The current opioid overdose epidemic plaguing Texas and the rest of the nation includes two distinct but interrelated trends: a 15-year increase in deaths involving opioid prescription pain relievers such as oxycodone and hydrocodone, and a more recent surge in heroin overdose deaths.
To help combat the epidemic, the Comprehensive Addiction and Recovery Act was recently introduced in the U. S. Senate. This act will expand the availability of medication-assisted treatment, increase the prescription drug take-back program, and provide training and equipping first responders on the use of the overdose-reversal drug naloxone.
It is a good start. But more is needed at state and national level. We need medication-assisted treatment facilities that are culturally competent and can meet the existing demand.
The demographic composition of heroin users entering treatment has shifted over the years from inner-city minorities to a more widespread geographical distribution involving white men and women in their late 20s living outside of large urban areas.
Here in Texas, the average age of a person dying with a mention of heroin has dropped, from 40 years old in 2005 to 35 years old in 2013, and the proportion of whites entering treatment for heroin dependence has increased from 44 percent in 1985 to 59 percent in 2014.
Among users of pain pills, 74 percent were white and average age was 35. There have also been increases in the rates of use of opioids by Hispanics and African Americans.
State lawmakers have noticed these trends and implemented policy changes that have started to affect the epidemic. The decline in other opiate deaths in Texas is partially due to the rescheduling of hydrocodone and the reductions in the availability of opioid pills following the Texas “pill mill” law, which prohibited prescribers from dispensing opioids from their offices and mandated use of the prescription monitoring program.
In Florida, a similar law resulted in a 27 percent decline in opioid analgesics and a 28 percent decline in deaths for benzodiazepines. However, the heroin overdose death rate in Florida then increased 122 percent, which is another example of the shifts in drug use based on availability and cost.
A side effect from the controls on the over-prescribing of legal opioids such as oxycodone and hydrocodone has resulted in those addicted to pain pills to not seek treatment for their dependence, but rather switch to other alternatives. The cheapest and easiest alternative is heroin.
Moving forward, states like Texas should put more of an emphasis on medication-assisted treatment options for those addicted to opiates or heroin, and on expanding the treatment capacity immediately.
Look at the numbers. In 2012, there were an estimated 1.5 million opioid users who received medication treatment such as methadone or buprenorphine, which lessens cravings and can help individuals heal as they escape the ravages of opioid use.
But there were also more than 2.5 million Americans who met the criteria for dependence or abuse of prescription pain pills or heroin who weren’t on medication treatment, and another 2 million who began using these drugs in 2012. This means we could have 4.6 million opioid-addicted people, yet we are able to provide medication-assisted treatment to fewer than 1.5 million.
We must also make naloxone more easily available. Naloxone can prevent deaths due to heroin use, but it should also be prescribed along with any pain pill that could cause overdose. Naloxone would be particularly appropriate for new inductees to methadone treatment, pain pill patients with cognitive impairments, those on heavy doses of pain pills who may not remember their medication schedule, or those who have previously suffered overdoses.
There has been a 200 percent increase in the rate of overdose deaths involving opioid pain relievers and heroin since 2000. Recognizing that pain pills can be as deadly as heroin and that we can prevent overdoses by having naloxone available would not only mean saving the life of a young son and getting him into drug treatment, but it would also mean keeping granddad alive until his medication schedule can be adjusted.
We have treatment options. We only need to remove existing barriers for people to receive appropriate treatment.
Jane Maxwell is a research scientist in the School of Social Work at The University of Texas at Austin.
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