Doctors most often prescribe opioids to relieve pain from toothaches and dental procedures, injuries, surgeries and chronic conditions such as cancer. Opioids usually are safe when they are used correctly, but people who misuse opioids can easily become addicted.
Of the 21.5 million Americans age 12 or older who had a substance use disorder in 2014, 1.9 million were addicted to prescription pain relievers, compared to 586,000 who were addicted to heroin.
Overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years, escalating to 16,651 deaths in the United States in 2010. In fact, 78 people die each day from opioid overdose, and 20.8 percent have a substance use disorder. However, only 10 percent receive treatment.
In his new landmark report, "Facing Addiction in America," Surgeon General Vivek Murthy noted that substance abuse in this country historically has been viewed as being a moral failing, a stigma that may discourage those with substance abuse disorders from seeking help. Decades of research support common reasons for avoiding treatment from cost to lack of awareness or knowledge.
According to the 2014 National Survey on Drug Use and Health, the most common reasons people who needed treatment for addiction did not seek help included:
- could not afford or did not have health insurance (39 percent)
- not ready to stop using drugs (29 percent)
- fear of negative opinion from neighbors or the community (18 percent)
- fear that treatment would affect work (17 percent)
- no knowledge of where to find help (14 percent)
- denial of addiction (8 percent)
With the goal of changing the public's attitude toward addiction, Murthy's report points out that alcohol and drug addiction — a three-stage cycle of binge/intoxication, withdrawal/negative affect and preoccupation/anticipation — is a chronic brain disease that has potential for recurrence and recovery.
The report commends programs, such as Alcoholics Anonymous, that have helped about 25 million people recover. The Affordable Care Act — which President-elect Donald Trump has vowed to repeal — has provided 20 million people access to health insurance not otherwise obtainable, and the Mental Health Parity and Addiction Equity Act of 2008 makes addiction treatment a health benefit for millions.
But does the journey to addition begin in the doctor's office? In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult his or her own bottle of pills.
William Maixner, professor of anesthesiology at Duke University School of Medicine and director of Duke's Center for Translational Pain Medicine, is among those who think that, while notable, Murthy's report needs to be more inclusive, such as addressing alternatives to opioids for pain management, suggesting that chronic pain is another epidemic with few good therapies beyond opioids.
The United States has a serious substance abuse problem, which poses a major public health challenge. The most devastating consequences are seen in the thousands of lives that are lost each year as a result of substance misuse, including those who lose their lives from opioid overdose.
In his report, Murthy urges Americans and insurance providers to treat addicts with the same compassion and care we give to other illnesses, such as cancer and diabetes, investing in treatment to help people get the help they need.
