The Opioid Epidemic – America’s Deadliest Addiction and Britain’s Opioid Problem
130 Americans die everyday from an opioid overdose – that’s more people killed in the USA by the opioid epidemic than deaths through gun violence or breast cancer. Experts are pointing to fentanyl as a major cause of drug overdose and death in America, including where other drugs are cut with fentanyl. In Britain, the nation’s opioid problem is on the rise too. Last year, the Office for National Statistics reported that fentanyl deaths were up by 29%.
In January 2019, TRT World News investigated the opioid epidemic in their Roundtable programme. They asked how the opioid epidemic has come about in the US and now in the UK.
And can it be stopped? Chaired by David Foster, the Roundtable panel included: UKAT Admissions Manager, Nicki Hari, who is in long-term recovery from opioid addiction; Widney Brown from the Drug Policy Alliance in New York; and Indra Cidambi from The Center for Network Therapy in New Jersey.
The Opioid Epidemic in America – OxyContin, Heroin and Fentanyl
Widney Brown explained how the current opioid epidemic in the USA has developed.
“This particular overdose crisis has been driven in part by the use of prescription drugs, particularly OxyContin, marketed widely as an effective pain-reliever. But their risk of dependency was not well understood and so people became addicted to it,” Brown said. “They started cutting access to the drug because people were becoming dependent – they then turned to heroin which they bought on the illegal market.”
Currently, fentanyl is causing the biggest health problems in the US opioid epidemic. Brown said: “Increasingly, heroin and other drugs, including cocaine and meth are being cut by fentanyl. People don’t know that they are taking the fentanyl. It is extremely strong. It causes you to stop breathing almost immediately.”
Indra Cidambi explained further about the high strength of fentanyl in comparison to other opioids. “Fentanyl is a deadly drug, as we know. It’s 50-100% more potent than heroin. Even a slight increase in the use can lead to overdose and death.”
A structural problem within the US healthcare system was highlighted, which tends to favour prescribing medications instead of providing addiction treatment where it’s needed. “Big pharma want to go and sell drugs. And the insurance companies don’t want to treat addiction because it’s so expensive. So it’s treated with medication, which is the cheaper option covered by insurance policies in the States.”
Indra Cidambi concurred: “Alternative treatments are not being covered by insurance most times. So [doctors] are constrained with what they have and they want to help the patient.”
Britain’s Opioid Problem – The Emerging Truth
Nicki Hari called for more help for people to come off addictive opioid drugs in Britain. In her role in the UKAT Admissions team, Nicki has seen a recent increase in people enquiring about addiction treatment for drugs including fentanyl and OxyContin, drugs she had previously only associated with America. “People are starting to realise, actually maybe I have got a problem. I’ve been on this medication for 10, 15, 20 years. Where’s the help for people getting off these drugs? That’s what worries me,” she said.
As with the opioid epidemic in the US, the Roundtable panel highlighted problems with the British healthcare system. Difficulties included the lack of time in GP appointments to investigate opioid addiction, as well as financial pressures on the NHS, including within GP practices.
Can the Opioid Epidemic be Solved?
The Roundtable panel put forward several ideas to address the opioid epidemic in the US and the UK.
1. Addiction treatment for people with an opioid problem
Nicki Hari called for a more targeted solution for people who are now addicted to opioids. “There isn’t enough time and money and resources on the NHS to investigate what the problem is,” Hari said. “Essentially what they are doing is sticking a plaster over the wound – and not treating the wound.”Nicki also explained her own transformation in terms of drug addiction awareness, when she accessed specialist help for opioid addiction. “When I was told I was a drug addict, I was mortified – because a drug addict to me was someone that had come from poverty, was injecting heroin, was sleeping on park benches.
“I was a mum, two children, middle/ working class person. […] But after coming out of rehab and doing the counselling and the therapy, I’ve realised that drug addiction isn’t a bad word, it’s an illness.”
2. Better training for doctors about opioid addiction
Indra Cidambi pointed to medical training as a vital part of the solution. “In medical school, the doctors in general are not given education about these treatments and the pain medications. What happened was addiction was not thought of in depth. Only now in America, we are looking more at integrating these in the medical school and also with the residency training,” Cidambi said.
3. Rigorous testing of new opioid medications
Widney Brown pointed to more thorough testing of new opioid drugs by the US Government before they are licensed. “It’s the Government’s responsibility, the Food and Drug Administration, to know what the dependency risks of a new drug are,” Brown said. “[With OxyContin] they relied on Purdue Pharma [the creator and distributor] to tell them what the dependency risk is rather than themselves investigate that.”
4. Prescribing non-addictive medications for chronic pain
Indra Cidambi said that non-addictive pain medications should be used much more. “For chronic pain, you don’t need to be treating patients with this kind of medication. There are other medications which you can use that are non-addictive.”
Referring to her own experience of being prescribed strong opioids for chronic pain, Nicki Hari said: “I think what they should have done was given Paracetamol and Nurofen – and told me to come back in a month.”
5. Medical marijuana for pain relief
Widney Brown said that recent US studies suggest that medical marijuana could help reduce the risk of opioid overdose. “States that allow medical marijuana for the treatment of pain have much lower rates of overdose,” Brown said. “Whether it’s a cause and effect or correlation, we still need to understand.”