EDITORIAL
The Opioid Epidemic: A Public Health Emergency
As most of us are aware, the United States is experiencing
an opioid epidemic. In 2017, there were 70,237 drug
overdose deaths in the country, with two thirds of them
associated with an opioid (Hedegaard, Miniño, & Warner,
2018; Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019).
The age-adjusted rate of drug overdose deaths has
risen from 6.1 per 100,000 in 1999 to 21.7 in 2017
(Hedegaard et al., 2018).
Although some of us would say, the epidemic does
not affect my practice, or my patients are “different”
and not involved with opioid dependency, the statistics
say otherwise. There is no “typical” user or abuser.
They come from all walks of life. Perhaps there was
a surgical procedure, an accident, or chronic low back
pain that precipitated a prescription for an opioid that
escalated into misuse and abuse. According to data
from the 2015 National Survey on Drug Use and Health,
nearly one in three adults in the United States use pre-
scription opioids, and of those, roughly 21%–29% of
patients with chronic pain misuse them. Approximately
8%–12% develop an opioid use disorder (National
Institute on Drug Abuse, 2018).
From 2010 to 2014, drug overdose deaths that
involved at least one specific drug (on a death certificate)
included the opioids, heroin, oxycodone, methadone,
morphine, hydrocodone, and fentanyl; benzodiazepines,
alprazolam, and diazepam; and the stimulants, cocaine
and methamphetamine (Warner, Trinidad, Bastian,
Miniño, & Hedegaard, 2016). It is unknown whether
the drug was a prescription misused by the patient, a
diverted prescription, a drug bought off the street, and/or
an illicitly manufactured drug (Seth, Rudd, Noonan, &
Haegerich, 2018). In particular, illicitly manufactured
fentanyl has become a significant factor in overdoses.
Some of our patients may be affected by the opioid
epidemic. One example is a cancer rehabilitation patient.
Oncology professionals are seeing more patients with
cancer and concomitant chronic pain that has not been
controlled, has been mismanaged, or managed with high
doses of opioids. In addition, the number of people with
a current or past substance use disorder (SUD), who now
require cancer treatment, is increasing (Paice, 2018a). The
prevalence of SUDs in patients with cancer is unknown;
however, if 9% of all Americans currently meet the di-
agnostic criteria for a SUD, oncology practices likely
March/April 2019 • Volume 44 • Number 2
Copyright © 2019 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
provide care to some of those individuals (Paice,
2018b).
An article by Van Zee (2009) describes one factor
that has influenced the opioid crisis. Van Zee writes
about the aggressive marketing of OxyContin begin-
ning in the late 1990s. In 2001 alone, the pharmaceutical
company spent $200 million to market and promote the
opioid. At the time, the pharmaceutical company reassured
medical professionals that patients would not become
addicted to this opioid, quoting statistics that the risk of
addiction was extremely small and, in some publications,
stated it was less than 1% (National Institute on Drug
Abuse, 2018; Van Zee, 2009). As a result, there was wide-
spread prescribing of the drug; however, before long it was
clear that this medication was highly addictive. In 2007,
the pharmaceutical company, along with three company
executives, pled guilty to criminal charges of misbranding
OxyContin by claiming that it was less addictive and less
subject to abuse and addiction than other opioids.
In 2018, in response to the opioid epidemic, the
American Academy of Physical Medicine and Rehabil-
itation revised their 2014 position statement on opioid
prescribing. Recognizing that chronic pain affects more
than 100 million Americans, the goal of the physicians
in the American Academy of Physical Medicine and
Rehabilitation is to avoid adverse events associated
with opioid usage, including addiction, misuse, abuse,
diversion, and death (Shaw et al., 2018). However, the
organization does state that carefully selected patients
can demonstrate functional improvements from a treat-
ment plan that includes opioid medications (p. 681).
The opioid epidemic, it affects everyone.
CONFLICT OF INTEREST
The author declares no conflict of interest.
Pamala D. Larsen, PhD
Editor-in-Chief,
Loveland, CO, USA
References
Hedegaard, H., Miniño, A. M., & Warner, M. (2018). Drug
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www.rehabnursingjournal.com 67
68 Editorial
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https://www.drugabuse.gov/drugs-abuse/opioids/opioid-
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Paice, J. A. (2018a). Cancer pain management and the opioid crisis
in America: How to preserve hard-earned gains in improving the
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Paice, J. A. (2018b, August). Navigating cancer pain management
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Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G.
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Seth, P., Rudd, R. A., Noonan, R. K., & Haegerich, T. M. (2018).
Quantifying the epidemic of prescription opioid overdose
Copyright © 2019 by the Association of Rehabilitation Nurses. Unauthorized reproduction of this article is prohibited.
P. Larsen
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