Opioid Abuse

That there is an opioid epidemic is indisputable. I remember as an anesthesia technician a member of the nursing staff had been dismissed because she was caught in an operating room with her hands in a used needle bin, trying to steal syringes with left over fentanyl.

North Carolina, it seems, is especially susceptible to abuse. From 2005 to 2015 total opioid related deaths in North Carolina rose from 642 to 1,110; “a 73% increase.” In 2017 there were ten million prescriptions written in North Carolina alone. From 1999 to 2016 over twelve thousand unintentional opioid related deaths occurred in North Carolina. According to the CDC the cost of opioid-related overdoses had reached more than one billion dollars by 2015. Most of these overdoses involved pain medications and more recently heroin, fentanyl, and fentanyl analogues have resulted in increased deaths. In many cases addicts become so obsessed that they end up homeless and so desperate that they turn to theft to afford their twenty to forty pills-a-day addiction.

Because of the various forms of opioids available, and to avoid confusion, it’s important to clarify the distinctions between opiates and opioids, however trivial it may now seem. Opioids traditionally alluded to drugs designed to mimic the effects of opium but with different chemical make-ups. Contemporarily, the term “opioids” now refers to the entire family of opiates including natural, synthetic, and semi-synthetic.

Governor Roy Cooper is proposing that the epidemic should be mitigated by increasing funds for medical treatment. The hope is to use Naloxone, a reversal agent for opioid overdoses or substitutes, to help save addicts, but so long as “more affordable” opiates are available on the black market treatment is unlikely to have long-term effects. Once addicted to prescription, users turn to cheaper street heroin when they can no longer get their prescriptions refilled. Therein lies the most severe dangers of opioid addiction because there is no way of moderating the potency of street heroin as opposed to the FDA regulated prescription pills.

There is even evidence that the epidemic is perpetuated in some cases by various police departments. In January of 2016, eleven members of law enforcement including five deputies, two former employees and one dispatcher in North Hampton County were arrested as a part of “Operation Rockfish,” an undercover operation conducted by the FBI, for interstate heroin trafficking.

Considering the temptation for police corruption and appeal of unregulated street heroin the solution likely to be most effective to this epidemic is legalization. According to addiction statistics in Uruguay which legalized all drugs in 2001, drug use has declined across all age groups and overdose deaths have plummeted to just three per million adults compared to the United States’ 185 per million.

According to the North Carolina Opioid Action Plan, opioid-related overdose deaths have increased by over 800% from 1999-2016 due to unprecedented availability of cheap heroin and fentanyl. The goal is to have reduced overdoses, rates of opioid related emergency department visits, and over-supply of opioid prescriptions including the total number of pills dispensed, the percentage of patients receiving more than an average daily doses of opioid analgesics per quarter, percentage of prescription days and percentage of prescription days any patient had at least one opioid and at least one benzodiazepine prescription on the same day per quarter by increasing trends of the number of buprenorphine prescriptions and naloxone administrations, and certified peer support specialists by the year 2021. The action plan offers little information in terms of how these goals will be achieved aside from the expansion of treatment and recovery oriented systems of care prescribing more naloxone and reducing the number of opioid prescriptions dispensed.

Four North Carolina cities are on the top twenty-five list for opioid abuse. Wilmington is number one on the list. Hickory is fifth; Jacksonville is twelfth and Fayetteville is eighteenth. According to a report conducted by the organization Castlight, which specializes in health care related information, there is a strong correlation between southern states and opioid abuse. Twenty-two of the twenty-five states in the report are in the south. The abuse rate for these cities is roughly fifty percent. Abuse is determined by patients “who received more than a ninety day supply of opioids who also received an opioid prescription from four or more physicians between 2011 and 2015.” The report also found that opioid abuse cost employers twice as much each year in medical expenses or about eighty-six-hundred dollars more than non-using colleagues. It also found that those over fifty years of age were four times more likely to abuse opioids than those under thirty.

There also seems to be a correlation between income and abuse rates with a little more than six percent of those living in areas with an average annual income of less than forty-thousand dollars while areas with an average income of eighty-five-thousand or more only saw an abuse rate of approximately two and a half percent. The same study found that states that had legalized cannabis use had abuse rates of a little less than three percent compared to the nearly five and half abuse percentage of states that has not yet decriminalized marijuana. According to the report the mentally ill are especially susceptible at a staggering “8.6 percent” abuse rate.

It would seem that circumventing addiction once opioids have been prescribed is highly unlikely. The safest way to manage addictions and prevent deaths is to legalize opioids so that addicts have access to regulated opioids and don’t feel obligated to resort to criminal means of obtaining cheaper, unregulated heroin.

Some theorize that the government doesn't want to decriminalize substances because of the profitability of the private prison system through the Corrections Corporation of America. The occupancy clauses of the CCA require states to keep their prisons full or pay a hefty fine. Considering the amount of lobbying allowed in Washington, it’s not inconceivable to think that state and federal governments are being bribed by lobbyists of private prison corporations to support legislature such as “the war on drugs” as a means of maintaining enough prisoners to meet the requirements of the occupancy clauses imposed by the Corrections Corporation of America and other private prison corporations.

In 2011 the Management and Training Corporation, which runs a state prison complex in Arizona, filed a claim against the Arizona Department of Corrections for not honoring its "lock up quotas" in the amount of $10 million and was awarded $3 million in damages and a guarantee to honor the 97% occupancy clause within 5 months. It’s not hard to see how this motivates states with poorer performing economies to perpetuate more arrests and lengthen sentences to avoid paying fines to the private prison corporation they’ve contracted.

When taking into account how strongly pharmaceutical companies initially pushed opioids and the amount of people currently addicted, treatment and legalization seem to be the only means of mitigating the epidemic but is unlikely considering its contributions to “lock up quotas”. Criminalization has only served to ostracize and endanger addicts while allowing black market dealers and the private prison system to profit. Considering the amount of unnecessary fatalities from current legislature and the success rate of other governments who have decriminalized drugs we have little to lose in terms of morality and tens of thousands of lives annually that could potentially be saved. Pharmaceutical companies and prison systems have profited for decades on generations of people we’ve allowed to become addicted on an incredibly destructive substance. It seems the least we could do is allow addicts some respite in the form of regulated resources and treatment. Legalization would also discourage illegal trafficking by police departments as they would no longer be able to flip seized street heroin which users wouldn’t have to resort to anyway. This solution, however unlikely, seems to be our best hope at circumventing a growing epidemic but will likely never be implemented due to the profits current legislature and legislators make from lobbying from privatized prison corporations.