Almost a decade ago, a raging epidemic of prescription pain medications prompted manufacturers, public health policy makers, and law enforcement agencies to enact multiple measures to curtail the drug supply.
Today, that abuse has morphed into a more deadly epidemic of heroin often laced with drugs that simulate the effect of opiates and are powerful enough to kill with small amounts.
In 2015, there were a total of 38,597 opioid and heroin deaths nationwide, or an average of 106 per day, according to the U.S. Centers for Disease Control and Prevention. That number is part of a nationwide total of 52,404 deaths from all drug overdoses, or an average of 144 per day.
Across Florida–once a major hub of prescription drug abuse and the proliferation of “pill mills”– there were seven opiate overdose deaths per day in 2015, a number that was projected to rise to about 12 fatalities per day–or almost double–during 2016. (Among the most commonly abused opioids are oxycodone, hydrocodone, methadone, and fentanyl).
“If you look at the number overdose deaths, it’s a huge problem,” said Steven Kurtz, Ph.D., sociologist, and director of Nova Southeastern University’s (NSU) Center for Applied Research on Substance Use and Health Disparities (ARSH), and a professor at NSU’s College of Arts, Humanities, and Social Sciences.
“The sheer number of people who are dependent on opiates in the U.S. is a tragedy. That’s why action was taken on so many levels in the public health community to curtail and restrain the supply side. It got out of control.”
When the supply of prescription opioids tightened, users turned to a more potent and less expensive drug–heroin. That was further complicated when illegally manufactured fentanyl–a synthetic opioid pain medication up to 50 times more powerful than heroin–found its way into the heroin supply, causing a spike in deaths.
“What started as an opioid epidemic morphed into a heroin epidemic,” Kurtz said. “Now the epidemic is in heroin combined with fentanyl. The illicit fentanyl is so potent, you can poison a population with a very small amount…It’s all building on itself.”
Opioid addiction exploded among users who crushed and dissolved the pills in liquid (rather than swallow the pill whole) in order to inhale or inject the drug. Doing so increases the speed of absorption and enables the user to feel the full effect all at once. This was especially dangerous with high-dosage opioid pills usually prescribed to seriously-ill patients and designed for extended release over a period of about 8 to 12 hours.
“This became a precursor to heroin use because–at some point–the level of drug needed to get the same high became too expensive. Heroin is a potent and cheaper source of the same drug,” Kurtz said.
Today, abuse deterrent formulations, known as ADFs, prevent tampering with extended-release opioid medications, which are formulated in crush-resistant pills. But abuse-deterrent mechanisms are not yet available for the majority of short-acting prescription opioids on the market, Kurtz said.
“ADFs have a place in controlling the opioid epidemic but their impact will be limited as long as those without abuse-deterrent mechanisms are still marketed,” Kurtz said, adding that prevention and treatment measures also are needed.
“We need to do a lot more in the way of primary prevention,” Kurtz said. “So far, the battle has mostly been trying to control the prescription drug supply and not on primary prevention and education that needs to start in grade school.”