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Deanna Collazo, Ashley Vargas, Aiting Huang, Sonaly Rodrigo

Cris Longhurst

ENGL 2010

19 September 2023

The Rise of Opiate Addiction in America Over the Decade

It is no secret that we have seen a rise in society of overdoses and fatal effects of opiate

addiction. More than 106,000 people in the U.S. died from drug-involved overdose in 2021,

including illicit drugs and prescription opioids (NIH, “Drug Overdose Death Rates”). With this

alarming rate, it is easy to ask “Why?” Though, this question is important and we must ask these

things in order to gain conclusions. We must consider many contributing factors in order to dig

deep, see underneath, and decide what our best route is to help those battling addiction, as well

as those affected by them. Whether it is someone close to us that lost their battle to addiction,

seeing the increase of drug paraphernalia on our streets, or watching our homeless populations

struggle to find peace and healing from their addictions, we are all affected by this.

WHY ARE WE SEEING AN INCREASE?

In order to get to the root of the issue, we must first dig deeper into all the layers. First,

what exactly is “drug addiction?” in a factual sense. According to NIDA, “Addiction is defined

as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite

adverse consequences. It is considered a brain disorder, because it involves functional changes to

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brain circuits involved in reward, stress, and self-control. Those changes may last a long time

after a person has stopped taking drugs” (NIDA, Drug Misuse and Addiction).

Prescription Opiates A story we hear too many times, someone is prescribed opiates

from an accident or injury becoming dependent and eventually addicted. About 80% of heroin

users report they first misused prescription opiates(SAMHSA 1). With these alarming rates, we

have to realize there is a huge correlation and pipeline between the pain relievers and heroin

usage.

So we think, how does this happen? How does someone just go from a simple

prescription for their back, to full blown IV drug usage? When someone begins to misuse

opiates, they develop something called an “acquired tolerance”, which means the body naturally

will need more opiates to feel the same effects the user originally felt the first time of usage.

Opiate tolerance can build quickly, within 3-4 days. It also depends on predetermined factors as

well as frequency of usage. With that happening, someone becoming physically dependent on

opiates to relieve their pain, they are going to need more and more- and eventually begin running

out of their prescription early. While their doctor may keep prescribing eventually they cannot

fill the prescription in time and the addicted individual needs it more than ever. They will now

begin to experience withdrawal symptoms.

Opiate withdrawal is a very uncomfortable experience. It affects the individual in a

physical way as well as mental way. They will feel flu-like symptoms, such as: aches and pains,

restlessness, mood swings, nausea, diarrhea, overwhelming drug cravings, and anxiety. This

creates a whole new level of need and want of the addicted person's drug of choice. Now we
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must understand how horrible this must feel, and how they will only be thinking of taking this

feeling away. With the addict having already run through their entire prescription, now they must

begin to look somewhere a lot darker and unregulated, the illicit market. Users may first begin to

try or buy opiate pills on the street, however this can become very pricey and also dangerous as a

lot of these pills are not authentic and contain fentanyl, a deadly opiate analog that is a lot

stronger than regular opiates. So, heroin becomes their new drug of choice. Easier to get,

cheaper, and they will need a lot less than they needed for their prescription. This begins the

deadly and physically draining cycle of addiction.

Synthetic Opioids Within the midst of our nation wide battle of addiction, a new issue has

emerged. This issue is deadlier, stronger, and way more addictive - we are talking about

“Synthetic Opioids”. They are new psychoactive substances characterized by different features;

such as easy availability on the Internet, low price, purity, legality, and lack of detection in

laboratory tests. They have not been approved nor are they recommended for human use. Opioid

misuse is associated with somatic and psychiatric complications. For many substances, limited

pharmacological information is available, increasing the risk of harmful adverse events(Karila

2). With this new drug coming on to the streets, we are beginning to see people take advantage of

it.

Working inside of rehabs, it is reported that a lot of peoples’ drug tests are coming back

positive for fentanyl, even if the patient is not exclusively using opiates! This means that people

who are manufacturing and illegally selling these drugs are trying to save money by cutting them

with something cheaper and more potent. However, this new activity comes with huge, even

fatal, consequences. According to UNODC, “ …overdose deaths increased by 265% between

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2012 and 2015 and fatalities increased by 72% just between the years 2014 and 2015 (UNODC

2). In all, more than 5,000 deaths caused by fentanyl and its analogues have been recorded since

2013”(Karila 5). Not only is this drug creating a new wave in the battle of addiction regarding

fatalities, but it is 50 times stronger than heroin, making it a lot easier to become addicted and

engrossed in the cycle.

HOW ARE AMERICANS HANDLING THIS ISSUE?

The Centers for Disease Control and Prevention (CDC) has been helping fund various

health departments to help with the ongoing Opioid crisis. “These efforts include timelier

tracking of nonfatal and fatal drug overdoses, improving toxicology to better track

polysubstance-involved deaths, enhancing linkage to care for people with opioid use disorder

and risk for opioid overdose, improving prescription drug monitoring programs, implementing

health systems interventions, partnering with public safety, and implementing other innovative

surveillance and prevention activities” (CDC Paragraph #3). There are many approaches to

combating the opioid crisis. Lets focus on what action from the list above is being taken at a

more local level.

State Funding Every state has chosen a different route to combat the excessive use

of opioids depending on their specific needs. Utah for example has chosen to make

Naloxone more accessible to providers and first responders. It made it simple for

Naloxone to be prescribed and administered for anyone in need. Despite this it was found
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that those struggling with addiction were not reaching out and making use of this

resource. Utah then decided to pass Bill H.B. 192

OPIATE OVERDOSE RESPONSE ACT -- PILOT PROGRAM. This bill allowed

for Naloxone to be distributed directly to the general population. To make it even more

attainable Utah equipped many public places, the SLC Libraries for instance, with

Naloxone rescue kits. Libraries are often seen as a neutral safe zone and equipping them

made the process effortless. One of the media outlets trying to give exposure to this new

bill is the Salt Lake Tribune. According to them, “The experience is as normal as picking

up a book on hold — except you leave with the ability to reverse an opioid overdose.”

[...] “To date, Utah Naloxone has distributed more than 5,000 kits to libraries. The Salt

Lake County Library gives out about 500 to 600 kits to residents annually”(Peterson).

This has been a step forward, but we can’t help but ask ‘what's next’?

HOW ARE WE LEADING THE FUTURE OF OPIOID ADDICTION IN AMERICA?

Can addicts have a future recovering from this? Yes. According to NIDA, “Research on

the science of addiction and the treatment of substance use disorders has led to the development

of research-based methods that help people to stop using drugs and resume productive lives, also

known as being in recovery” (NIDA, “Treatment and Recovery 7). With the alarming death
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statistics of opiate overdoses, around 131 deaths per day to be exact, we must work intently and

wisely to combat the seemingly always rising issue.

Inpatient Treatment Detox The treatment of opioid dependence in inpatient detoxification

first includes some detoxification treatment in the acute phase, relapse prevention and

psychosocial treatment in the recovery phase. The process of using detoxification and physical

therapy to reduce withdrawal symptoms and prevent physical health problems caused by sudden

drug withdrawal. Detox involves alternative therapies that primarily use medications that are

similar to pharmaceuticals. Currently, methadone and buprenorphine are widely used. Taper the

dose based on the patient's physical response. There are also non-replacement treatments, such as

clonidine treatment. Second, relapse prevention or psychosocial intervention. The main drug is

naloxone, which is more effective in preventing relapse.(Jake R ,Original Investigation

Substance Use and Addiction)

Psychotherapy For example, cognitive behavioral therapy can allow patients to change

unhealthy cognitive styles and behavioral patterns that lead to substance abuse, help patients

cope with acute and chronic cravings, improve patients' social skills, and strengthen patients'

non-drug behaviors. Experiences and thoughts about this vicious cycle caused by drug use,

withdrawal, cravings, or negative stimuli may be helpful to patients.

Hospitals are often the last line of defense against substance use disorders, as overdoses

and poisonings often require hospitalization. Every day, approximately 7,000 people are treated
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in U.S. emergency rooms for opioid abuse. However, despite the rapid spread of this epidemic,

little is known about the outcomes of patients hospitalized for opioid misuse. Additionally, there

is few data on the demographic and socioeconomic characteristics, intensity of opioid abuse, and

hospitalization characteristics of this patient population. Patients admitted for opioid/heroin

poisoning were more likely to be white, 50-64 years old, Medicare recipients with disabilities,

and residents of low-income areas. As the U.S. battles opioids, efforts are needed to help

hospitals respond to rising levels of opioid poisoning, especially among vulnerable populations.

and residents of low-income areas.

CONCLUSION

So we come to understand that there are multiple factors contributing to the rise in opiate

overdose over the decade. We know that it starts out with someone growing a dependency to

their opiate prescription and the withdrawal symptoms push them to seek out options on the

illicit market. Costs build up so they reach for cheap alternatives that are unbeknownst to them

full of harmful ingredients. These cheap ingredients are more potent, increasing the chance of

addiction and overdosing. It’s important to realize that this can happen to anyone. No one

expects to become injured one day and grow a dependency to something they were prescribed to

help their pain. So it’s important to understand the roots of the issue and learn about ways we can

help combat the opioid crisis.

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We can start by doing research on what our community has done to improve the matter

and spread the words ourselves. We went over how Utah equipped libraries with free Naloxone

rescue kits. So to make the most of that resource, we can post about it on social media so more

people are aware of it and can make use of it. We also discussed some forms of recovery

available for addicts seeking help. Two were Inpatient Treatment Detox and Psychotherapy. So

perhaps in doing our part to educate ourselves and educate others, we’ll eventually see a decline

in the annual number of people lost to overdosing on opiates.

Works Cited

“CBHSQ Data Review: Associations of Nonmedical Pain Reliever Use and Initiation of Heroin

Use in the United States.” Samhsa.gov, 2013,

www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm.

“Drug Overdose Death Rates.” National Institutes of Health, U.S. Department of Health and

Human Services, 10 July 2023,

nida.nih.gov/research-topics/trends-statistics/overdose-death-rates.

Karila, Laurent, et al. “New Synthetic Opioids: Part of a New Addiction Landscape.”

Neuroscience & Biobehavioral Reviews, vol. 106, Nov. 2019, pp. 133–140,
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https://doi.org/10.1016/j.neubiorev.2018.06.010.

“Mortality Quadrupled Among Opioid-Driven Hospitalizations, Notably Within Lower-Income

And Disabled White Populations”

https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0689 Dec 2017

NIDA. "Naloxone DrugFacts." National Institute on Drug Abuse, 11 Jan. 2022,

https://nida.nih.gov/publications/drugfacts/naloxone Accessed 25 Sep. 2023.

Original Investigation Substance Use and Addiction

Jake R. Morgan, PhD1; Joshua A. Barocas, MD2; Sean M. Murphy, PhD3; et al

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774168 Dec 15, 2020

“Overdose Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control

and Prevention, 8 Aug. 2023, https://www.cdc.gov/opioids/basics/epidemic.html

Peterson, Kolbie. “Books, Internet, Naloxone? How Utah Libraries Created a ‘Culture Shift’

around Opioid Addiction.” The Salt Lake Tribune, 19 Oct. 2021,

www.sltrib.com/news/2021/10/19/books-internet-naloxone/.

“Treatment and Recovery.” National Institutes of Health, U.S. Department of Health and Human

Services, 9 Mar. 2023,

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nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery. In 2021,

approximately 80,411 people died from an overdose involving an opioid