The growing problem of opioid misuse


By: Jennifer Chubinski

This month I am going to steal a great idea from one of Julie Heath’s recent blogs and start with a quiz question.  

                Which of the following results in the HIGHEST number of deaths in Ohio and Kentucky each year?

  1. Traffic accidents,
  2. Falls,
  3. Firearms, or
  4. Accidental drug poisonings and drug overdoses?

The answer is in the graphs below. 

Blog 3_1
Blog 3_2Sources: The Ohio Department of Health, available here; the Injury Prevention and Research Center and the Kentucky Cabinet for Health and Family Services, available here. There are many groups in both states working on this problem, but many of the charts in this blog come from a particularly compelling presentation on the Opioid Epidemic by The Ohio Department of Health, available here

In both Ohio and Kentucky, unintentional drug overdoses have overtaken motor vehicle traffic accidents as the leading cause of unintentional deaths.  Overdose deaths have also surpassed motor vehicle traffic accidents in national data.  Four people in Ohio and two people in Kentucky die each day from unintentional drug overdoses. 

What is an unintentional drug overdose death?

Unintentional or “accidental” drug overdoses or poisonings happen when no harm is intended, usually from misuse or abuse of a drug, or when someone takes too much of a drug for medical reasons. 

What is causing the increase in deaths?

The dramatic rise in unintentional deaths is being driven by steep increases in the number of deaths from prescription pain relievers, specifically opioids such as OxyContin, Vicodin, Percocet or codeine.  These drugs are killing more people in our region and across the country than illegal drugs such as crack cocaine or heroin ever have.

Blog 3_3Source: The Ohio Department of Health, available here.

Though this is a national trend, Ohio and Kentucky are particularly problematic because they have some of the highest age-adjusted rates of opioid pain reliever use per capita and a high percentage of pain reliever sales per kilogram of prescription drugs sold.  The availability of opioids has risen steeply.  According to the Ohio Department of Health, in 2010 enough opioid doses were distributed to pharmacies in Ohio to provide every Ohioan with 60 pills.  You can see from the chart below that there is a strong relationship between increased availability and overdose deaths.

Blog 3_4Source: The Ohio Department of Health, available here.

Why are these drugs so addictive?

Because I’m not a substance abuse expert, I wondered why these drugs are so addictive.  The answer is that the opiates in these drugs have a powerful effect on the human brain: They create an incredible sense of euphoria.  The opiates release artificial endorphins in the brain, creating good feelings for the user.  With regular use of the drugs, the brain stops producing natural endorphins. The user must take these drugs to avoid feeling really bad, both physically and emotionally.  Many people who die from opioid misuse were first prescribed the drug by a doctor to manage a legitimate pain issue. 

Who is misusing?

According to the Ohio Department of Health, men, adults ages 25-54, Whites and those living in rural counties are at the highest risk for opioid abuse and death.   And those who die are only part of the problem. The Ohio Department of Health, using estimates from The Substance Abuse and Mental Health Services Administration (SAMHSA), created the infographic below. For every prescription pain reliever death, 130 people are dependent on pain relievers and 825 people are nonmedical users.  While 8% of adults in Kentucky and 6% of adults in Ohio report misusing prescription pain relievers many more in both states (KY =33%, OH = 20%) report having family members and friends who have experienced problems as a result of abusing prescription pain relievers.  With numbers this large it is very likely that you know someone with this problem. 

Blog 3_5Source: The Ohio Department of Health available here.

Heroin and its connection to this problem.

Heroin is also an opium-based pain reliever.  While our region has had success in limiting access to prescription opioid pain reliever, we have seen a sharp increase in users shifting to heroin, which is often less expensive than prescription pain relievers. The Cincinnati Enquirer recently published a very powerful series about the heroin epidemic. If you haven’t read about the local men, women and children whose lives are deeply affected by this problem, I strongly recommend you spend a few minutes watching the videos available here

 So what can you do? 

The Centers for Disease Control and Prevention lists recommendations for health care providers, insurers, and state and federal agencies here. They include limiting the use of opioid medications to only specific types of pain issues, monitoring prescriptions claims for signs of misuse, and improving substance abuse treatment services available.  You can make sure any current opioid prescriptions in your household are kept in a secure location (such as a pill lock box) and that unused pills are disposed of correctly at drop-off sites. To find one look here.