Research the Effects of Opioids on Society

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Bonnie Hein

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A recent newspaper investigation revealed that drug wholesalers have shipped 780 million prescription painkillers to West Virginia over a six-year period. This amounted to more than 400 pills per person in West Virginia.

According to the Centers for Disease Control and Prevention (CDC), six counties of West Virginia ranked in the top 10 in the nation for fatal pain pill overdoses. Between 2007 and 2012, more than 1,700 West Virginians died of hydrocodone or oxycodone overdoses, affecting generations of families and representing only a fragment of a growing national crisis.

More than 33,000 people in the United States were killed from opioid overdoses in 2015, and in that year, for the first time, the number of deaths from heroin surpassed those from gun homicides, according to the CDC.  There are now approximately 91 opioid overdose deaths per day.

Opioid prescriptions and opioid-involved deaths (from both prescription opioids and heroin) quadrupled in the United States between 2000 and 2015.

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What is an opioid?

Opioids are a type of narcotic pain medication with the intended medical use of dulling a person's perception of pain by affecting the body's nervous system. They work by binding to opioid receptors in the brain, spinal cord, and other areas of the body.

There are many different drugs in the opiate category, many of which are prescription drugs, such as hydrocodone, oxycodone, morphine, fentanyl, and methadone. Heroin belongs to this same class of drugs, and four in five heroin users began by misusing prescription opioid pain medications.

Opioids also affect the brain's pleasure system and may cause a person to feel euphoric. Opioid abuse may entail taking the drug in ways other than those prescribed for the purpose of intensifying this sense of euphoria. Orally prescribed opioids moderately treat pain with steady release of the drug, where snorting or injecting the drug produces an immediate, strong high which is highly addictive and dangerous.

Is there an antidote to overdoses?

When someone takes too much of an opioid, it can cause him or her to stop breathing.  Naloxone (or Narcan) is a life-saving antidote which can reverse an opioid overdose by neutralizing the opioids in body's system and restoring breathing.  As the number of opioid overdoses escalated, the prices of the antidote have skyrocketed.

While Naloxone has been available since 1971 and is currently available in generic forms, prices rose from less than less than $1 per milliliter vial in 2005 to more than $15 in 2014. Pharmaceutical companies defend the increasing prices with newer delivery systems, such as auto-injectors and nasal sprays.  Additionally, they stress the price increases do not reflect the final price consumers pay after insurance and financial assistance programs are considered.

The opioid epidemic and antidote price increases have not gone unnoticed by our federal government.

How is the United States responding to the epidemic?

In the U.S. Congressional Documents Library, use the Congressional Hearings Quick Finder tool's drop-down menus and choose the 114th Congress, Any Chamber, Any Committee, and enter the search "opioid epidemic" AND cost AND naloxone in the text field:

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Note that phrase, "opioid epidemic" is in quotation marks and the Boolean operator AND is in capital letters. You may view related hearings including the first search result, What Are the State Governments Doing to Combat the Opioid Abuse Epidemic: Hearing before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, House of Representatives, One Hundred Fourteenth Congress, First Session.

While Americans represent less than 5% of the world's population, they consumed 80% of the world's opioids, according to the American Society of Interventional Pain Physicians. American doctors prescribed them so much that in March 2016, the CDC published the Guideline for Prescribing Opioids for Chronic Pain, urging medical practitioners to be more judicious when recommending them.

For more information, do a full text search in HeinOnline of "Guideline for Prescribing Opioids for Chronic Pain" AND CDC and sort by Volume Date (Newest First) to view the most recent information. Note the March 23, 2016 notice in the Federal Register at 81 Fed. Reg. 15525:

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In October 2015, President Barack Obama issued a Memorandum to Federal Departments and Agencies directing two important steps to combat the prescription drug abuse and heroin epidemic. And on December 7, 2016, President Barack Obama signed the "21st Century Cures Act," which provides $1 billion in new funding targeted at opioid abuse.

For more information, do a full text search of Obama AND opioid within the U.S. Presidential Library. Browse to 2015 Memorandum on Addressing Prescription Drug Abuse and Heroin Use to view the full text of the Memorandum and 2016 Statement on Senate Passage of the 21st Century Cures Act to view President Obama's comments, both included in the  in the Daily Compilation of Presidential Documents.

Find more information in HeinOnline

The best way to do a topical search in HeinOnline is to determine key terms and complete a full text proximity search across all subscribed HeinOnline collections. The first step is to identify some key terms to use, such as: prescription, epidemic, opioid, opioids, opiate, opiates.  Enter your key terms within quotation marks and a tilde symbol denoting the number to words within one another. Therefore, entering "prescription epidemic"~50 will provide results with prescription and epidemic within 50 words of one another. Click here to view search results.

As the term opioid can occur in multiple forms, use a wildcard indicator (*) after the stem of the term to search all endings. Important tip: wildcard indicators may not be used within proximity searches, therefore "prescription epidemic opioid*"~50 would not work.

Using the Boolean operators such as AND and OR will provide additional options. You may also group terms or search queries using parentheses ( ) to form sub-queries within one search request.  Therefore, entering ("prescription epidemic"~50 AND opioid*) OR ("prescription epidemic"~50 AND opiate*) will search the terms prescription and epidemic within 50 terms of each other AND opioid, opioids OR prescription and epidemic within 50 terms of each other AND opiate, opiates:

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Looking to the future

Prescriptions for OxyContin have fallen nearly 40% since 2010, and as a result, its Connecticut manufacturer, Purdue Pharma has lost billions in revenue. The company is now pursuing a new strategy to put the painkiller that set off the U.S. opioid epidemic into medicine cabinets throughout the world.

A network of international companies owned by the family of Purdue Pharma is now entering rapidly into Latin America, Asia, the Middle East, Africa and other regions.  By pushing for broad use of painkillers in places ill-prepared to deal with the ravages of opioid abuse and addiction, this epidemic may become a worldwide issue.

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