An estimated 2.1 million people in the United States had a substance use disorder related to prescription opioid pain medicines in 2016. However, only a fraction of people with prescription opioid use disorders receives speciality treatment (17.5 per cent in 2016). Overdose deaths linked to these medicines were five times higher in 2016 than 1999. There is now also a rise in heroin use and heroin use disorder as some people shift from prescription opioids to their cheaper street relative; 626,000 people had a heroin use disorder in 2016, and more than 15,000 Americans died of a heroin overdose in 2016. Besides overdose, consequences of the opioid crisis include a rising incidence of infants born dependent on opioids because their mothers used these substances during pregnancy and increased the spread of infectious diseases, including HIV and hepatitis C (HCV), as was seen in 2015 in southern Indiana.
Effective prevention and treatment strategies exist for opioid misuse and use disorder but are highly underutilized across the United States. An initiative of the Secretary of Health and Human Services (HHS) began in 2015 to address the complex problem of prescription opioid and heroin use. In 2017, HHS announced five priorities for addressing the opioid crisis:
- improving access to treatment and recovery services
- promoting the use of overdose-reversing drugs
- strengthening our understanding of the epidemic through better public health surveillance
- providing support for cutting-edge research on pain and addiction
- advancing better practices for pain management
Effective medications exist to treat opioid use disorder: methadone, buprenorphine, and naltrexone. These medications could help many people recover from opioid use disorder, but they remain highly underutilized. Fewer than half of private-sector treatment programs offer medications for opioid use disorders, and of patients in those programs who might benefit, only a third actually receive it. Overcoming the misunderstandings and other barriers that prevent wider adoption of these treatments is crucial for tackling the problem of opioid use disorder and the epidemic of opioid overdose in the United States.