The Opioid Epidemic
By Hadley Heath Manning, Director of Policy, Independent Women’s Forum

America has an opioid overdose epidemic. Opioid overdose now claims
91 American lives each day, and more than 1,000 people visit emergency
IN THIS ISSUE rooms daily due to the misuse of opioid drugs. In August 2017, President
WHAT YOU NEED Trump announced that he would declare a National State of Emergency
TO KNOW.................................. 1 regarding opioid abuse.
Opioids are drugs that act on the nervous system to reduce pain,
WHY YOU SHOULD CARE.... 2 including legal prescription drugs like oxycodone, hydrocodone, codeine,
and morphine, as well as the illegal drug heroin. While legal opioids are
MORE INFORMATION............ 2 safe when used properly under doctor’s orders, they can be harmful if
misused. Overdose happens by depressing the body’s respiratory system,
Scope of the
Opioid Crisis............................ 2 and breathing stops.
Opioid addiction does not discriminate: It can happen to people of
Impact on Women all races, all incomes, both male and female. However, addiction can have
and Children.............................3
unique consequences for women, especially expectant mothers whose
Economic Impact.....................3 babies may suffer from withdrawal.
Many factors have contributed to the recent surge in opioid addiction:
Factors Contributing
Advocacy groups pressured health providers to be more aggressive in
to the Crisis ............................ 4
treating pain. Government policies fostered incentives for prescribing pain
Combatting the Crisis ........... 5 medications. Insurance plans, including Medicaid and Medicare, often
covered opioids but not other pain-management treatments. And other
WHAT YOU CAN DO ............. 6 economic factors—like joblessness—led to spikes in drug addiction as well.
However, we may be beginning to turn the tide in the fight against
opioid abuse. Education—for policymakers, doctors and patients—is the
first step. Positive policy changes can help empower health providers by
relieving the pressure to prescribe drugs in response to pain.
The opioid crisis is tragically destroying lives and
costing our health system.
Scope of the
lD  rug Overdose Deaths Have Tripled Opioid Crisis
Since 2000: As Chris Christie, Chair of
the President’s Commission on the Opioid From 2000 to 2015, opioid overdose claimed
Crisis, said, “We have a 9/11 scale loss every more than half a million American lives.
three weeks.” This loss of life is tragic and During approximately the same time period,
astounding. Opioid abuse is affecting even the the number of people dying each year from
most vulnerable, newborn babies, in the form opioid overdose quadrupled, indicating a
of opioid withdrawal syndrome. troubling trend. More than 33,000 people
l I t Costs our Health System, Criminal died from opioid overdose in 2015, a record
Justice System and Economy: The estimated high. This translates to more than 90 deaths
cost of the opioid epidemic are as high as $78.5 per day. Six in ten drug overdoses in the U.S.
billion annually. Joblessness and drug abuse involve opioids.
form a vicious cycle, meaning the unemployed More than 2 million Americans struggle
are at higher risk for addiction, but drug with addiction to prescription opioids,
addiction sadly can also make it impossible for and 591,000 are addicted to heroin (these
people to find new jobs. numbers are not mutually exclusive). One in
lV  arious Factors Helped Create the Problem: four patients with an opioid prescription will
Government policies and health advocacy groups misuse the drugs and between 8 to 12 percent
contributed by elevating pain to be the “fifth will develop opioid use disorder, the medical
vital sign,” encouraging the over-prescription of term for addiction.
opioids for pain relief, and restricting insurance Problematically, although opioid
coverage only to pharmaceutical pain treatment. prescriptions have decreased from 2010 to 2015
lP  ositive Changes Can Reverse Course: by 18 percent, opioid-related deaths remain
There’s hope that together, policymakers, high because addicted people often turn to
health providers, and communities can provide illicit opioids, like synthetically produced
help for those who are facing addiction, and fentanyl or heroin. It is estimated that 4-6
just as importantly, work to prevent future percent of people with opioid prescriptions
addiction before it starts. turn to heroin use, and 80 percent of heroin
users first misused a prescription opioid drug.
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Drug poisonings are now the number one compared to the 2 days for healthy newborns.
cause of death for Americans under 50. Importantly, drug abuse during pregnancy can
As Thomas Gilson, the medical examiner also lead to a host of other health problems
for Cuyahoga County, OH, pointed out, and complications. In some areas, NAS has
the loss of life due to opioid overdose is contributed to an increase in infant mortality.
now equal to the casualties of the entire Among pregnant women, 17-19 percent
Vietnam conflict. Chris Christie, Chair of the are prescribed opioids. Dr. Randy Tobler, a
President’s Commission on the Opioid Crisis, board-certified OB-GYN, explained in an IWF
made a similarly stark comparison when he podcast that pregnancy and the post-partum
said, “We have a 9/11 scale loss every three period can be especially difficult times for
weeks.” women to taper or stop opioid use because
This should be a wake-up call: We are truly the time can be marked by physical pain and
experiencing a national emergency. emotional stress.
The impact on maternal health isn’t the
Impact on Women and Children only way the opioid crisis affects women
Typically, substance use disorders affect men and families. Opioid addiction is most likely
more than women. But this is not true for to affect women (and men) in their prime
opioid use disorder. Women are just as likely parenting years, ages 25-54. This tragically
as men to be affected, but it’s important to means that the crisis is contributing to an
understand the ways that women and men increase in home removals by Departments
are affected differently. The opioid crisis has of Child Services. When opioid abuse is taking
particularly dire consequences for women. place, it is not safe for children to be in the
Women have a greater inflammatory home.
response to pain than men and are more likely Because of the link to illicit drugs, the
to have chronic pain. They are also more likely opioid crisis is also associated with an increase
to get opioid prescriptions and take these in HIV and Hepatitis C infections from
drugs for longer periods of time. injections. Women who resort to illicit drug
Sadly, incidence of neonatal abstinence markets can also be drawn into sex work or
syndrome (NAS)—opioid withdrawal in face violence and abuse.
newborn babies—has seen a five-fold increase
since the year 2000. Every 25 minutes, a baby Economic Impact
with NAS is born. These infants typically Of course, the human cost of the opioid
have to stay in hospitals for about 17 days, epidemic far overshadows its cost in dollars,

IWF Policy Focus, October 2017 n 3
but in addition to the tragic loss of life, the Factors Contributing to the Crisis
U.S. is experiencing an incredible economic It’s tempting to oversimplify this epidemic and
burden due to opioid abuse. place all the blame on one party, whether it’s
Several studies have attempted to account government, doctors, drug companies, patients,
for the costs, but it is very difficult to consider insurers, the economy, or culture. But reality is
how the crisis affects so many different more complex: Many factors contributed.
sectors: health care (where 1,000 emergency In the 1990’s, the health community began
room visits per day are related to opioid to treat pain with opioids more aggressively.
misuse), the criminal justice system, other Drug prescriptions increased dramatically.
social supports like Child Protective Services, Doctors didn’t just do this because they
and the opportunity cost of so many addicted wanted to relieve pain (although that’s an
(or deceased) Americans unable to contribute understandable impulse), but the culture in
to the economy. So even the many studies on hospitals was greatly influenced by advocacy
this topic may not fully capture the costs. groups like the American Pain Society and
A 2011 study in the journal Pain Medicine government policies imposed via the Medicare
put the total cost at $55.7 billion, combining an and Medicaid programs.
estimated $25 billion in additional costs to the In 1996, the American Pain Society began
healthcare system, $5.1 billion to the criminal a campaign to elevate pain as the “fifth
justice system, and $26.5 billion in lost wages. vital sign.” This was misguided. Pain, unlike
Another study in Med Care in 2013 also the other vital signs, cannot be objectively
included drug addiction treatment costs and measured. Providers depend on patients to say
put the total figure at $78.5 billion. how much it hurts. This provides an opening
A health economist at Harvard, Anupam for drug addicts to abuse the system.
Jena, told The New Yorker that he believes Doctors also faced pressure from the
the cost could be as high as $100 or $150 government as well: The Center for Medicaid
billion annually. He uses $5 million per life, the and Medicare Services included questions
value that life insurance companies often use, about pain management in patient satisfaction
to come up with this figure. surveys that were linked to payment,
No matter what the exact amount, it’s clear encouraging a standard of patient-pleasing
that a public health crisis that is damaging so over good medicine. This fostered a culture
many lives is taking a toll on our economy as well. that encouraged healthcare providers to offer

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pain-relieving prescriptions, popular with This will need to be a multi-pronged approach:
patients, without adequate regard for the President Trump created a Commission on
potential long-term downside to these drugs. the Opioid Crisis, led by Chair Chris Christie.
Few people outside of medicine are aware This Commission will study the epidemic and
of the influence of another very powerful make recommendations to lawmakers and the
organization, the Joint Commission. The public about how to combat opioid addiction.
JC has a unique statutory mandate to In 2017, Medicare removed questions about
accredit hospitals to work with Medicare, pain from patient satisfaction surveys. Doctors
and most states rely on JC accreditation as should not feel pressure to prescribe drugs to
a prerequisite for Medicaid reimbursement get high scores on these surveys. This was a step
as well. These are by far the biggest payers in the right direction. Government policies and
in American health care. If the JC says jump, guidance from the Joint Commission should be
hospitals ask, “How high?” reviewed to empower individual health providers
Since 2001, the JC has issued pain and get away from over-standardization.
management and treatment standards. Last Health providers and patients need to be
year, dozens of health providers and groups aware of the potential for addiction to certain
sent a letter to the JC, saying that its standards opioid drugs. There should be every effort
“encourage unnecessary, unhelpful, and unsafe to use other pain treatment therapies when
pain treatments that interfere with primary appropriate. Patients often need to be educated
disease management.” The letter asked that about their pain; pain is typically a symptom of
JC change its standards to allow individual a deeper health issue, not a disease in itself.
clinicians to use their judgment for pain Insurers, including Medicare and Medicaid,
assessment rather than mandating routine should cover non-opioid pain treatments
pain assessment. so that patients can afford these options.
Communities should continue to do outreach
Combatting the Crisis to those at risk for addiction or already
The good news is that the United States has addicted, and help connect them with the help
started to address the opioid crisis. There they need to fight back.
are efforts at every level, from community The opioid epidemic will not be easy
organizations to the highest levels of to combat, but through cultural and policy
government, to treat addiction and prevent changes, we can work to reduce the misuse of
new addictions before they start. opioid drugs and ultimately save lives.

IWF Policy Focus, October 2017 n 5
l  et Informed: Learn more about the opioid
G a political/policy issue (it will be fun!).
epidemic. Visit: Write a letter to the editor. Show up at
n O
 ffice of National Drug Control Policy local government meetings and make your
opinions known. Go to rallies. Better yet,
n C
 enters for Disease Control
organize rallies! A few motivated people can
n N
 ational Institute on Drug Abuse change the world.
 alk to Your Friends: Help your friends lR
 emain Engaged Politically: Too many
and family understand these important good citizens see election time as the only
issues. Tell them about what’s going on time they need to pay attention to politics.
and encourage them to join you in getting We need everyone to pay attention and
involved. hold elected officials accountable. Let your
 ecome a Leader in the Community: Get Representatives know your opinions. After
a group together each month to talk about all, they are supposed to work for you!

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