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Dec 6, 2023

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1 Causes of the Opioid Epidemic Marquel Hayes Department of Public Health, Anne Arundel Community College PBH-202-200: Emerging Public Health Issues Michael D. Sawdey, PhD, MPH April 11, 2021

2 Causes of the Opioid Epidemic The heroin and prescription opioid epidemic is “the misuse and addiction to opioids— including prescription pain relievers, heroin, and synthetic opioids such as fentanyl” (National Institute on Drug Abuse, 2021). According to Centers for Disease Control and Prevention (2021b), approximately 500,000 people died from an opioid-related overdose during the years of 1999-2019 in the United States. In 2019, 10.1 million people misused prescription opioids, 2 million people used methamphetamine, 745,000 people used heroin, and 1.6 million people had an opioid use disorder (Assistant Secretary of Public Affairs, 2021). The opioid epidemic originated in the late 1990s when pharmaceutical companies introduced pain-relieving opioids to the medical community, promising non-addictive prescription opioids (Assistant Secretary of Public Affairs, 2021). Consequently, healthcare workers were providing patients with opioids at greater rates which led to its misuse. The opioid epidemic is a substantial public health crisis that continues to plague the nation each year. The total estimated economic burden of the opioid epidemic in the United States is $78.5 billion per year (National Institute on Drug Abuse, 2021). The economic burden encompasses healthcare costs, lost productivity, treatment, and law enforcement. Moreover, the opioid epidemic can affect childbirth and the spread of disease. Opioid misuse among pregnant women impacts the health of their child by causing neonatal abstinence syndrome (NAS)—"a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth” (CDC, 2020). Additionally, opioid use increased the spread of infectious diseases such as HIV and hepatitis C due to the sharing of needles. HIV/AIDS is another public health crisis with fatal outcomes (National Institute on Drug Abuse, 2021). Social determinants of health are the “conditions in the places where people live, learn, work, and pay that affect a wide range of health and quality-of life-risks and outcomes” (CDC, 2021a). Individuals experiencing economic instability are at increased risk for opioid misuse such as unemployment, low income, and debt. Studies have found that unemployment and sparse economic opportunities can lead to opioid addiction. Losing a job has physical and

3 psychological effects such as the loss of health insurance and feelings of despair and loneliness. The article “The True Cause of the Opioid Epidemic” highlights that “Americans are dying ‘deaths of despair’—that the reason the life expectancies of poor Americans are stagnating, or declining is that their dwindling economic opportunities spur them toward drugs, alcohol, and suicide” (Khazan, 2020). Further, those with limited access to education and adequate health care facilities are at increased risk as well. Proper education about opioids along with medical guidance and proper rationing could minimize the likelihood of opioid misuse and addiction. Specific areas in the United States that are more directly impacted by the opioid epidemic than others are those that are low income and often rural. A major reason these areas are significantly affected is because prescription opioids are heavily circulated in these areas along with minimal economic opportunities, access to proper education and healthcare services. The United States Department of Health and Human Services states that Medicaid recipients are more likely to be given prescription opioids at higher doses for longer periods of time (Volkow, 2020). Yet, they are less likely to have access to proper addiction treatment. Medicaid stipulations vary from state to state; however, it mainly includes healthcare coverage for low income families, the elderly, and those with disabilities (Centers for Medicare & Medicaid, n.d.).

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