We must tackle opioid problem before it leads to an AIDS epidemic

We must tackle opioid problem before it leads to an AIDS epidemic
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A stitch in time saves nine. This may not be the reality we want or a society we court but we are in a crisis mode as far as opioids use is concerned. How did we get here? Who is to blame? Could it be our government or the physicians prescribing opioids? Some have argued culpability for civil society and of course who would forget the drug companies?

It’s time to accept this epidemic is here and focus on finding lasting solutions. One would hope that as a nation we could rise up to this mammoth challenge facing our generation. Working in the emergency room of a hospital for one year provided me a unique lens to peek into this Pandora box.

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Whether it was chronic pain or mental illness, opioid addiction or cognitive impairment, intravenous drug use or HIV, the scourge portrays a vicious cycle that crystallizes the crisis especially among frequent users of the emergency room. Connecting these dots is strangely lacking in our public debates and policy-making while kicking the can down the road until it assumes epidemic proportions is mostly commonplace as we saw with HIV in the early 1980’s or more recently with Ebola and Zika virus.

 

We live in a country where 80 percent of heroin addiction is attributed to misuse of prescription opioids. In its 2015 report the Economist dissected America’s worsening opioids crisis with shocking numbers on the toll of this epidemic on our cities.

Teen deaths from drug overdose driven primarily by opioids increased by 19 percent from 2014 to 2015 according to the National Center for Health Statistics. To give this some perspective, the American society of Addiction Medicine described opioid addiction as a major contributor to the over 50,000 accidental deaths in the US from lethal drug overdose in 2015. 

There are about 1.1 million Americans living with HIV with percent six of all new infection attributed to injection drug use according to Center for Disease Control and Prevention (CC) reports. A number some experts argue is under-reported.

The misuse of opioids and injection drug use has been linked to increase in risky sexual behaviors such as unprotected sex at a time CDC reports only one-third of Americans use condoms during sexual intercourse. This must be viewed against the backdrop that sexual transmission is a major route for HIV spread and that in 2016 the CDC found needle and syringe sharing a common practice with a high risk of HIV transmission among people who inject drugs in the United States.

A chronic pain patient is more likely to become dependent or addicted to opioids. The misuse of prescription opioids on the other hand is associated with initiating injection drug use. Researchers have long shown that persons with chronic pain are more likely to suffer from mental illnesses like depression and vice-versa.

A point highlighted in a retrospective study of outpatients in a chronic pain clinic that I co-authored with the highly respected pain specialist, Anita Gupta. It is worth mentioning that mentally ill patients are probably more likely to develop opioid addiction and abuse. It is therefore reasonable to believe failure to address this opioids crisis will not only translate to more IVDUs and a consequential spike in the HIV prevalence down the road but is tantamount to putting the current mental health crisis in the US on steroids.

A listen to the current debacle on health care throws more light on the need to address this most burning of issues. More than 70 million Americans depend on Medicaid, many of them patients seen in our hospitals with drug addiction and mental health disorders in small towns and big cities. Any collapse in Medicaid without a thought-out alternative for caring and carrying its current burden will be catastrophic for the United States and such a scenario would likely herald the explosion of a myriad of epidemics and a national security nightmare on many levels.

Fixing our opioid burden will take more than a task force or billions of dollars in budgetary allocation. While these may be praise-worthy steps, a multi-faceted highly targeted inter-disciplinary approach remains the only substantive option capable of not just dealing with the crisis in real time but would also arrest the vicious cycle that feeds it.

Patients in the United States often receive opioids for common low-pain risk surgical procedures. No excuses for the physician who over-prescribed opioids but in these days of uncountable metrics and patient-centered care you be damned to say no.

Oftentimes physicians find themselves not only prescribing these opioids to maintain a happy clientele but also to avoid financial penalties. So when the CDC says we consume 80 percent of the world's opioids that should be our moment for sober reflection.

The interconnectivity shared by the current opioid crisis vis-à-vis addiction and dependence with IVDU, HIV, Chronic pain and Mental illness needs to be the fulcrum on which any lasting solution is balanced. Connecting the dots should be the foundation for a winning strategy. Any notion that we can address one and not the other is truly living to fight another day. Let’s make hay while the sun is still shining.

Onyechi Megafu, M.D. is a Resident Physician in the Department of Anesthesiology and Perioperative Medicine of Drexel University College of Medicine Philadelphia. He holds an MPHIL in HIV/AIDS Management from Africa Centre for HIV/AIDS Management and has worked in many hospitals both in the U.S. and overseas.