The Opioid Epidemic as a Public Health Crisis

Opioids are a class of drugs that include the illicit drug heroin and legal prescription analgesics oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.²⁰ Opioids interact with opioid receptors in the central nervous system and brain to produce pleasure and reduce pain and have a high rate of misuse and abuse.²⁰ Substance abuse disorder is a primary, chronic, and relapsing brain disease characterized by the pathologic pursuit of reward and/or relief by substance abuse.²¹ Drug misuse is defined as the use of medications for purposes for which they were not prescribed.²² Roughly 21 to 29% of patients prescribed opioids for chronic pain misuse them²³ and between 8 and 12% develop an opioid use disorder.^24-26 An estimated 4 to 6% who misuse prescription opioids transition to heroin abuse.^24-26 This is a major shift the method of introduction to heroin for abusers. In 1960, 80% patients entering treatment for heroin reported that heroin was the first opioid drug that they had abused, whereas in the 2000s, 75% of individuals seeking treatment for heroin addiction reported that their first opioid was a prescription drug.²⁵ This has led to an overwhelming epidemic of opioid abuse that resulted in up to 136 overdose deaths each day in 2019.¹ A concomitant increase in neonatal abstinence syndrome due to opioid use during pregnancy²⁷ and HIV and hepatitis C rates due to intravenous drug abuse,^28,29 are some of the additional public health crises associated with this epidemic.

Figure 1. Increase in Opioid Overdose Deaths in the United States.¹⁰⁸

Figure 1. Increase in Opioid Overdose Deaths in the United States.¹⁰⁸