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In 2018, which is the most recent data available from the National Institute of Health, 46,802 people in the United States died from a narcotic overdose. Narcotics also are known as opioids because they are derived from the opium poppy. Common opioids include morphine, fentanyl, Percocet, Norco and heroin. As concerning as the most recent mortality data is, there is a clear connection to prescription medication contributing to this escalating problem — and that is tragic.
The numbers from NIH include prescription medication and illicit drugs. Prescription drugs were involved in nearly a third of overdose deaths in 2018. For a point of reference, only 3,442 people died from prescription drug overdoses in 1999. So, what has changed to lead to such a dramatic increase in overdose deaths since 1999? In 2001, The Joint Commission that accredits hospitals made pain the fifth vital sign. This led to more people reporting pain and more people being treated for pain.
While this problem is multifaceted, one of the primary problems is simply treating pain. A study done in 2010 showed that 16.9% of men and 20.7% of women in the U.S. experience pain most days. Those percentages represent millions of people, and the more prescriptions that are written for pain, the higher the risk of addiction.
Narcotics are addictive, they activate powerful pleasure centers in your brain releasing endorphin, which is your brain's feel-good chemical signal. Endorphins create a sense of well-being while decreasing your perception of pain. Addiction is described as compulsive drug-seeking behavior despite negative consequences.
Narcotics can cause opioid-induced hyperalgesia, which is when narcotics cause increased sensitivity or aggravate preexisting pain. This only happens in some patients and research is ongoing as to why. Also, patients on narcotic pain medications become tolerant to medication the longer they take it, requiring larger and larger doses. This becomes dangerous because the side effects become more likely the higher the dose. The most concerning side effect is apnea, which is when you stop breathing, this is what causes death in the setting of using opioids. This side effect can become more common when narcotics are used in combination with certain sleeping medicine, anxiety medicine and alcohol.
If you are someone who uses narcotics to manage chronic pain it is important to know what you can do to reduce your risk of addiction. Firstly, I recommend talking to your doctor about a prescription for Narcan (naloxone), which can help reverse the effects of a narcotics overdose. Narcan is available as a nasal spray you can store at home, and quickly restores a person’s ability to breath. Secondly, consider working with your doctor to taper off of the medication you are using and explore alternative methods to manage your pain. Long-term narcotic use has other side effects that can create more problems, and if at all possible, use should be short term.
Lowering rates of addiction should be a top priority for the medical community and I am encouraged to see organizations like Centura Health taking steps to reduce the prescription use of narcotics.