California Identifies “Hot Spots” Where Opioid Poisonings are Occurring
The World Health Organization provides several key facts regarding opioids:
Opioids are psychoactive substances derived from the opium poppy or their synthetic analogues. Examples are morphine, heroin, tramadol, oxycodone, and methadone.
Worldwide, an estimated 69,000 people die from opioid overdose each year.
There are an estimated 15 million people who suffer from opioid dependence (i.e. an addiction to opioids). The majority of people dependent on opioids use illicitly cultivated and manufactured heroin, but an increasing proportion use prescription opioids.
There are effective treatments for opioid dependence yet only 10% of people who need such treatment are receiving it.
Due to their effect on the part of the brain which regulates breathing, opioids in high doses can cause respiratory depression and death. An opioid overdose can be identified by a combination of three signs and symptoms referred to as the “opioid overdose triad” which includes: pinpoint pupils; unconsciousness; respiratory depression.
Because of their capacity to cause respiratory depression, opioids are responsible for a high proportion of fatal drug overdoses around the world. The number of opioid overdoses has increased in recent years, in part due to the increased use of opioids in the management of chronic non-cancer pain.
The rates of prescription opioid poisoning are concentrated in ‘hot spots,’ typically in rural areas, small towns, and suburban areas, according to a recent study from the University of California, Davis. A map showing the concentration of opioid-related problems shows Northern California as the hottest spot by far.
Researchers seeking reasons for the higher rate of poisonings in these areas isolated three main causes: (1) availability of prescription opioids, (2) medical need for prescription opioids, and (3) economic stressors.
Part of what has made the opioid epidemic so insidious is the legitimacy of the drug. This is borne out in the fact that the suppliers of this poison are not shady criminals, but respectable pharmacies: the rate of poisonings matches the density of pharmacies.
Blue collar workers are far more likely to sustain injuries on the job, resulting in the prescription of opioids for pain management. In these cases, the drug “pushers” are often well-meaning doctors.
The World Health Organization reports that pharmaceutical opioids, in particular, strong opioids of the type that are typically involved in opioid overdoses, have been restricted in the past to the management of acute pain and cancer pain, such as is recommended in the WHO Cancer Pain Ladder. There has been a trend in the last 10 years to use opioids in the management of chronic non-cancer pain, such as back pain.
Rural and suburban communities with higher unemployment, low median income, and poverty are also more vulnerable to the abuse of prescription opioids, researchers stated. The abuse stems from “a way to manage chronic stress and resulting anxious and mood disorders.”
More than 32 million people abuse opioids worldwide, researchers stated. And in the United States, the number of deaths related to prescription opioid poisoning has increased 400 percent between 1999 and 2014, “and account for more deaths than heroin, cocaine and stimulant poisoning combined.”
A February 2016 study showed that daily doses of prescription opioids in North America increased from 2.4 billion per annum to 5.3 billion per annum between 2011 and 2013.
Prevention of opioid overdose
Beyond approaches to reducing drug use in general in the community, specific measures to prevent opioid overdose include: increasing the availability of opioid dependence treatment, including for those dependent on prescription opioids; reducing irrational or inappropriate opioid prescribing. Steps have also been taken to increase the availability of naloxone, a fast-acting opioid overdose-reversal medicine.
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