Today in the United States, 2.5 million Americans are addicted to opioids, but many more are at risk. Over 12 million Americans are reported to misuse opioids, sometimes borrowing from a friend’s prescription or simply consuming above their prescribed dosage. For an in-depth discussion about the opioid crisis, check out a recent episode, entitled “The Opioid Tsunami,” on the Aspen Institute’s podcast, Aspen Ideas To Go.
The recent Surgeon General’s Report labeled the opioid crisis an epidemic, and the costs of this epidemic are frighteningly high. In 2015, over 33,000 people died from overdosing on opioids — a number four times higher than the death toll in 1999 — and the problem shows no signs of slowing down. Indeed, in 2015, over 130,000 people tried heroin for the first time — and, given the addictive nature of heroin, it’s likely that it won’t be their only time.
That’s because it’s not as simple as just making a choice. Often, we tend automatically to associate substance use disorders with moral failure. When we talk about substance use disorders, especially with opioids, calls to “just say no,” or “just stop using,” have little to do with the actual nature of the disorder. And, when we deride those who need our help through recovery as lazy or immoral, we’re really missing what, exactly, a substance use disorder is.
What Does Opioid Addiction Look Like?
To answer that question, it’s important to understand what opioids are and how they actually work. Opioids are substances that bind to certain “ports” in our brains, called receptors, that, when joined, produce morphine-like effects. They are extremely effective in lessening pain and have numerous other medical uses.
Our bodies produce natural opioids that bind to our opioid receptors. Morphine, and other opioids, bind to these receptors and mimic the effects of our natural opioids, mitigating our pain, slowing our breathing, and making us sleepy.
While opioids produce a euphoric effect — a generally intense and desirable feeling of physical pleasure — many who suffer from an opioid-related substance use disorder are trying to stay ahead of withdrawal.
How Does Withdrawal Work?
Let’s say you’ve been injured at work. The pain is chronic and acute. Your doctor prescribes an opioid pain reliever — in this case, Oxycodone — to bring you some relief. You take your prescribed dosage, and after a while, you notice that it takes more of the medication to mitigate your pain each time.
This is because the drug has physically changed you, altering your opioid receptors to require more and more of the medication to produce the same pain-relieving effect. This phenomenon is called “tolerance,” and it puts those suffering from a substance use disorder at increasingly heightened risk for overdose.
When you try to go without the drug, you become physically sick. You develop unpleasant flu-like symptoms, such as muscle aches, excessive sweating, insomnia, abdominal cramps, nausea and vomiting, and high blood pressure — to name a few.
To put it simply, your body can’t go without the drug. The drug has physically changed how your body operates, what it requires, and even how you think.
When we talk about substance abuse, the language of morality and responsibility isn’t helpful. At best, it misdiagnoses the nature of the problem. At worst, as we’ve noted before, it creates a stigma around substance abuse that discourages people from seeking help — and help is our greatest weapon in the fight against substance use disorders.
The Costs of Over-Prescribing
In addition to the biological traps of addictive substances, there are also prevailing trends in the United States that make substance use disorders increasingly common. Most notably, doctors tend to over-prescribe opioid medications, increasing the likelihood of dependency. According to a survey conducted last year by the National Safety Council, 99 percent of doctors are prescribing highly addictive opioid medications for longer than the three-day period recommended by the Centers for Disease Control and Prevention.
This trend is compounded by the fact that 23 percent said they prescribe at least a month’s worth of opioids. Keep in mind: Evidence shows that 30-day use causes changes in the brain. That doctors so routinely prescribe opioids is unsurprising. Seventy-four percent of doctors believe that morphine and oxycodone are the most effective ways to treat pain, when some studies show that Ibuprofen and acetaminophen are safer and more effective for acute pain.
The trend of over-prescription is so pronounced that in 2012 health care providers wrote 259 million prescriptions for painkillers—approximately enough to provide every adult American with a bottle of pills. The point is not to disparage those in the medical profession, but rather to illustrate that our lack of knowledge of opioids is so pervasive — and so devastating — that it contributes to a growing prevalence of substance use disorders.
The Role of Communities in Recovery
While there is much to be done about the opioid epidemic in our country, communities and individuals also have a vital role to play. Simply discussing substance use disorders in an understanding and informed manner can shed light on these issues, reduce stigma, and bring more support to those in recovery, or who are seeking recovery.
Supportive recovery communities are also immensely important to helping individuals overcome substance use disorders. That’s because it can be nearly impossible to break the cycle of addiction alone. Research also shows that receiving treatment within in community increases the effectiveness of the treatment.
One such community is The Phoenix, a 2016 Stand Together Foundation Catalyst, that has helped over 22,000 people lead sober lives by combining a recovery-encouraging environment with the rewards of empowering physical activity. While we can do much as a country to help fight substance use disorders, true empowerment starts in the community. We hope you stand with us.