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Why “Just Say No” Won’t Stop the Opioid Crisis

By Jenni Deming

Just say no profileOpioid addiction has a familiar face.

It has the eyes of the retired grandmother next door. It has the smile of the bag boy at your local grocery store. And it has the ears, nose and skin of the lawyer, nurse and social worker you’ve known since childhood.

Maybe it even has some of your own features. Or your parent’s. Or your child’s.

The point is this: Opioid addiction is affecting every corner of our society. What typically starts off as an innocent way to treat pain — whether chronic or post-operative — may end in years of struggle with prescription painkillers. And it can lead to even deadlier substances along the way, like heroin or fentanyl, a synthetic opioid. It’s an epidemic that doesn’t discriminate.

The Uncomfortable Statistics

In 2015, the National Survey on Drug Use and Mental Health estimated that two million people suffered from some form of pain reliever use disorder.1 And based on preliminary reports from The New York Times, more than 59,000 people died from drug overdoses in 2016 alone, making it the leading cause of death for people under the age of 50.2

President Trump has even declared opioid addiction a “national emergency” and promised to focus more time, money and attention on the problem.3 But confusion remains as to the best way to treat this complex issue that has been decades in the making.

It’s not as simple as banning prescription painkillers. And it’s certainly not as simple as using an outdated “Just Say No” campaign to ward off impressionable adolescents.

That’s because most people who are addicted to opioids began using them for things like chronic back pain, arthritis or surgery recovery — conditions associated with older patients and legitimate prescriptions. D.A.R.E. programs in schools aren’t likely to be beneficial when it comes to opioids.

How Today’s Crisis Began

In the 1990s, a new prescription painkiller, OxyContin, hit the pharmaceutical market. With an estimated 100 million people suffering from chronic pain, patients were eager for a miracle drug to alleviate their aches.4 And opioid manufacturers were eager to educate both doctors and patients on this allegedly safe and effective way to help them find relief.5

Fast-forward to 2015, when it was reported that an estimated one in three adults had a prescription for painkillers. Put another way, the amount of opioids prescribed in that year alone was “enough for every American to be medicated around the clock for three weeks.”6 And overdose deaths were skyrocketing as well.

Slowly, the health community became aware of the dangers of prescription opioids. These painkillers weren’t as harmless as they’d been told. And as providers began writing fewer prescriptions, their patients — some of whom were already addicted — looked elsewhere to find their relief. When they couldn’t afford or find painkillers illegally, they moved on to heroin, which was often cheaper and produced a stronger high.

A July 2014 study from researchers at Washington University in St. Louis described the connection between prescription opioids and heroin. It was stunningly clear:

“Of those who began their opioid abuse in the 1960s, more than 80% indicated that they initiated their abuse with heroin. In a near complete reversal, 75% of those who began their opioid abuse in the 2000s reported that their first regular opioid was a prescription drug.”7

The study went on to say that nearly everyone polled “(94%) indicated that they used heroin because prescription opioids were far more expensive and harder to obtain.”

According to the Centers for Disease Control and Prevention, the rate of heroin-related deaths quadrupled between 2002 and 2013, adding that “people who are addicted to prescription opioids are 40 times more likely to become addicted to heroin.”8

And with a new population of users clamoring for stronger and easier-to-acquire drugs like heroin, drug dealers found an opportunity to profit from another, even cheaper substance called fentanyl.

Fentanyl (which is 50-100 times more powerful than morphine) and carfentanil (which is 10,000 times stronger than morphine) are synthetic opioids known to cause overdoses with comparatively small amounts.9 More often than not, users don’t even know their street-acquired painkillers or heroin are laced with these deadly substances until an overdose occurs.

It’s estimated that between 2013 and 2015 more than 9,000 deaths were caused by these lethal synthetic opioids.10 They are so strong, in fact, that first responders must be careful to avoid contact with the drugs when helping patients. And when it comes to the patients themselves, it can take several times the normal dose of the opioid antidote naloxone to save a person who is overdosing on fentanyl.

Treating the Stigma

While doctors are slowing down their opioid prescriptions, that’s not much help for the millions of Americans who are already addicted. For them, a comprehensive treatment approach is the answer.

According to the Surgeon General, “only 1 in 10 people with a substance use disorder receive any kind of specialty treatment.”11 That’s likely due to the stigma associated with drug use, which is still a huge barrier for many who need treatment. But opioid addiction is not a moral failure. It’s a medical condition. And as such, treatment should be addressed and guided by qualified healthcare professionals — without shame.

Most experts agree that the best course of recovery involves some form of medication-assisted treatment, along with other forms of therapy. As reported by the National Institute on Drug Abuse, drugs like buprenorphine and methadone can be an enormous help as patients fight cravings and kick their heroin or painkiller addiction:

“The cycle of euphoria, crash, and craving — sometimes repeated several times a day — is a hallmark of addiction and results in severe behavioral disruption. These characteristics result from heroin’s rapid onset and short duration of action in the brain. In contrast, methadone and buprenorphine have gradual onsets of action and produce stable levels of the drug in the brain. As a result, patients maintained on these medications do not experience a rush, while they also markedly reduce their desire to use opioids.”12

Drug addiction isn’t usually an isolated event. It can be caused by or lead to other mental health issues, such as depression and anxiety. Each individual’s circumstances are different and should be treated as such. That’s why a customized, integrated treatment program is such an important part of the recovery equation, according to the National Institute on Drug Abuse:

“Within a treatment program, successful clinicians can establish a positive, therapeutic relationship with their patients. The clinician should ensure that a treatment plan is developed cooperatively with the person seeking treatment, that the plan is followed, and that treatment expectations are clearly understood. Medical, psychiatric and social services should also be available.”12

While the opioid crisis is, unfortunately, nowhere near an end, it is finally getting the broad attention it deserves. And many patients are getting the help they need. Now it’s up to healthcare professionals, government officials and each of us to change the face of opioid addiction for good.


1 Hughes, Arthur, et al. Prescription Drug Use and Misuse in the United States: Results From the 2015 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, September 2016.

2 Katz, Josh. “Drug Deaths in America Are Rising Faster Than Ever.” The New York Times, June 5, 2017.

3 Achenbach, Joel, et al. “Trump Says Opioid Crisis Is a National Emergency, Pledges More Money and Attention.” The Washington Post, August 10, 2017.

4 Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. Institute of Medicine, 2011.

5 Gounder, Celine. “Who Is Responsible for the Pain Pill Epidemic?The New Yorker, November 8, 2013.

6 Promising Actions for Safer Opioid Prescribing.” Centers for Disease Control and Prevention, July 2017.

7 Cicero, Theodore, et al. “The Changing Face of Heroin Use in the United States.” JAMA Psychiatry, 2014.

8 Today’s Heroin Epidemic.” Centers for Disease Control and Prevention, July 2015.

9 Vardanyan, Ruben and Victor Hruby. “Fentanyl-Related Compounds and Derivatives.” National Library of Medicine, August 19, 2014.

10 Blau, Matt. “STAT Forecast: Opioids Could Kill Nearly 500,000 Americans in the Next Decade.” STAT, June 27, 2017.

11 Facing Addiction in America: Surgeon General’s Report on Alcohol, Drugs and Health. Office of the Surgeon General, US Department of Health and Human Services, November 2016.

12 Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).National Institute on Drug Abuse, December 2012.