 Our nation is at the peak of a crisis that has been deemed a national emergency by President Donald Trump; the opioid epidemic. Annual opioid deaths have surpassed gun homicides and car accident deaths in the United States of America since 2014 and this trend only shows signs of continuing as no laws, required protocols or guidelines, or governmental acts have been put in place by higher authorities (Blau). It is necessary for stricter protocols, laws, and alternative practices to be put into place in order to minimize and eventually end this horrifying and destructive epidemic. 

America’s opioid epidemic is nothing new; in fact, mass opioid addiction has been a serious issue for over a century, dating back to the post-Civil War era when morphine and heroin were used regularly as painkillers for wounded soldiers. In 1900, an estimated 300,000 Americans were addicted to morphine, many being Civil War veterans. Two years prior, in 1898, heroin was released as a cough suppressant in both pill and liquid elixir form by the Bayer Company (Daly 1). True addiction is defined by the National Institute on Drug Abuse as a chronic, relapsing brain disease that is indicated by compulsive drug seeking and use, despite harmful consequences; and while physical dependency is not the same thing as addiction, it is often accompanied by the latter. “In 2001, a study shows that between 18 and 45 percent of patients who take opioids for more than three months will develop true addiction, not physical dependency.” (Daly 3). Roughly one-third of America’s population suffers from chronic pain, or 100 million Americans. From 1991 to 2011, the number of annual opioid prescriptions in the U.S. had climbed from 76 million to 219 million, respectively. Also during this 20-year period, emergency room visits for opioid abuse had more than doubled from 145,000 in 2004 to 306,000 in 2008 (Carroll). Other notable statistics from this period include: “From 1995-2002 drug manufacturers were the nation’s most profitable industry.” and, “Federal data from 2011 reveals that nearly 80 percent of people who had used heroin in the previous year also had a history of abusing prescription painkillers.” (Daly 3,7). On top of prescription opioids, the number of heroin users increased from 380,000 in 2005 to 670,000 in 2012 (Carroll). The opioid epidemic has only worsened in the recent years after this period. In 2014, opioid deaths surpassed that of car accidents and gun homicides as 28,000 people in America died from opioid abuse and in 2016, the number of deaths related to opioids raised to nearly 35,000 (Vestal). From these quotes and statistics alone, one can see why the opioid epidemic in the U.S. has been declared a state of emergency. For years, chronic pain has been treated by prescription narcotics such as oxycodone, tramadol, and morphine, all of which are highly addictive. Opioids are extremely potent and effective because they change the way the brain perceives pain messages from the brain and can begin to create dependency within the body that is extremely difficult to return from once that dependence on the medication develops. Many doctors believe that, with careful and deliberate attention and examination, opioids can and/or should be the primary way to treat patients with medical conditions like chronic pain. If a majority of the 100 million Americans suffering from chronic pain are treated with narcotics, that is an alarming percentage of American’s population obtaining these prescriptions and practicing the use of them legally. Prescription narcotics are also used for treatment of many other common conditions such as surgery and trauma recovery, cancer, pregnancy labor, rheumatoid arthritis, fibromyalgia, and urinary tract infections, among many others that are less common or severe. Because of their accessibility, potency, and craved recreational use, which can be similar to the effects of heroin, prescription opioids have become one of America’s most commonly used drugs (Morelli 2). All signs point to America’s epidemic, which has already reached national emergency levels, to increase and only worsen.

Many guidelines have been suggested or been approved by legislative bodies, governmental agencies, and health systems such as online databases where physicians can check prescription and medical histories of their patients, but no required actions have been implemented, nor have there been laws put in place. The Food and Drug Administration ensures that medications are safe and effective but are legally prohibited from interfering with the “practice” of medicine. Though this prevents the FDA from overseeing how physicians prescribe opioids to their patients they have developed the Risk Evaluation and Mitigation Strategy (REMS) in order to limit the nonmedical practice and overdose of drugs that have potential for severe harm. The REMS is a way for the FDA to better ensure these drugs are being prescribed to the right patients for the right reasons in the right dosages. After laboratory testing, certification, monitoring, and conversion among related products, a drug can be labeled as safe for pharmaceutical companies to distribute and physicians to be prescribed. Through the REMS, drug manufacturers now must be required to provide a form of education in selecting the proper patient, counseling, and assessment for abuse, dependency, and addiction to prescribers. Though this sounds effective, the FDA expects these drug manufacturers to provide all education as well as the costs for this education which raises many red flags in the pharmaceutical and medical industry, such as if these manufacturers are attempting to make an effective change as expected behind their closed doors (Nelson). In 2012, Kentucky became the first state to require all prescribing physicians to check an online database called the prescription drug monitoring program (PDMP) before prescribing opioid painkillers and other harmful or addictive drugs to their patients. The White House Office of National Drug Control Policy has encouraged all other states to enact similar laws and databases but not at all states have. Since 2012, sixteen other states have followed in the footsteps of Kentucky, but the lack of urgency or care from the U.S. government and remaining states is something to notice (Vestal). The states that have implemented these electronic pharmacy registries also give the patient an option to opt out for privacy reasons, so a physician cannot always see what medications a patient has taken or is currently taking. Another flaw with the electronic databases is many states PDMPs are not compatible with other states, so patients can drive across state lines to receive another prescription and no one would ever know (Hoffman). Between 2012 and 2013, the first year the database was implemented, hydrocodone prescribing dropped 13 percent, oxycodone and tramadol dropped 12 percent, and oxymorphone dropped 36 percent in Kentucky (Vestal). These changes can be attributed to the PDMP database being implemented, but also to Dr. Phillip Chang from the University of Kentucky Albert B. Chandler Hospital. Dr. Chang prompted the emergency department at Chandler Hospital to implement new guidelines that called for prescribing opioids as a “last resort” and they have been so effective that the same protocol has been implemented in 10 other health systems across the state of Kentucky. Starting in the 1990s, doctors were often scolded for “undertreating” their patients’ pain and the life-changing power of opioids were turned to by physicians to bring about peace and comfort in those patients’ lives. Now the tides have changed and it once again on these doctors to scramble for alternatives to the misery that is accompanied with opioids. More and more medical associations are offering training to physicians about opioids and chronic pain and urging them to begin treatment with alternatives like non-opioid medications, physical therapy, acupuncture, anti-inflammatories, antidepressants, and counseling, among others (Hoffman). 

Opioid overdoses, including prescription painkillers and heroin, have been the number one cause of injury-related death in America since 2014. Government health officials have reacted by providing strategies and recommendations for physicians who treat patients with chronic pain, but have not implemented required protocols or laws. The Center for Disease Control and Prevention’s (CDC) set of 2014 guidelines recommend using a urine drug test before prescribing addictive opioids like oxycontin, codeine, and morphine. The CDC also recommended primary care doctors to spare opioid prescriptions to those suffering from cancer, serious illnesses, or those receiving palliative care, which is end-of-life treatment. Primary care doctors were the majority targeted by the CDC because, according to their own data, opioid sales and prescriptions have quadrupled since 1999, and primary care doctors account for nearly have of the prescriptions from 1999 to 2014. A simple implementation of a urine drug test protocol for doctors to follow before prescribing highly addictive opioids would allow the prescriber to determine multiple occasions where a narcotic should not be described. A failed drug test would indicate that the patient is already taking opioids. A negative drug test from someone who is already prescribed opioids could indicate that they are selling them or giving them away; or a positive drug test from a new patient may show that they are illegally obtaining opioids through “doctor shopping”, when patients consult multiple doctors in order to obtain access to more prescriptions and more narcotics, or “pill mills”, which are doctors who illegally write prescriptions for patients in exchange for cash and/or other subsidies (Leonard). Though suggestions have been made and guidelines have been put forth by experts and officials, no laws have been implemented to require these suggestions and guidelines for prescribing physicians to follow—the time is now. 

Though the fact that the opioid crisis is real and as relentless and detrimental as they come, some argue that the overprescribing of opioids is not what caused the epidemic and is not the reason why it continues to grow today. A percentage of opioid abusers are young people who have illegally obtained the narcotics in some form, such as knowing family members and/or friends with prescriptions. Adults building off of a previous addiction or those who have relapsed are also among those who make up a percentage of opioid abusers in America. Experts and officials understand that; but the lack of notice, care, and knowledge of those prescriptions outside of doctors’ offices is what has caused and continues to cause this epidemic. Pharmaceutical companies are not going to stop manufacturing and distributing these drugs as they are needed by patients with certain conditions. Opioids are not distributed to the public, they are obtained through prescribing physicians. One statistic to look at is that 77 percent of people who are addicted to opioids either started off doing cocaine or had done cocaine at some point during their addiction, the only difference being: cocaine cannot be supplied medically. Drug addiction may not always begin with something as addictive as opioids but the power they have over the mind and body are catastrophic. 75 percent of heroin addicts in the U.S. began with prescription opioids. Prescription opioids have similar long-term effects to heroin and morphine but are much more attainable especially with prescriptions being handed out with little to no regulations. Many prescription opioid users in the U.S. are “short-term” users such as those who have acute pains from surgery or dental work. One study found that 640,000 surgical patients who had never previously taken opioids found that a small percentage used the drugs for more than three months after recovery from surgery. Percentages varied from less than 0.12 percent for C-section patients up to 1.4 percent for knee surgery patients. However, data from the Center for Disease Control and Prevention shows that 26 percent of people exposed to opioids become addicted and 70 percent of people are exposed to medical opioids in their lifetime (Szalavitz). The accessibility of prescription opioids in America has caused and will to continue to further the peak of the American opioid epidemic. 

The U.S. is at the pinnacle of a disastrous epidemic that is only raising its’ ceiling every year. Experts and officials are aware and still no protocols or laws have been implemented universally to minimize the effects opioid addiction and abuse has had on the citizens of America, with deaths reaching all-time highs and surpassing car accidents and gun homicides. It is necessary for stricter protocols, laws, and alternative practices to be put into place in order to minimize and eventually end this horrifying and destructive epidemic. 
