How a prescription medicine became an overdose epidemic

The opioid crisis in the US is well known and is the subject of much debate and media attention; in 2017 alone, an overdose of opioids contributed to more than two-thirds (67.8%) of overdose deaths in the US, with a total of 47,600 deaths. Currently, 175 Americans die daily from drug overdose and the majority of these are on opioids. In the UK, we have generally not seen the same levels of use in recent years that would be worrying, although it would be complacent to assume that we do not have a problem.

Prescibed opiods became an overdose

According to the NHS Business Services Authority, 12.8% of the adult population in England were prescribed opioids in 2017/18. A study by Public Health England concluded that this is a decrease in the number of prescribed opioids from 2016 onwards, although demonstrably this does not mean that there is no problem to address. This figure relates only to prescribed opioids and does not take into account the use of opioids obtained without a prescription or illegal opioids such as heroin.

Prescribed opioids are necessary and appropriate when used in accordance with prescription guidelines. However, the associated risks, especially when not used according to the guidelines, are well documented and should not be ignored. Possible negative consequences of using opioids include dependence, overdose and withdrawal, which are serious. The 2018 data shows that 128 people die every day in the United States after an overdose of opioids. The misuse of and addiction to opioids – including prescription painkillers, heroin and synthetic opioids such as fentanyl – is a serious national crisis affecting public health as well as social and economic well-being.

How did this happen?

In the late 1990s, pharmaceutical companies assured the medical community that patients would not become addicted to prescription opioid painkillers, and healthcare providers began to prescribe them at an accelerated rate. This then led to a widespread diversion and abuse of these drugs before it became clear that these drugs could indeed be highly addictive.

Overdose rates of opioids began to rise. In 2017 more than 47,000 Americans died as a result of an overdose of opioids, including prescription opioids, heroin and illegally produced fentanyl, a potent synthetic opioid. In the same year, an estimated 1.7 million people in the United States suffered from drug use disorders associated with prescription opioid analgesics, and 652,000 people suffered from a heroin use disorder (which is not mutually exclusive).

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