Drug overdose is the leading cause of accidental death in America, with an average of three Oregonians dying every week from prescription painkiller poisoning alone, while many more succumb to heroin, fentanyl and other illicit opioids. Thousands more develop an opioid-use disorder and are at significant risk for overdose.
Former Oregon Assistant Attorney General David Hart pointed out that "in 2014, enough opioids were prescribed in Oregon for nearly every person in the state to have a bottle." More recently, the Oregon Heath Authority stated that more drug-poisoning deaths in Oregon involve prescription opioids than any other type of drug, including alcohol, methamphetamines, heroin and cocaine.
Between 1999 and 2013, sales of prescription opioids quadrupled, and yet studies show that the amount of pain Americans report is about the same. Additionally, research has shown that about 80 percent of heroin users started by misusing prescription opioids.
These statistics are staggering, and Oregon lawmakers have taken action to tackle the opioid crisis by passing a law that provides safe-use recommendations to those who prescribe such pain-relieving drugs. While such laws have contributed to modest decreases in opioid prescriptions across the country, the national overdose death rate related to opioids has continued to increase.
Clearly, the issue is much deeper than simply monitoring prescriptions.
While it is certainly helpful to educate opioid prescribers and to provide guidelines and support to help them manage patients' pain without enabling addiction, ending the overdose epidemic requires a comprehensive approach that also includes more aggressive efforts to identify and treat addiction.
Not everyone who is prescribed opioids has the same risk for developing an addiction or misusing opioids. People who experience problems tend to have other substance-use issues as well, and a majority also have mental health concerns. So, simply focusing on opioids alone will not solve the problem. If we're going to end the opioid epidemic in America, we need to widen our lens and focus on the root issue, which is the disease of addiction.
The Hazelden Betty Ford Institute for Recovery Advocacy, in collaboration with the University of Maryland School of Public Health, recently released a report on the overlap between opioid problems and other drug problems. Among other findings, the research revealed that half of opioid overdose survivors interviewed in a 2016 study had either current or past problems with alcohol or other drugs, and the majority (75 percent) of the accidental overdoses they experienced involved poly-substance use.
Among a 2016 national sample of young adults who had used heroin in the past month, 97 percent also had used cigarettes, 89 percent also had used alcohol and 82 percent also had used marijuana.
Historically, our tendency as a nation has been to respond to drug crises by fighting the specific drugs in question. Too often, though, one drug crisis gives way to another. As soon as one ends, another begins.
Our challenge in the midst of the current crisis is to design programs and policies that address much more than opioids and that tackle the complex underlying health condition — addiction. Here are just a few solutions that shift the focus beyond fighting drugs to improving people's health:
• Education systems should develop the capacity to identify adolescents and young adults who engage in any form of substance use and route them to intervention programs.
• Physicians who prescribe opioids should comprehensively screen for patients' substance-use histories and carefully monitor for signs of addiction in all patients.
People with opioid-use disorders should be provided comprehensive long-term addiction treatment and recovery support that address all forms of substance use as well as co-occurring mental and physical health issues.
We are confronting the opioid crisis at the Hazelden Betty Ford Foundation by providing comprehensive, long-term treatment that does not rely solely on medications or any other one therapy but instead utilizes multiple evidence-based practices according to individual needs.
But treatment is just one facet of this fight. My hope is that we can work together as communities to end the opioid epidemic and address the longstanding root of all our drug crises — addiction.