The US Centers for Disease Control and Prevention recently announced that drug overdose deaths topped 100,000 for the first time in a one-year stretch. For the period of April 2020 to April 2021, CDC data showed a nearly 29% increase from the previous year. Experts believe the precipitous rise was driven by abuse of the synthetic opioid fentanyl, as well as the COVID-19 pandemic, which has left many drug users feeling isolated and unable to get treatment or other support.
Fentanyl is believed to be much more potent than heroin and morphine.
This unsettling news comes as addiction to opioids is already at epidemic levels. Opioids are a class of drugs that include pain relievers available by prescription. They also carry the risk of overdose and are often misused because of the euphoric feeling they induce. Addiction and overdoses occur among people using prescription opioids (natural and semi-synthetic opioids and methadone), street drugs such as heroin, and synthetic opioids such as fentanyl. All opioids can relieve pain and create a euphoric feeling.
North America hit hard by opioid crisis
The opioid crisis has especially permeated North America. Over the past quarter-century, it has cost the United States and Canada more than 600,000 lives, which exceeds their fatalities from World War I and II combined. Exacerbated by COVID-19, last year marked the worst year on record in both countries in opioid deaths. The United States saw a 33% spike in fatal overdoses from 2019 to nearly 70,000. In Canada, fatal opioid overdoses skyrocketed 62% from 2019 to more than 6,200.
In response to the soaring opioid addictions and deaths in the United States and Canada over the past 25 years, Stanford University and the British journal “The Lancet” collaborated to form a commission. The commission combined Stanford scholars with other leading experts in the US and Canada, with the goal of better understanding the opioid crisis and proposing solutions to stop its spread domestically and internationally.
In February 2022, the commission issued a paper highlighted by its findings on the opioid epidemic and made seven categories of recommendations aimed at defusing the crisis. The paper appeared in The Lancet.
Dr. Keith Humphreys, a professor of psychiatry in the Department of Psychiatry and Behavioral Sciences at Stanford University and a former White House drug policy advisor, chaired the commission. He’s also a career research scientist with the VA Palo Alto Health Care System in California.
Humphreys teaches addiction treatment methods to medical students, psychiatric residents and clinical psychology interns. He has published more than 400 peer-reviewed scientific papers, receiving national and international awards for his work. In addition to working in the White House, he has been a consultant to the Centers for Disease Control and Prevention, the National Institute on Alcohol Abuse and Alcoholism, the Center for Mental Health Services and other government agencies. He’s also deputy editor in chief of the journal Addiction.
Other VA researchers on the commission included Dr. Erin Krebs of Minneapolis VA, Dr. Christine Timko of VA Palo Alto, and Dr. Amy Bohnert of the Ann Arbor VA in Michigan.
Humphreys spoke to VA Research Currents about the opioid epidemic, his commission’s recommendations, and what VA is doing to help Veterans addicted to opioids, among other pertinent issues.
VA Research Currents: Who is mostly to blame for the opioid crisis?
Humphreys: There’s plenty of blame to go around. The commission criticizes the manufacturers, companies like Purdue Pharma and Johnson & Johnson, for their aggressive and misleading marketing. Multiple manufacturers have been criminally convicted for lying about how dangerous these medications are. We also note failures in the FDA, which was too pliant when dealing with opioid manufacturers, including Purdue’s marketing campaign that suggested the opioid OxyContin was less addictive than other painkillers. That was a lie. There were also failures by distribution companies that over-shipped opioids. There were failures with the medical community being insufficiently critical and in some cases susceptible to bribery. We had doctors writing piles of prescriptions for money, not in VA, but in pill mills, which are facilities that resemble a regular pain clinic and that illegally prescribe opioids. There have also been failures in education in not giving medical, nursing and dental students enough training about addiction. We don’t equip them for a condition they’re going to see every single day. There have been political failures, as well. A lot of money is sloshing around, and legislators and policymakers have sometimes been swayed by the wrong people. They listened to lobbyists when they should have listened to evidence. That was also a failure. We address that in the report, too.
How extensive is the opioid problem in VA given that chronic pain is such a huge problem with Veterans?
Our patients have suffered a great deal. There’s no other way to say it. We care for a Veteran population that’s disproportionately male and disproportionately at that stage of life when pain is prevalent. We have a lot of rural people, and a lot of people who face significant economic challenges. All of those things are risk factors for opioid addiction and overdose. We were not immune to the problems of over prescribing. I wish it weren’t true, but we definitely were part of the national surge of prescribing opioids too broadly. Last year, I collaborated with VA’s Dr. David Atkins, Dr. Carolyn Clancy and Dr. William Becker on an article for the Journal of General Internal Medicine that documented how much Veterans have suffered from opioid addiction and how much we need to do for them.
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