The American opioid epidemic may be misleading to some people. While prescription painkillers and heroin are both addictive and carry the potential for overdose death, the U.S. is not actually in the midst of an opioid drug epidemic. We are, in fact, in the grips of an addiction epidemic. Case in point: Efforts to limit access to prescription opioids have had the effect of making it harder to acquire certain drugs, but people are still dying at unprecedented rates. Why? The answer being that the epidemic we face is not the disease of drugs, but rather the disease of addiction—a debilitating mental illness.
Remove every drug from the equation, and the mental health disorder known as addiction will live on. We could take it even further, arguing that the crisis we actually face is the epidemic of untreated addiction. And if that is the case, it is hard to compare the problem we see to epidemics of the past, such as the AIDS epidemic.
A Waxing or Waning Epidemic
The field of epidemiology, much like addiction, is not an exact science. Experts have a good understanding of both, but there are no guarantees which way things will go. Will the epidemic wax or wane, will the recovering addict continue to improve or will they relapse? Questions that are hard to answer. Attempts to curb the opioid use disorder epidemic stealing lives across the country are extensive, and multifaceted.
- The adoption of prescription drug monitoring programs for combatting “doctor shopping.”
- Revising provider opioid prescribing practice guidelines.
- Expanding access to the opioid overdose reversal drug naloxone.
- The most important effort of all, increasing access and funding for addiction treatment services across the nation.
The last effort is the most significant. It is the only tactic that addresses the root problem, rather than just the symptoms of addiction, i.e. dependence and overdose. Making painkillers harder to acquire or abuse will only serve to force opioid addicts to find their drugs elsewhere. Naloxone can save lives, but it cannot cure addiction. Treatment is the most effective measure for ending the opioid use disorder epidemic.
Hope On the Horizon
The severity of the American opioid epidemic can be most easily gauged by the death toll associated with abuse, as opposed to opioid addiction rates. If the death toll increases, efforts are not having the desired effect. On the other hand, if fewer people die in any given year, one could argue that the measures implemented have been effective. With opioid overdoses surpassing traffic fatalities, you might think that the crisis is as bad as ever. However, the big picture may tell another story altogether.
Using epidemiological models, researchers believe that there may be an end in sight. At least regarding opioid overdose death rates. A couple of years back, a group of researchers from Columbia University used what is known as Farr’s Law to develop projections regarding the epidemic. Looking at overdose death rate data from 1980 to 2011, it showed that 2016-17 would be the height of the opioid epidemic. According to the models developed using Farr’s Law, the death rate should line up with that of the 1980’s by the year 2034. However, the authors warn:
Although the method we applied originated from studies of infectious diseases, it is unknown whether Farr’s Law applies to epidemics of a non-infectious origin. It is plausible that a non-communicable disease, such as drug overdose, can follow infectious patterns…Mortality data over the next two decades will ultimately test the accuracy of our projections. If the drug overdose epidemic is indeed waning, it may imply that the intensified efforts in recent years, such as enhanced prescription drug monitoring, are working and should be continued.”
Can We See the Forest for the Trees?
It would be nice if their projections hold true. Every life saved is a step in the right direction, even if efforts fail to address the underlying cause of the epidemic—addiction. But if we accept that addiction, while in fact a disease, is something quite different than other health conditions, there is really no way of knowing how things will go. What we can bet on is that expanding access to addiction treatment is a sure way of seeing results. All other efforts are likely to only produce superficial results, merely scratching the surface of the greater problem that is an addiction epidemic.
The greatest life-saving potential can be found in treatment centers and the rooms of recovery for continued maintenance. If you or loved one is in the grips of opioid addiction, please contact PACE Recovery Center.