What the Opioid Epidemic Means in Virginia

In a nation where addiction is slow to be recognized as a disease, “opioid epidemic” sounds almost unbelievable. Surely we have more important diseases to worry about such as cancer, AIDS, and diabetes, right? Yet this year the Obama administration has proposed $1 billion in new funding for treatment and research on treatment to address the opioid epidemic in our country. An estimated 44 people die every day from prescription painkiller overdose in the United States. Since 2008, 115,000 Americans have died of overdose from opioid painkillers.

Named for the receptors on which they act in the brain, opioids are drugs that relieve physical and emotional pain. Opioids include opiates, which is an older term for drugs derived from opium, such as morphine. Common opioids include prescription painkillers such as OxyContin, hydrocodone, Percocet, methadone and Vicodin, as well as drugs like morphine and heroin. Opioids cause a rush of dopamine in the brain, conditioning the brain over time and altering pathways dealing with pleasure, memory, learning, and decision-making.

“The brain is not designed to handle it,” said Dr. Ruben Baler, a scientist with the National Institute on Drug Abuse. “It’s an engineering problem.”
– Jason Cherkis, “Dying To Be Free,” The Huffington Post

The rise in opioid use in the United States is largely due to unregulated overprescription of painkillers beginning in 1999. Sales of painkillers quadrupled between 1999 and 2010. OxyContin, in particular, hit rural Appalachia hard, Southwest Virginia included. Recent evidence indicates that OxyContin’s effects wear off much faster than pharmaceutical companies claimed. This means that people will need to take the drug more frequently, which is more likely to cause addiction due to repeated behavior.

People in rural Virginia were also at higher risk for addiction in general, in part due to poverty, a known precursor for addiction. Poverty causes people extreme stress and hopelessness, which often results in mental illness. A new study has found that when unemployment rates rise 1%, fatal opioid overdose rates and emergency room visits rise by 3.6% and 7%, respectively.

As state and federal law enforcement began to crack down on prescription and distribution of painkillers, people who were now addicted to painkillers turned to heroin, which is cheaper and in some areas more readily available.
Screenshot from the YouTube video by Leah Dick, featured in her post This is what an addict looks like, 2/22/16.

The opioid epidemic is strongly affecting the Commonwealth of Virginia. In 2013 there were more drug-related deaths in Virginia per capita than motor vehicle deaths. Two people in Virginia die from prescription opioid and heroin overdose every day according to the 2016 policy brief for the Virginia Senate. Untreated substance challenges cost the state of Virginia more than $600 million annually in health care and public safety expenses. The policy brief also specified that, “Virginia’s Medicaid program spent $26 million on opioid use and misuse in 2013, with $10 million of this spending occurring in Southwest Virginia.” Eighty percent of the 986 drug overdose deaths in Virginia in 2014 were due to prescription opioids and heroin. The Virginia Department of Health syndromic surveillance October 2016 report shows that the rising trend of emergency room visits for opioid overdoses has continued, especially in Southwest Virginia where emergency room visits have risen 71% since September.

Statistics this dire may feel remote, but the opioid epidemic is far from being a distant problem or one isolated to pockets of the population. Opioids penetrate both low and high-income areas, affecting young people, older people (especially ages 55-64), and infants. The opioid epidemic has taken such a hold of Virginia and of America that we will need to address the issue at a community level in order to see much progress.

Latest science informs us that the best approach to treating opioid substance use disorders is medication-assisted therapy (MAT). Suboxone and methadone keep people stable enough in recovery to live more normal lives. Pregnant women who are addicted to opioids are advised to take buprenorphine (Subutex) to stabilize themselves and their babies until delivery. People with substance use disorders are more than twice as likely to stay in treatment and not relapse if they are receiving medication than if they are not. Furthermore, total healthcare costs for people with substance use disorders on methadone are 50 to 62% lower than people not on an MAT program. Unfortunately, access to MAT is currently very limited. Even if every slot available for MAT treatment in the US were filled, over 914,000 would be left without treatment.

Abstinence-based approaches to treating opioid addiction have failed, often resulting in fatal overdose due to lower tolerance following abstinence. Incarceration of people with opioid substance use disorders is also ineffective, and may even impair that person’s ability to recover by putting additional stress on the person. Addiction is known to be a chronic disease of the brain requiring long-term treatment. And to quote NIDA Director, Dr. Nora Volkow, “If we embrace the concept of addiction as a chronic disease…perhaps we will be able to feel empathy for a patient suffering from a disease we call addiction.”

Laurel Sindewald is Executive Director of Handshake Media, Incorporated, publishers of the free addictions recovery smartphone app, New2Recovery.

This post was updated on 5/4/17.