ATrain Education

 

Continuing Education for Health Professionals

Opioid Epidemic: How Did We Get Here and Where Do We Go Now?

Module 2

The Painful Numbers of Opioid Abuse

The Centers for Disease Control and Prevention (CDC) has declared the overuse and abuse of opioids an epidemic (Hedegaard et al., 2014; Rudd et al., 2016). Ninety-one Americans die every day from an opioid overdose (CDC, 2017). The United States consumes 99% of all the world’s hydrocodone, 80% of the world’s oxycodone, and 65% of the world’s hydromorphone prescription opiate supply. 25% of all workers’ compensation costs relate to opioids and $56 billion per year is spent on opioid abuse costs.

Trends of opioid overdose-related deaths have increased 5.5% annually, from 6 deaths per 100,000 people in the United States in 1999 to 16.3 in 2015. In adults aged 45 to 54 the death rate from drug overdose was the highest of all age populations showing a constant trend upward of 10% annual increase in abuse and deaths (NCHS, 2015). Clearly, America has an opioid epidemic that is claiming lives and lifestyles. Additional statistics, not as easily identified but very real, are the lost productive work hours and loss of meaningful lives, families, and marriages due to opioid abuse (ASAM, 2016).

 

Deaths by Age Cohorts 1999–2015

chart: overdose-related deaths by age

 

1Significant increasing trend, p < 0.005.
2Rate for age group 45–54 in 2015 was significantly hight than for any other age group, p < 0.001.
Notes: Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug overdose deaths are identified using underlying cause-of-death codes X40–X44, X60–X64, X85, and Y10–Y14. Access data table for this figure at: https://www.cdc.gov/nchs/data/databriefs/db273_table.pdf#2.
Source: NCHS, National Vital Statistics System, Mortality.

 

Opioid drugs include:

Natural Opioids

  • Morphine
  • Codeine (only available in generic form)
  • Thebaine

Semi-synthetic

  • Hydrocodone (Hysingla ER, Zohydro ER)
  • Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
  • Hydromorphone (Dilaudid, Exalgo)
  • Oxycodone (OxyContin)
  • Heroin

Fully synthetic/manmade

  • Fentanyl (Actiq, Duragesic, Fentora)
  • Meperidine (Demerol)
  • Methadone (Dolophine, Methadose)
  • Tramadol
  • Levorphanol
  • Pethidine
  • Dextropropoxiphene

Whereas natural opiates come from the opium plant and the active ingredient is morphine, semi-synthetic opioids are those created in laboratories and include hydromorphone, hydrocodone, and oxycodone as well as the illegal drug heroin. All of these are called narcotics and are schedule II drugs, except for heroin, which is an illegal schedule I drug and hasn’t been approved for any medical use.

Substance abuse is global in scale and claims millions of lives worldwide. The number of people classified with drug user disorders has increased for the first time in six years (UNODC, 2014). Worldwide, over 250 million people between the ages of 15 and 64 used at least one illicit drug in 2014, which represents 5% of the world’s population. Over 207,000 deaths were reported to be drug related in the same year.

In the United States more than 29 million people over age 12 used cocaine, heroine, amphetamines, or opiates once in the year surveyed (World Drug Report, 2016). More than 200 million Americans aged 12 or over had used an illicit drug at least once in their lifetime and half of those had used an illicit drug within the past year (WHO, 2014).

 

Answer: C

Test Your Knowledge

Which of the following is NOT an opioid?

  1. Morphine
  2. Hydrocodone
  3. Cocaine
  4. Fentanyl

Apply Your Knowledge

You are a medical/surgical nurse and your patient is complaining of pain rated at 5 out of 10 who has orders for hydrocodone. What nonpharmacologic options do you have to help with pain reduction? How often do you try to offer those to your patients?

Is your healthcare facility supportive of your efforts to offer nonpharmacologic options for pain control?

Online Resources

YouTube: The History of Opioids

https://www.youtube.com/watch?v=4MIseokXcxY

YouTube: Terrifying Facts About The Current Opioid Addiction Epidemic

https://www.youtube.com/watch?v=Owjm9AKn4bg

    Instructions
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