Editor’s Note: A recording of the webinar in its entirety will soon be available online. Please check back for updates.
A few years ago, the Bill, Hillary & Chelsea Clinton Foundation’s Health Matters Initiative (CHMI) set an ambitious goal: to cut prescription drug abuse deaths in half, saving approximately 10,000 lives across all demographics—including college students. To help accomplish this goal, CHMI joined forces with the Jed Foundation, a leading nonprofit already working to protect the emotional health of college students. Together they formed the Jed and Clinton Health Matters Campus Program, designed to help colleges and universities assess and enhance mental health promotion and suicide and substance abuse prevention programming on campus.
As part of this effort, the Campus Program invited Andrew Kolodny, M.D., Chief Medical Officer of Phoenix House and Executive Director of Physicians for Responsible Opioid Prescribing (PROP), to conduct a webinar for administrators of its member schools. Entitled “The Prescription Opioid and Heroin Crisis: Responding to an Epidemic of Addiction,” the presentation examined why so many Americans are becoming addicted to opioids, a class of drugs made from opium and that includes heroin as well as prescription medications (such as oxycodone and hydrocodone) used to treat pain. Dr. Kolodny focused on the roots of the epidemic, how it’s affecting college students, and what schools can do about it. Here are the major takeaways.
- This is not your father’s drug crisis.While every era has its drug du jour, the drug crises of yesteryear never reached the proportions of the current opioid epidemic. To illustrate this point, Dr. Kolodny’s graph showed the number of unintentional drug overdose deaths from 1970 to 2007. The results were stark: In the 1970s, at the height of the heroin epidemic, there were about 1.5 such deaths per hundred thousand; during the cocaine craze in the late 1980s and early ’90s, that number rose to about two per hundred thousand. By 2007, it more than quadrupled to almost nine. In 2013, there were nearly 44 thousand overdose deaths, and they occurred in every region of the country. That is why the U.S. Centers for Disease Control has called this crisis the worst drug epidemic in United States history.
- Most heroin addictions begin with opioid painkillers.Prescription opioid pain relievers produce an effect on the brain that is indistinguishable from that of heroin. When young people addicted to prescription pain relievers suddenly encounter difficulty getting repeat prescriptions, they often turn to the black market, where they can get heroin relatively cheaply. The result? Four out of five heroin users today began their opioid addiction with prescription pain meds.
- A change in perception is key.One of Dr. Kolodny’s most powerful statements was that “when we talk about opioid painkillers, we’re essentially talking about heroin pills.” Unfortunately, young people don’t see it that way. While 73 percent of eighth graders say occasional heroin use without a needle is high risk, only 26 percent of them consider occasional Vicodin (hydrocodone) use high risk. Equally important, studies show that college students who perceive opioid painkillers as low risk are more likely to abuse them. So it follows that if more college students realize the risks of these meds—if they understand that they are essentially “heroin pills”—they’ll be less likely to misuse them.
- The real driver of the opioid epidemic has been prescribing—not necessarily non-medical drug use.This is another way in which today’s opioid epidemic differs from the drug crises that came before it: You can’t say that the root cause of past heroin or cocaine epidemics was that doctors prescribed them too casually. Yet that’s exactly what Dr. Kolodny said is happening with opioids today.
Non-medical use of opioids (cue the teenager rummaging through his parents’ medicine cabinet, or buying from dealers on the street) certainly happens and is a serious problem, but rates of such use actually have been declining. At the same time, rates of opioid addiction and overdose deaths are still rising. How can this be? The answer is simple: The opioid epidemic isn’t one of prescription drug abuse; it’s a crisis of opioid addiction, and the problem often starts with a doctor’s prescription. Dr. Kolodny showed in detail how pharmaceutical companies began aggressively marketing opioids as non-addictive, safe and effective for chronic pain, and easy to quit—claims that have since proved to be untrue. Yet members of the medical community still routinely prescribe these powerful meds in situations where a less addictive painkiller would do (for example, a ski injury or wisdom tooth removal) and for conditions for which opioid therapy hasn’t been proven safe or effective (like chronic pain). How routinely? In 2008, the U.S. accounted for 5 percent of the world’s population, but we consumed 80 percent of its oxycodone and 99 percent of its hydrocodone. And according to the CDC, health care providers wrote 259 million prescriptions for opioids in 2012, enough for every American adult to have a bottle of pills.
- There are often better alternatives to opioids for pain.The National Safety Council issued a report showing that a combination of over-the-counter meds—such as ibuprofen (Advil) and acetaminophen (Tylenol)—actually can be more effective for acute pain than opioids. And workers’ compensation figures show that workers prescribed opioids are far less likely to return to work than those given any other course of treatment. Opioids are a particularly poor choice for chronic pain because the risk of addiction and tolerance—needing more and more of a drug to achieve the same effect—is so high.
- Ending the epidemic requires preventing new cases of addiction, and providing treatment for those already addicted.For colleges in particular, he said, prevention efforts should focus on raising awareness on campus; improving perceived risk of prescription opioids via social marketing campaigns; and ensuring campus health providers are prescribing responsibly. On the treatment side, Dr. Kolodny advised making it a priority to improve identification of opioid-addicted students and linkage to treatment.
Dr. Kolodny also strongly advised making naloxone—the heroin overdose antidote—available in student housing and other high-risk areas.
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