It is no secret that our country is not doing as well as it could right now. There are many contributing factors as to why this is the case. One of the most severe and devastating contributors is the opioid epidemic. This epidemic has been sweeping the nation, leaving bodies in its path. While many communities are being affected by this issue, there are those that are taking a greater hit than others.
One such area is the city of Philadelphia. It’s seen a considerable spike in drug overdoses recently. As a result, city officials have been trying to find a way to address the problem and save the people of their city struggling with opioid addiction.
The “Great Problem” that is Opioids
Even though drug overdose has risen to the leading cause of death under the age of 50, there are people who still do not fully grasp the overwhelming path of destruction that it is leaving in its wake. Just last year alone, 2016 saw a least 59,000 deaths as a result of drug overdose. Of these 59,000 deaths, opioid overdose was responsible for a massive 33,000. This is a 19 percent increase from the 2015. This means that while drug overdose is a problem for many different types of drugs, opioids are by far the greatest threat to human life. Drug overdose is the leading cause of accidental deaths in the United States according to the American Society of Addiction Medicine. Opioid deaths grew 396 percent from 1999 to 2014.
Why is this issue suddenly increasing to such great amounts? There are a few ideas as to why; however, over-prescription is by far the leading theory. Since 1999 prescriptions for opioids have quadrupled. This is most likely the reason that the number of deaths involving opioids, prescription opioids, and heroin, have also quadrupled. In the United States last year, 236 million prescriptions were written for opioids. This is an astronomical amount of prescriptions. If you were to divide them up, the amount of opioids prescribed would be enough to give every single person in the United States a bottle to themselves.
Why are doctors giving out so much of this highly addictive painkiller if there are other options? The Center for Disease Control recommends that opioids only be prescribed for 3 days or less if the situation is not dire. More often than not, opioids are prescribed for much longer than the recommended time. The National Safety Council conducted a survey in which they discovered that 99 percent of doctors were surpassing the 3 day recommendation of highly addictive painkillers. If patients are given these painkillers for longer than the suggested time period than addiction is almost a guarantee.
Philadelphia’s Relationship with Opioids
As we see opioids disparaging the country, we need to realize that some areas are more affected than others. One extremely struggling city is Philadelphia, Pennsylvania. Opioids are contaminating the city and claiming many lives. In 2016, about 900 drug overdoses occurred. This number is almost 30 percent more than the previous year; a sign that drug overdose is only getting worse and not better. In fact, drug overdose was responsible for more than triple the deaths that occurred from homicides. Opioids were by far the leading drug offender as they were present in 80 percent of the drug overdoses in Philadelphia. (For more in-depth statistics, and for the source of some listed here, please visit https://www.phila.gov/health/pdfs/chartv1e1.pdf).
Philadelphia may be a popular tourist destination but most overdoses that occurred were by actual residents. According to the Philadelphia Department of Health, 90 percent of overdoses that occurred in 2014-2015 were by residents. Of the 10 percent of nonresidents, many came from areas that also struggled with similar problems.
In order to fully comprehend how bad the opioid problem is, we need to look at more than just drug overdoses. These are only the people who lost their lives; there are many more that needed hospitalization. From 2007 to 2015, the number of opioid hospital emergencies rose from .4 percent to .7 percent. Of all of the cities in Pennsylvania, Philadelphia has the highest rate of hospital admission at 47 per 100,000. This can be extremely costly. Opioid overdose hospital admissions cost the state 27 million in 2016.
There are several actions that need to be taken once admitted. The overdose reversal drug, naloxone, is usually administered to prevent further damage after an overdose. As long as individuals administer CPR and help prevent loss of oxygen to the brain, there is no reason to not experience a full recovery. If oxygen cannot reach the brain, cells begin to dye and irreversible damage can occur after just 10 minutes. After 15 minutes, recovery becomes almost impossible and highly unlikely.
Prescription Opioids, Heroin and Fentanyl
What other drugs occur from the use of highly addictive painkillers? City Health Commissioner of Philadelphia, Thomas Farley has said that “Most people who are using heroin didn’t start out using heroin. Most people started out using pills, particularly prescription painkillers: OxyContin, Vicodin, Percocet, and there are many other prescription painkillers.”
There is much truth to this statement. There is what everyone calls “gateway drugs.” Individuals who become addicted to painkillers are 19 times more likely to use heroin. This is apparent in the statistics from early December. Opioids killed 35 people during this short amount of time. Toxicology screenings revealed that of the 35 people who overdosed, 18 of them had heroin in their systems.
Not only is heroin a part of this trend but other drugs as well. Like Heroin, Fentanyl has been found present in many drug overdoses since 2013. Toxicology tests reveal that approximately 50 percent of opioid overdoses saw the presence of Fentanyl as well. Many times this drug is added to others without the user’s knowledge. According to the CDC, it is 50 to 100 times more potent than morphine.
Not everyone is using opioids at the same rate. Among gender there is an extreme variance. Men were found to be three times more likely to overdose on opioids than females. As to why these differences are observed, there are many contributing factors. Men tend to use drugs at an earlier age, as well as in greater amounts. This could be because they feel they need more to feel the effects in a larger body mass. They are also more likely to abuse alcohol and tobacco which could be why the gates are opened for other, more serious illicit drugs.
Not only do we observe a difference in gender, but in ethnicity as well. Whites are two times more likely to overdose on opioids than African Americans. Overdose of Hispanics fall somewhere in the middle. This could be due to the nature in which pain medicine is being prescribed. Whites could be being prescribed more painkillers than other ethnicities; specifically OxyContin and Vicodin which are highly addictive.
We see opioids being used by different ages as well. Opioid overdose is most common in people between the ages of 25 and 59. Why is this so common? It could be because people in college are using different drugs other than opioids such as marijuana, cocaine, hallucinogens, alcohol, and tobacco. Conceivably, once out of college the stress of life could lead to other more serious drugs. As for those above the age of 60; surgery becomes more risky the older that you get. Once men and women reach a certain age, surgery should be avoided at all costs which means that these individuals may not be taking as many painkillers to recover. These are just a few possible contributing factors.
What is Being Done to Fix the Problem?
Philadelphia is very aware of the problem and is trying to take steps to prevent and lesson the effect of the opioid epidemic on the city. The Mayor, Jim Kenney, appointed a 16-member task force composed of health and law officials to deal with the issue at hand. The task force was designed to meet every two weeks from February to April. These three months were designed to come up with a plan in order to save the city of Philadelphia.
They would do this through examining and reviewing other major cities approach to handling the opioid crisis. While Philadelphia’s problems may be more specific and require more a more particular approach, they felt that this was a good place to start. The goal was to deliver a plan to Mayor Kenney after its completion in April. The final plan was delivered on May 19th. The full report can be read here.
Outside Government Help
Donald Trump and the government have been trying to come up with a way to approach and fix the opioid epidemic. One way he has attempted to do this is through the appointment of a Commission. Made up of people from different backgrounds, its goals are much like the Mayor of Philadelphia’s Commission. To investigate and analyze an approach to the opioid crisis that will be most beneficial and efficient for the country. It is set to release its findings in October of this year.
The 2018 fiscal budget has also been aimed at devoting a good chunk of money toward addressing the problem. Through a combination of treatment, law enforcement, and border security, the administration hopes to accomplish the difficult. Year after year we have seen an increase in drug overdose and Donald Trump is very aware of this, as he has been affected in his family as well. He lost a brother to alcoholism and because of this; he understands the very real problem our country is facing.
While Trump’s budget seems to be focused on taking a strong stand against the opioid crisis, there are other aspects of our government that could hurt it greatly. The Affordable Care Act, created under Obama, provides important funding for drug treatment and care. The Trump administration has been working very hard to repeal this health law without grasping what it will truly mean for the American people.
According to an analysis by the U.S. Department of Health and Human Services, Pennsylvania could lose 30 percent of federal funds that are allocated for rehabilitation if this law is repealed. This would be a huge hit to the people of Pennsylvania and a huge step backwards. The uninsured rate would go up dramatically as people lost the ability to obtain private insurance through the ACA marketplaces and through the drastic defunding of Medicaid. As a whole the new health care bill would hurt the recovery of this country.
What does this mean?
We need to learn how to avoid making this problem worse and how to avoid making the same issue in the future. Doctors should be more aware of their patients and potential issues that can arise when prescribing opioids. They should not be prescribed unless absolutely necessary and for long than the recommended 3 day periods. Doctors should also be more aware of other medication their patients may be taking and the effect that combining opioids with other medications has. As a doctor, the most important thing you can do is recognize when your patient needs help and supply them with options and access to treatment in order to recover.
We still have a very long road to recovery. With the amount of drug overdoses we have observed in the past few years, the threat is very real. While Philadelphia is struggling more than most places around the country; it has the right idea to start addressing the issue. The Mayor and its inhabitants have come to realize that the opioid epidemic is no longer on their doorstep, but living in their home. With this knowledge, they have decided to move forward toward recovery. Maybe other parts of the country will follow if they observe how important it is to come up with a solution to save our people.
If you or a loved one is struggling with an opioid addiction call us at any time. We are here to help the citizens of Philadelphia overcome the opioid epidemic.