Rates of opioid addiction in the United States have continued to increase leading to the destruction of families, a decline in labor participation, and rising healthcare costs. Out of all the drug overdose deaths in 2015, 63.1% involved an opioid. This problem has been appropriately called an epidemic and its consequences and widespread effect have become impossible for the government to ignore. On October 5, the Committee on Health, Education, Labor, and Pensions convened for the first of three hearings concerning the opioid epidemic. The problem has become so multifaceted that even the best policymakers and healthcare professionals don’t seem to know how to effectively address it. Furthermore, the recent success in new initiatives, legislation, and stricter regulation of prescription opioids is not translating into significant reduction in overdose deaths. Even though this rapidly growing problem is decimating communities across the country, outside of heavily affected areas this issue is still lacking in visibility.

A New Ally in West Virginia

Luckily the opioid problem recently received nationwide attention due to the efforts and actions of an unexpected ally. The Senators hearing with CDC, NIH, SAMHSA, and FDA came a week after the first lady had put together a round table to be more informed about the issue. Director of Health and Human, Services, Tom Price, Governor Chris Christie, Kellyanne Conway and persons directly affected by the epidemic were in attendance. October 10, Melania Trump took another step in bringing attention to the epidemic when she travelled to the town of Huntington located in Cabell county, West Virginia. Dubbed the country’s overdose capital, Cabell County alone accounted for just over 15% of the state’s overdose deaths in 2016. Cabell county is easily one of the most at risk areas of the country when it comes to the opioid epidemic especially considering West Virginia’s overdose death rate is almost three times the national average and continuing to rise. On her visit the first lady went to Lily’s place, a hospital that treats infants Neonatal syndrome. For every 1,000 births 33 children are born dependent on drugs. For Melania Trump, who has listed the safety and care of children as her top priority, the opioid epidemic is important to address. When asked about the First Lady’s visit, Congressman Evan Jenkins, who is the representative of West Virginia’s 3^rd district, expressed how important it was that attention be brought to the opioid issue. Representative Jenkins, whose jurisdiction includes Cabell county, is passionate about this issue and has helped get important legislation, including Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act passed in an attempt to address this issue at the federal level.

Complexities

The question is how to address this issue. The opioid epidemic is like a virus; not only is it spreading, it’s evolving and with each change becoming more dangerous. If this problem is going to be addressed it needs to be treated as a national problem and given adequate resources in order to tackle the issue on multiple levels. The focus of many legislators and people in the medical community was lowering the rate of prescriptions in hopes that making access more difficult would start to fix the problem of addiction. The majority of addicts get hooked after receiving a prescription to treat chronic pain resulting from a legitimate injury and then become dependent on their medication. According to the CDC, 25% of patients who were given a 10-day prescription were still found to be using a year later. This is unsurprising considering it can take as few as 3 days to get hooked on prescription opioids. The good news is that through the combined efforts of educational programs, PDMPs, new legislation, and the implementation of state surveillance systems prescribing rates in West Virginia have gone down. This was expected to considerably reduce instances of first exposure and access to opioids especially since the majority of non-medical users got their drugs from a family or friend for free or from a prescribing doctor.

With more doctors refusing to prescribe high potency opioids and the lacuna in resources to identify and treat addicts, people are turning to stronger illegal substances. Therefore, despite the successful reduction in prescribing rates, Cabell County overdose deaths continue to rise. Between 2001 and 2016 deaths due to opioid overdose rose by 88% peaking with 133 deaths in 2016.

Synthetic Opioids

The development of synthetic opioids has made the reduction in prescription rates practically negligible. The opioid epidemic has been marked by gradual escalation from prescription opioids to heroin and later to fentanyl and carfentanil. Fentanyl can be 50 to 100 times more potent than heroin or morphine and carfentanil 100 times more potent than fentanyl. This makes it so that the line between a high and death is not easily known. Shown below are lethal amounts of heroin and fentanyl and carfentanil.

The increase in use of these substances has created the need for an international response because in addition to being made in the US, shipments of fentanyl and carfentanil are arriving through the international postal service from China and India. To address this problem legislative measures are being taken, such as the Synthetics Tracking and Overdose Prevention Act (STOP), which was introduced by Senators Rubio, Klobuchar, Hassan, and Portman. These new substances are particularly lethal because of their potency and because they are often laced in with heroin without the users knowledge. Carfentanil was never even meant for human consumption, it was originally made as a tranquilizer for large animals. The potency problem makes it more difficult for first responders or those administering anti overdose drugs such as Narcan to save the user. In an overdose involving fentanyl or carfentanil multiple doses of Narcan are needed to return a user’s breathing to normal and keep them from dying.

The Need for Funding

As made evident by the continued rise in overdose deaths and the shift in the use of prescriptions to heroin, fentanyl, and carfentanil the opioid epidemic is a problem that demands multiple solutions. While it should be viewed as a success it’s clear that reducing the number of prescriptions is not enough to address the changing nature of this problem. Funding innovations in research for anti-overdose treatment, alternative pain solutions, increased PDMPs, continued education, collaboration at the local level, providing psychosocial support and treatment to addicts, and preventing first exposure are only some of the ways that the country can begin to address an issue of this magnitude. Experts from the CDC, NIH, SAMHSA, and the FDA testified asserting that they can make progress but only if they are given the adequate funding and support. In order to make progress this truly needs to be treated as a national crisis and fortunately it seems as though the importance of the issue is striking a chord with the First Lady. Increased visibility as well as capturing the interest of the president and the public alike could lead to a joint effort to address this problem effectively.

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