THE OPIOID EPIDEMIC 1

Shyla Brailsford, Alexandra Hitchens, Erin Moore, Zoe Parajon, and Jena Peppercorn

HPEB 553: Community Health Problems

Community Health Analysis (CHA) Report: The Opioid Epidemic

Dr. Meetze, DrPH, MPH, CHES

November 21, 2017

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Epidemiological Diagnosis

The use of opioid drugs in the United States has taken the country by storm, thus

resulting in a very serious epidemic, causing thousands of overdoses and deaths. “Opioids” are

medications and other drugs (such as heroin) that produce morphine-like effects, and are mostly

used medically as painkillers. Common opioids include “OxyContin, Vicodin, morphine, and

methadone F” (Hughes, 2016). However, according to the CDC, the rate of deaths due to opioid

overdoses has increased by 200 percent since the year 2000 (Rudd, Aleshire, Zibbell, & Gladden,

2016). In 2015, 2 million people had prescription opioid use disorders and 33,091 people died

from overdosing on opioids just in our country alone, where drug overdoses are the highest cause

of accidental death. Due to medical costs from these morbidity and mortality rates, the estimated

economic impact of opioid usage in the United States racks up to nearly $78.5 billion, according

to the U.S. Department of Health & Human Services. The drug addiction disease affects many

populations, but when it comes to opioid usage, the populations these drugs are affecting most

are adolescents from ages 12 to 17. In 2015, according to the American Society of Addiction

medicine, 276,000 adolescents were found to be nonmedical users of opioid drugs, with 122,000

adolescents being addicted to those pain-relieving drugs.

Race/ethnicity, geographic location and socioeconomic status all affect drug users

differently. For example, the Henry J. Kaiser Family Foundation has found that white non-

Hispanic Americans had 27,056 opioid overdose deaths, whereas black non-Hispanic Americans

had 2,741 opioid overdose deaths and the Hispanic American population had 2,507 overdose

deaths, in the year 2015. The white population has a significantly higher death rate in this

country than any other race. Geographically, opioid usage varies. The states with the highest

amount of deaths due to opioid overdoses include California, Michigan, Ohio, Florida,
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Pennsylvania, New York, and Massachusetts. Similarly, socioeconomic status affects opioid

prescriptions and addictions. People with wealthier incomes are more likely to be prescribed

opioids for pain management, thus making them more likely to become addicted and therefore

abuse the drugs (Fortuna, 2013).

Gender also plays a role in how drug users respond to opioids. Women had the highest

rate of opioid abuse, in 2015. Between 1999 and 2010, overdose deaths from prescription

painkillers increased more than 400 percent among women, compared to an increase of 237

percent among men. Between 2002 and 2013, heroin use among women increased 100 percent

compared to an increase of 50 percent among men (Hughes, 2016). Furthermore, these rates for

prescribing opioids to adolescent age 15 to 19 nearly doubled from 6.4 percent to 11.2 percent

between 1994 to 2007. Doctors have the ability to prescribe medications as they see fit, the

FDA’s approval, in 2015, of OxyContin for adolescents ages 11 through 16 years, with “pain

severe enough to require daily around-the-clock, long term opioid treatment for which alternative

treatment options are inadequate,” has offered guidance to help pediatricians to prescribe opioid

pain medications safely (Hughes, 2016).

Teens may misuse opioids to experience the high and euphoria; to lessen the feelings of

stress, anxiety, and physical pain; and or use them in a response to peer pressure (Hughes, 2016).

However, most adolescents who misuse prescribed pain relievers receive them from a friend or

relative. A small percentage of those who use pain relievers, obtained a prescription from a

medical professional.
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Behavioral & Environmental Diagnosis

It is beneficial for health care professionals to know which groups are more vulnerable to

misuse, abuse, or overdose, so they can monitor at-risk patients. There are a vast number of

factors that can contribute to susceptibility to opioid abuse. These include environmental,

behavioral, as well as, non-behavioral factors.

Environmental risk factors play a role in the daily lives of individuals. There is an

assortment of environmental risk factors that may contribute to developing an addiction;

however, the more common ones are availability of drugs and peer influences. Dr. Michael H

Lowenstein, notes that “studies have shown for years that physicians’ prescribing behaviours are

a driving influence in painkiller overdoses and overdose-related deaths” (“Overprescription of

Opioids”, 2014). This trend has become widespread; therefore, there has been an increase in the

availability of opioid prescriptions, which has led to the diversion and exploitation of these

drugs. These practices of overprescribing leave individuals with opioids that have gone unused.

Most individuals keep these opioids in their medicine cabinets in case they are needed for future

pain, instead of properly disposing them. Community drug take-back programs allow the public

to bring unused drugs to particular locations for the proper disposal of these drugs. Individuals

may not take advantage of these programs if they are not convenient. This behavior may be a

problem of the environment as well, because of the inconvenience factor.

Relationships with peers may have a significant impact on the development of addictions.

Individuals with an increased exposure to substance using friends are more likely to initiate use

of substances in the future. Adolescents typically gain first access to opioids through their peers.

According to Russell, Trudeau, and Leland (2015), “Adolescents who indicate they fell into

patterns of dependence report first access to opioids through peers rather than from family or
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their own prescriptions” (p. 1328). This insinuates that those individuals in an environment

where their peers are able to supply opiates are more vulnerable to addiction.

The way in which an individual decides to behave affects their lives, whether it be

positively or negatively. Behavioral risk factors such as: early-onset of cigarette and alcohol use,

and an individual’s attitude and beliefs heighten one's’ risk of developing an addiction.

According to the National Institute on Drug Abuse (2014), “By the time they are seniors, almost

70 percent of high school students will have tried alcohol, half will have taken an illegal drug,

nearly 40 percent will have smoked a cigarette, and more than 20 percent will have used a

prescription drug for a nonmedical purpose” (para. 1). Early-onset of drug use is an important

predictor of the development of an addiction in the future. According to the National Institute on

Drug Abuse (2014), “The majority of those who have a substance use disorder started using

before age 18 and developed their disorder by age 20” (para. 11). Among the first addictive

substances, people try are marijuana, alcohol, and cigarettes. These are typically referred to as

“gateway drugs” and there are different explanations as for why particular adolescents that get

involved with these drugs escalate to an addiction. One explanation is that individuals who abuse

drugs are often around other people who also have the same abusing behavior, this gives the

individual an opportunity to be surrounded by other drugs. Another explanation is tied to a

biological cause, which refers to an individual having a family history of drug abuse.

An individual’s attitude and beliefs may contribute to the development of an addiction.

Adolescents are programmed to seek out new experiences to, ultimately, find out who they are.

Adolescents that believe drugs are “cool” or are safe are more likely to use drugs (National

Institute on Drug Abuse, 2014). Adolescents often believe that experimenting with these drugs
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will have no adverse health effects. These beliefs permit adolescents to engage in the use of

drugs, all while being free from uncertainty or remorse.

Non-behavioral risk factors play a key role in an individual developing an opioid

addiction, as these factors are not under the control of the individual. There is a genetic

component to drug abuse addiction, in which inherited differences among individuals affect their

reaction to drugs. Biology has a significant role in predisposition to addictive behaviors. Specific

genes, within the brain, that are related to impulsivity may underlie addiction. These genes

change the ways specific neurotransmitters, that are linked to impulsivity, like serotonin and

dopamine, are produced, released, and re-absorbed into the cell. Simply, individuals are more

likely to suffer from an opiate addiction if they have a genetic predisposition towards

impulsivity; therefore, they may have a tendency to try new, potentially harmful things.

The user’s age is a non-behavioral risk factor that can play a distinctive role in the

progression of opioid abuse. Younger people are at a heightened risk of developing an opioid

addiction; however, the rates among older people are on the rise, as well. According to Graziani

and Nisticò (2016), “Studies on trends in non-medical prescription opioid use (NMPOU) such as

HYDRO, OXY, codeine and morphine show that in USA NMPOU is most prevalent among

individuals from 18 to 25 years of age” (p. 32). Adolescents are more likely to engage in risky

behaviors than their adult counterparts and will continue with these behaviors. Early-onset of

drug use in an adolescent can cause changes in his or her developing brain which may increase

the likelihood of progressing to addiction.

The opioid epidemic is a huge problem that has been increasing immensely among our

society. As seen in chronic diseases, many risk factors have been associated with an individual’s

increased susceptibility to opioid addiction. Often times, individuals believe they are too in
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control of their lives to develop an addiction; this is a faulty perception because addiction does

not discriminate. Susceptibility to addiction, is due to environmental, behavioral, and non-

behavioral factors and their interactions.

One of the most important factors that contributes to this major public health issue is how

high the number of prescriptions to opioids have been rising over the years. Adolescents are

being exposed to drugs, such as opioids, at very young ages. Although adolescents are able to get

prescribed themselves, another aspect to consider when taking into account the number of rising

prescriptions is the fact that adults who have children are also increasing their legal opioid use as

well. This means that a large number of adolescents are not having to seek out individuals who

sell the drugs illegally (Bass III, P.F., 2016). This creates a higher risk for the early onset of

opioid use and dependence, which contributes to this health issue progressing to young

adulthood. One approach that could be taken in a prevention effort to change this cycle of early

onset of addiction to opioids, would be to target these parents with prescriptions and inform them

of the risk they are putting their children at, even for later in life.

Not only does one’s ability to access opioids at a young age put the target population at

risk, there are also other behavioral factors that can put this group at risk. Arterberry, Horbal,

Buu, and Lin (2015) reported that early-onset of cigarette and alcohol use increased the

likelihood of opioid use, as well as the continual frequent use of cannabis contributed to all

stages of opioid use. These factors are also outlined in another study conducted by Meshesha,

Pickover, Teeters, and Murphy (2017), whose findings pointed to one of the recurring themes of

users of nonmedical prescription opioids had lower pleasure responses to stimuli, as well as

pleasant pictures less arousing than pictures of drug related images. Specifically, heroin

dependent individuals’ response to pleasant images greatly predicted the probability of a relapse.
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The early onset of use of marijuana and other addictive activities create a huge risk for these

users to find drug related images and activities more stimulating than healthy images and

behaviors. These findings are extremely vital when it comes to considering the opioid crisis

rising. While it would be ideal to put in place prevention strategies for all drug use, programs

focusing on ways to release dopamine in these individuals, other than drug use and images,

could be another angle to work from.

Community Based Organizations

One national community-based organization that addresses the opioid epidemic is the

Advocates for Opioid Recovery (Appendix 1). The mission of Advocates for Opioid Recovery

(AOR) is to create a new treatment plan for the opioid addiction. They hope to have more long-

term opioid addiction survivors who can positively engage in their families and communities.

Currently in the United States, the approach towards the opioid addiction is based on outdated

information and beliefs about addiction and recovery. Recent studies have revealed that opioid

addiction is a chemical, DNA-driven brain disease. It has been scientifically proven that treating

the disease of addiction with medicine saves lives and improves long-term outcomes. AOR is

actively working to break down the barriers that prevent patients from accessing recovery

medications they need. AOR argues that it would be unforgivable to deny someone with diabetes

or heart disease the medicine they need that has been scientifically proven to treat the disease, so

why are we not treating someone with an opioid addiction the same way? AOR is a nonpartisan

effort led by founding advisors Newt Gingrich, Patrick Kennedy and Van Jones. These leaders

have successful records in creating meaningful change across the recovery and healthcare

landscape. Here in South Carolina, Affinity Health Center is a community-based nonprofit

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organization in Rock Hill, with centers in Fort Mill and Clover as well (Appendix 2). They were

one of the organizations to receive over $300K in grants, to address the opioid epidemic in South

Carolina. According to the United States Department of Health and Human Services, the goal of

these grants is to broaden the community’s access to substance abuse and mental health services

in the hopes of controlling the opioid epidemic. The executive director of Affinity Health Center,

Anita Case, says the grant will be used to help the community understand the opioid crisis, in

addition to expanding psychiatric services to the public. The overall mission of Affinity Health

Center, is to provide its community with exceptional and comprehensive healthcare.

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References

American Society of Addiction Medicine (2016). Opioid Addiction 2016 Facts & Figures.

Retrieved October 15, 2017, from https://www.asam.org/docs/default-

source/advocacy/op

ioid-addiction-disease-facts-figures.pdf

Arterberry, B. J., Horbal, S. R., Buu, A., Lin, H. C. (2015). The effects of alcohol, cannabis, and

cigarette use on the initiation, reinitiation, and persistence of non-medical use of opioids,

sedatives, and tranquilizers in adults. Drug and Alcohol Dependence, 159(1), 86-92.

Retrieved from http://www.sciencedirect.com.pallas2.tcl.sc.edu/science/article/pii/S0376

871615017834?via%3Dihub

BASS III, P. F. (2016). Opioids. Contemporary Pediatrics, 33(9), 10-16. Retrieved from

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Fortuna, R., MD. (2013, June 26). Socioeconomic Status Plays Major Role in Opioid Pain

Control. Retreieved October 15, 2017 from https://www.urmc.rochester.edu/news/story/3

868/socioeconomic-status-plays-major-role-in-opioid-pain-control.aspx

Graziani, M., & Nisticò, R. (2016). Gender difference in prescription opioid abuse: A focus on

oxycodone and hydrocodone. Pharmacological Research, 108, 31-38. Doi:10.1016/j.phrs

2016.04.012
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Hughes A, Williams M, Lipari R, Bose J. Prescription Drug Use and Misuse in the United

States: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data

Review. September 2016. https://www.womenshealth.gov/files/documents/white-paper-o

pioid-508.pdf

Meshesha, L. Z., Pickover, A. M., Teeters, J. B., Murphy, J. G. (2017). A longitudinal behavioral

economic analysis of non-medical prescription opioid use among college students. The

Psychological Record, 67(2), 241-251. Retrieved from https://link-springer-com.pallas2.t

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Overprescription of opioids varies widely by US state. (2014). PharmacoEconomics &

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Rudd, R.A., MSPH, Aleshire, N., JD, Zibbell, J.E., PhD, & Gladden, R. M., PhD. (2016, January

01.) Increases in Drug and Opioid Overdose Deaths - United States, 2000-2014.

Retrieved October 15, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6

450a3.htm

Russell, B. S., Trudeau, J. J., & Leland, A. J. (2015). Social Influence on Adolescent

Polysubstance Use: The Escalation to Opioid Use. Substance Use & Misuse, 50(10),

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Secretary, H.O., & Assistant Secretary for Public Affairs (ASPA). (2017, June 15). About the

Epidemic. Retrieved October 15, 2017 from https://www.hhs.gov/opioids/about-the-epide

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mic/index.html#us-epidemic

Smoot, H. (2017, September 14). Two Rock Hill clinics receive over $300K in grants to

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Appendices

Appendix 1: Advocates for Opioid Recovery: https://www.opioidrecovery.org

Appendix 2: Affinity Health Center: http://affinityhealthcenter.org