The American opioid epidemic is one of the most critical public health issues affecting the nation. In August 2017, President Donald Trump was on the verge of declaring a national emergency for the epidemic. According to data from the U.S. Department of Health & Human Services, approximately 12.5 million Americans misused prescription opioids in 2015, leading to the deaths of over 31,000 people – about 85 deaths daily. To put the figure into perspective, in the forty year period between 1975 and 2015, a total of 3,432 people were killed by foreign and domestic terrorists on U.S. soil.
More alarmingly, a joint-study released by researchers from the University of Michigan and Dartmouth-Hitchcock Medical Center revealed that patients suffering from mental health disorders received 51.4% of the 115 million opioid prescriptions distributed across the country annually, despite comprising only 16 % of the adult population. Equally troubling is the fact that 18.7% of patients with mental illness – nearly one in five - received opioid prescriptions compared to just 5% for the average American. In other words, people with mental health disorders are almost four times as likely to use opioids.
What are opioids and what are they used for?
Opioids, such as hydrocodone, oxycodone, codeine and morphine, are a class of synthetic drugs derived from opium, which is a substance found inside the seed pods of the poppy plant. When consumed, opioids interact with the brain (or more specifically, with protein receptors in the central nervous system) to quickly relieve pain. Aside from pain management, opioids are also used to treat a number of other ailments such as cough, constipation and diarrhea. Opioids are legally available by prescription and are distributed in the form of capsules, tablets and liquids. Presently, the most popular opioid brands are OxyContin, Vicodin and Percocet.
Why are people with mental disorders vulnerable to opioids?
Opioids are the drug of choice to treat people suffering from acute or chronic pain caused by injuries and diseases and illnesses. Owing to the high risk of abuse, medical professionals tend to use extreme caution when prescribing opioids for patients suffering from chronic pain, especially since these drugs impair reflexes and judgement. Fortunately for employers, opiates will show up on a standard drug test, which helps to identify illicit users, however, if a user has a legitimate prescription, by law, the employer cannot be informed due to HIPAA regulations. In other words, drug testing will only identify illegal users of the drug.
The issue becomes significantly more complex when it comes to patients with mental health disorders. Studies have shown that depression, anxiety and other forms of mental illness cause people to experience higher rates of chronic pain, although some have argued that a significant number of the symptoms are psychosomatic.
In addition, since pain measurements are entirely subjective, people with psychiatric disorders tend to report higher levels of pain. This combination of factors will naturally influence doctors when writing prescriptions for their patients. Patients with disorders that affect their habits are also at a higher risk to overdose. For example, a patient diagnosed as having a compulsive disorder may compulsively self medicate and take more opioids than what they were prescribed. This can lead to an overdose that may result in death if the disorder is not identified and treated early enough in a different manner.
Alternatives to opioids
In recent years, there have been growing calls for patients with mental disorders to seek alternative treatments to manage their chronic pain. Treatments such as cognitive behavioral therapy, acupuncture, physical therapy and meditation present no risk of addiction or overdosing. These alternative treatments will also give patients an opportunity to understand the underlying reason for their chronic pain which may eventually lead to lifestyle changes and better long term outcomes.
Activities such as yoga have also grown in popularity for those suffering from mental illness. The act of breathing and stretching is widely recognized as a way to quiet the mind. Yoga comes with an added benefit and that is it can be practiced pretty much anywhere. Adding to that, it is cost effective too. Once someone knows the postures they are able to perform them on their own.
Alternative treatments for patients diagnosed with mental illness are a necessity. Prescribing opioids needs to be greatly reduced in order to reduce the vast number of overdoses plaguing the US. Activities that quiet the mind can do just that but there needs to be support from the medical community so that patients are able to learn what the alternatives are because after all if a patient doesn’t know what alternatives exist, they will forever be tied to the pharmaceutical treatment which in this case can lead to overdose and death.