemic. Opioid and heroin addiction are big problems — addiction, including alcoholism, is a huge problem, and it’s all treatable.