The single strongest indicator of the opioid crisis is drug overdoses, which have grown rapidly in recent years due to opioid dependency. The rise in overdose deaths has been driven by opioid dependency, fueled by over prescription. Between 1999 and 2015, prescription opioid sales per capita rose 356 percent[1]. During that period, opioid-related deaths quadrupled. From 2015 to 2016 alone, there was a 40 percent increase in number of opioid related deaths[2]. Opioid related deaths skyrocketed in 2016 with over 49,500 deaths[3]. That’s greater than the number of fatalities resulting from motor vehicle accidents and suicides the same year[4]. Furthermore, opioid-related deaths top the number of fatalities during the AIDS epidemic in 1995, homicides in 1991[5], and total deaths in the Vietnam War[6]. In addition to the sheer number of deaths, and cases of dependence, the most concerning aspect of this epidemic is its widespread affect on the American people.

Demographics

Opioid addiction and overdose rates are highest among non-Hispanic whites than any other demographic. Persons with lower levels of education have experienced the largest increase in mortality rate and are driving the overall increase in midlife mortality[7]. Sadly for many, opioid addiction is not a new or developing problem. The spread of opioids into more metropolitan areas has a lot to do with the attention being given to this issue, despite rural communities having had to struggle with this problem for the last decade. States that have been hit the hardest by this problem and have consistently had high opioid overdose rates include: West Virginia, Kentucky, Ohio, New Mexico, Nevada, and New Hampshire. West Virginia in particular merits attention because of how much the area has been affected by the opioid problem. Its overdose death rate is at double the national average and continuing to rise[8]. The opioid problem in West Virginia garnered national attention when it was discovered that three of the nation’s largest drug distributors had been funneling prescription painkillers into small communities. The town of Kermit for example, received 9 million hydrocodone pills over two years for its population of 392 people[9].

While it was previously dismissed as strictly a rural problem, opioid dependency and its consequences now impact large geographic areas and multiple demographic groups. Additionally, because of its rapid spread, the opioid epidemic affects all age groups, and has affected both genders equally.

Infants and opioids

When areas become so saturated with these substances as in the case in many of the states listed previously, the problem can even begin to affect infants. Women who abuse opioids while pregnant are at great risk for having a child with neonatal abstinence syndrome (NAS). In other words, the child, while in the womb, becomes dependent on opioids. If these substances are taken within a week of birth, the child will be born addicted to opioids and will likely undergo withdrawal symptoms. In response to this problem the first Neonatal abstinence treatment center opened in 2014 in Huntington, West Virginia. In 2015, a study conducted by the National Institute on Drug Abuse found that a baby suffering from opioid withdrawal is born every 25 minutes. In addition to the health issues associated with NAS, the financial costs for new parents are high. The average hospital cost of treatment and care for a NAS baby is $66,700 compared to $3,500 for non-NAS baby care[10]. Due to the prevalence of this problem many states have their own initiatives within hospitals to treat infants born with NAS.

Children

As children get older and enter their teens they will likely be exposed to opioids. In this age group, first exposure to opioids often occurs through dental practitioners prescribing painkillers after wisdom teeth removal. It was, as recently as a few years ago, common practice to be prescribed a 30-day supply of pills after the operation. Sports injuries also play a role in the prescribing of opioids to this group. In order to recover from an injury, athletes are often prescribed painkillers they may abuse. This population is also key is to the dispersal of the drug because they often will share, sell, or give away pills they do not take.

Prime age individuals

Prime-age individuals (ages 25 to 54) are perhaps the most affected by the opioid crisis. Overdose rates in this population are the highest, and this demographic has the greatest impact on the country’s labor force. Jobs go unfilled because of an inability to pass drug tests and there are employers who will immediately terminate workers who they suspect of abusing opioids. In a survey done by the National Safety Council, 20 percent of employers questioned said they would dismiss employees they knew were struggling with prescription drug abuse. Because this group makes up a large share of the work force and a large share of those driving the opioid epidemic, recovering addicts at this age struggle significantly because returning to work can be a trigger. In higher at-risk industries, like construction, it is often difficult to find a crew that is entirely free of opioid use. If those around a recovering addict are using, it is more likely that he will begin to use again. Once in recovery it can be difficult to find a place that is truly drug free. For these reasons many positions go unfilled and labor force participation among this group continues to drop.

The Elderly

Older members of the population are also strongly affected by the epidemic in two ways; suffering addiction themselves and dealing with the consequences of their children’s addiction. The older members of the opioid addicted population are generally concentrated in traditional manufacturing areas and became addicted after a work injury, or by way of a prescription after a surgery. Regardless of their opioid use status, older generations may still have a role to play as guardians for the children of addicts. Kinship care[11] has become more common in the face of this epidemic. The burden of raising young children is being moved to grandparents when their sons or daughters are deemed unfit to raise their children or pass away due to opioid abuse. There is not much knowledge about the resources available to kinship families, but there are several outreach initiatives being put in place to help children and their guardians. Kinship care is a benefit to the child involved in that it places them in the care of persons who they know and who can properly care for them. Furthermore, it can also save taxpayers $4 billion dollars each year by keeping children out of foster care.

Clearly the opioid crisis not an isolated problem because, not only does it affect drug users, but also their families, their communities, the economy, and the country at large. An increased awareness of the ever growing reach and impact of this problem is important in addressing the problem to ensure that no group of affected individuals gets left behind.

[1] Krueger, Alan B. “Where Have All the Workers Gone An Inquiry into the Decline of the US Labor Force Participation Rate” Brookings Papers on Economic Activity. Sept 7 -8 2017.

[2] In this instance opioid related deaths include those from prescription opioids (natural and semi-synthetic), heroin, and fentanyl and other synthetics (not including methadone). Lopez, German. “Drug overdose deaths skyrocketed in 2016 – and traditional opioid painkillers weren’t the cause.” Vox. September 05, 2017. Accessed January 22, 2018. https://www.vox.com/policy-and-politics/2017/9/5/16255040/opioid-epidemic-overdose-death-2016

[3] Lopez, German. “Drug overdose deaths skyrocketed in 2016 – and traditional opioid painkillers weren’t the cause.” Vox. September 05, 2017. Accessed January 22, 2018. https://www.vox.com/policy-and-politics/2017/9/5/16255040/opioid-epidemic-overdose-death-2016

[4] National Safety Council. “NSC Motor Vehicle Fatality Estimates.” National safety council Statistic Department. 2017. http://www.nsc.org/NewsDocuments/2017/12-month-estimates.pdf

[5] Worst years of the AIDS crisis and homicides respectively

[6] Welch, Ashley. “Drug overdoses killed more Americans last year than the Vietnam War.” CBS News. October 17, 2017. Accessed January 23, 2018. https://www.cbsnews.com/news/opioids-drug-overdose-killed-more-americans-last-year-than-the-vietnam-war/

[7] Case, Anne and Deaton, A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, Proceedings of the National Academy of Sciences, Woodrow Wilson School of Public and International Affairs and Department of Economics, Princeton University. 2015

[8] “Opioid Overdose.” Centers for Disease Control and Prevention. October 23, 2017. https://www.cdc.gov/drugoverdose/

[9] Mangan, Dan. “House committee investigates drug distributors for West Virginia painkiller pill flood.” CNBC. May 09, 2017. Accessed January 23, 2018. https://www.cnbc.com/2017/05/09/house-investigates-drug-distributors-over-west-virginia-opiod-glut.html

[10] Johnson, K. “Treatment of neonatal abstinence syndrome.” Archives of Disease in Childhood – Fetal and Neonatal Edition88, no. 1 (2003). doi:10.1136/fn.88.1.f2.

[11] Care by relatives who are not a child biological parents

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