A recent article in the New England Journal of Medicine by Dr. Wilson Compton and colleagues highlights the grave consequences of prescription opioid abuse in the United States. According to the article, a total of 10.3 million individuals reported nonmedical use of prescription opioids in 2014. Over a roughly ten-year period, emergency department visits involving abuse of prescription opioids have increased 150%, admissions to substance abuse treatment programs for treatment of opioid addiction have quadrupled, and deaths from prescription opioid overdose nearly quadrupled. Nationally, according to the U.S. Centers for Disease Control and Prevention, a total of 18,893 overdose-related deaths occurred in 2014, up from 16,235 in 2013.
Alongside the increases in prescription opioid abuse, there have been alarming increases in heroin usage and heroin-related mortality. Nationally, 914,000 people reported heroin use in 2014, a nearly 150% increase from 2007. Mortality from heroin overdose is now five times what it was in 2000, and reported associations between prescription opioid abuse and heroin use have been reported by several investigators. One article showed that heroin users are nearly 3 times as likely to report abuse of prescription opioids as those who do not use heroin. Another showed that incidence of heroin use among those who report prior nonmedical use of prescription opioids was 19 times as high as the incidence among persons who reported no previous nonmedical use of opioids. While progression to heroin use among those abusing prescription opioids remains relatively rare, the strong associations seen by a number of investigators between the two forms of abuse are worrisome.
In response to these trends, a number of interventions have been instituted in recent years. Educating healthcare professionals and the general public about appropriate prescribing principles is an important component of currently targeted public health efforts to reduce opioid abuse. In addition, the imposition of prescription drug monitoring programs, such as the one in Connecticut, and the design and formulation of drugs that reduce potential for abuse are key elements. While there are some indications that such programs have begun to impact prescribing practices, time will tell whether they effectively reduce the substantial morbidity and mortality suffered by Americans from opioid abuse.