Health

Why do overdose deaths increase after prescriptions are reduced?


BILLIONAmerica’s crackdown on drugs has sparked the modern opioid overdose epidemic—prescription drugs—Great success. According to data released by the American Medical Association (AMA) on September 8Opioid prescriptions have reduce in every state over the past decade, plummeting nearly 50% nationally.

However, efforts to prevent overdose deaths have been a major failure. Follow federal data. For the first time in April 2021, the number of drug overdose deaths over a 12-month period surpassed 100,000 in April 2021, with about 75% of the deaths related to opioids.

Many factors contribute to this, but the fundamental problem is that the growth of the drug market has outpaced efforts to prevent drug overdoses. “The prices of these drugs have never been cheaper. Daniel Ciccarone, professor of research on the opioid crisis at the University of California-San Francisco, said the potency of these drugs has never been higher.

According to Ciccarone, if prescription drugs were the first wave of the opioid epidemic, the second wave began in the late 2000s amid growing awareness of the risks posed by opioids. As states and the federal government roll out programs like prescription tracking, healthcare workers quickly reduced the number of opioid prescriptions they issued to protect their patients — and their medical licenses. However, this rapid reversal means that many patients are suddenly cut off from prescription opioids. Nabarun Dasgupta, who studies opioid overdose and substance use disorders at the Gillings School of Global Public Health at the University of North Carolina.

Many people continue to be left behind, he said: “There are many abandoned people who are on pain medication, who no longer have access to adequate pain management measures, and, therefore, increasingly have to go back to the street. We hear those stories every day.”

In the late 2010s, however, the United States appeared to have reached a turning point: the number of drug overdose deaths appeared to be leveling off nationally, even falling in states such as such Minnesota, Rhode Islandand Massachusetts, after active containment efforts. Thomas Stopka, associate professor of public health, said a host of new programs have been expanded, including public education, expanding access to opioid use disorder drugs, such as buprenorphine, and naloxone delivery programs, can lead to a reduction in deaths. and community medicine at Tufts University School of Medicine. The decline can also be due to the rise and fall of carfentanil—An opiate substance stronger than fentanyl— in the late 2000s, says Ciccarone.

Through this period, the illicit drug market continued to shift. First, the emergence of the synthetic opioid fentanyl, which in its legal form is often used for pain relief during and after surgery, but on the illicit market is prized because it is cheap to produce, easy to carry, and is easily portable. and results in it being stronger (but shorter lasting) than heroin. According to Dasgupta, the drug industry has also become more fractured following crackdowns on poppy cultivation and fentanyl production, with much of the production moving to Mexico, where many “manufacturers” Small producers are less concerned with quality control and are trying to produce a little faster. “

Fentanyl and its analogues (chemically similar drugs), which first appeared on the East Coast and gradually moved to the West, also play an important role in the increase in mortality. . The potency of different variants can vary considerably, which makes it difficult for drug users to adjust their dosage. This becomes even more of a threat when substances are mixed together.

Drug supply and drug use also become more risky. Fentanyl is increasingly used alongside stimulants such as methamphetamine and cocaine. At the time the substances were sold, they were often combined with other drugs. Many experts, including Ciccarone, say it’s unclear whether this was intentional. The result, however, is that many drug users, and even drug dealers, have no idea what’s in the drugs they buy. This is especially dangerous because it means users cannot tailor how much they consume to their individual opioid tolerance. People who don’t use opioids regularly and haven’t developed a tolerance can also unknowingly use them. In addition, in addition to fentanyl and its analogues, the drug may contain a variety of other chemicals, including xylazine animal tranquilizer and new psychostimulants like opioids nitazine.

COVID-19 pandemic make the situation even worse. Some experts argue that the drug supply has gotten even worse over the past few years, as drug distributors favor stronger substances by volume. The pandemic also cut off many people from their social, occupational, and normal life safety nets, exacerbating mental and sensory health problems that lead to substance use disorders. “Humans get hurt,” Ciccarone said. “We are isolated, we are scared. Our social network is damaged, our safety net is damaged. And that only leads to more deaths.”

Going forward, the AMA and drug use experts say the key will be to remove barriers that prevent people from accessing substance use disorder treatments, including medication. to treat opiate use disorders such as buprenorphine. It will also be important to expand access to life-saving tools, including drugs that reverse overdose. naloxone (also known as Narcan)exchange syringes, and fentanyl test strips.

Saving lives will require a huge investment of both financial resources and public attention, says Ciccarone. Although overdose deaths will rise and fall, the factors that drive many people to use drugs – trauma and suffering – will not go away, he said. “No magic bullets,” he said. “You need to pay attention to drug consumption in America in a bold, steady way, according to the Marshall Plan.”

Other must-read stories from TIME


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Other must-read stories from TIME


Contact us in letter@time.com.



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