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The Opioid Crisis has been termed the worst drug epidemic in the history of the U.S. (Hagan & Daigle, 2020). This column discusses the prevalence of opioid misuse, including the costs associated with the epidemic, as well as the origins of the issue.

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This column will focus on current reform measures being implemented across the U.S and in West Virginia. Harm reduction strategies are now being employed across the nation in order to reduce overdose deaths and provide treatment without stigmatizing those who misuse opioids.

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Deaths related to the opioid epidemic can be divided into three waves, as illustrated by this graph. The first began in the 1990s, as deaths related to prescribed opioids began to rise. Overdose deaths involving heroin sharply increased in 2010, establishing the second wave. The third, beginning in 2013, consisted of overdose deaths involving synthetic opioids, particularly fentanyl (Centers for Disease Control and Prevention, 2021).

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Harm reduction refers to the strategy of acknowledging that drug use occurs rather than ignoring it or criminalizing it in order to reduce the harmful effects to both the individual and public health as a whole. According to the Minnesota Department of Health (n.d.), it involves transitioning from "safer use, to managed use, [and] to abstinence," as well as meeting the patient "where they're at." This method would fall under the approach of labeling theory; by not stigmatizing drug use, individuals may be more likely to receive treatment.

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Harm reduction is a recognized public health model that has been used since the early 1980s to reduce the harms of active drug use, including reducing the spread of infectious disease.

Harm reduction accepts that licit and illicit drug use is part of our world and chooses to minimize the harmful effects rather than ignore, condemn, or criminalize them. Some of the principles of harm reduction include:

Providing a spectrum of strategies from safer use, to managed use, to abstinence.

Addressing the conditions of use.

Approaching with a non-judgmental, non-coercive provision of services and resources.

Including the voice and insight of people that use or have used drugs in the creation of programs and policies.

The biggest misconception is that harm reduction denies that drugs are harmful or even that harm reduction promotes drug use. In fact, harm reduction addresses and mitigates the harms to themselves and others. Another misconception is that harm reduction encourages use. Rather, harm reduction recognizes that when licit and/or illicit drug use is happening, there are effective strategies to make use less harmful.

Harm reduction applies to anyone along the spectrum:

Some people use experimentally

Some people use occasionally

Some people use regularly

Some people use chaotically

Harm reduction asks care providers to meet everyone where they're at. In order to do this, it is important to know why and how drug use started or why someone is considering using. The reasons are unique to each person, and change over time.

It's what's known

Pleasure, entertainment, or sense of wellbeing

Pills from a doctor aren't working anymore

It's cheaper than other kinds of care

Escape, coping, or numbing

Distance from emotions or feelings of unworthiness

Soften the pain of another trouble

Self-medicating for anxiety, depression, or trauma

To stay awake all night, or squelch hunger or cold

Considerations about how to implement a harm reduction approach in a clinical setting are complex. Some settings think of harm reduction as any positive movement towards sobriety. Other settings think of harm reduction as any positive movement, even if sobriety is not the current goal. Other settings think of harm reduction as anything to reduce risk in that moment, regardless of what happens in the next moment. These theoretical differences can be difficult to operationalize in programmatic standards.

Please visit the Opioid Dashboard for more information on opioid overdose death, nonfatal overdose, use, misuse, substance use disorder, prescribing practices, supply, diversion, harm reduction, co-occurring conditions, and social determinants of health.

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Harm reduction is a recognized public health model that has been used since the early 1980s to reduce the harms of active drug use, including reducing the spread of infectious disease. Harm reduction accepts that licit and illicit drug use is part of our world and chooses to minimize the harmful effects rather than ignore, condemn, or criminalize them.

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As stated, wave 1 deaths were the result of prescribed opioids. Increasing amounts of prescriptions and increased demand for pain management contributed to wave 1 fatalities.

Heroin was responsible for deaths during wave 2. Previous prescription opioid abusers reported transitioning to heroin due to its low cost and availability. Additionally, the opioid OxyContin was reformulated to deter abuse in 2010, which may have contributed to increased heroin use.

Wave 3 saw deaths related to fentanyl use. The deaths have been largely located in the Midwest and Northeast, and they appear to be a supply-side event rather than a culturally-driven demand (Ciccarone, 2019).

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The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis

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Number of overdose deaths involving opioids in West Virginia, by opioid category.

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West Virginia has experienced the brunt of the opioid epidemic. In 2015, the state had the highest number of opioid-related overdose deaths in the nation. This infographic from NIDA (2020) illustrates the rise in overdose deaths, as well as the rise of deaths attributed to synthetic opioids like fentanyl. The decline in mental health, abundance of labor-intensive jobs, like coal-mining, and overprescribing of opioids contributed to West Virginia's opioid crisis (Bowden et al., 2018).

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Prior to the 1980s, pain was rarely treated with opioids. Often, pain would go under-treated, and campaigns began to rally for increased access to pain management drugs. New standards for pain management lifted limits on physician prescriptions. Additionally, two studies emphasized that opioids are non-addictive, despite providing no scientific evidence. The developing culture surrounding increased pain management created the perfect environment for Purdue Pharma to release OxyContin.

Purdue Pharma widely promoted the use of OxyContin to lawmakers and physicians, claiming it was highly effective with little chance of patient addiction. As prescriptions skyrocketed, so too did opioid misuse. Purdue Pharma later admitted to knowing the drug was highly addictive, and they paid the price in a 2007 lawsuit in which they were fined over $600 million (DeWeerdt, 2019).

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In 2015, something happened in the United States that hadn't occurred there in the past 100 years: life expectancy entered a period of sustained decline. According to the World Bank Group, the country's average life expectancy fell from 78.8 years in 2014 to 78.7 years in 2015, and then to 78.5 years in 2016 and 2017.

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doi: https://doi.org/10.1038/d41586-019-02686-2
This article is part of Nature Outlook: Opioids, an editorially independent supplement produced with the financial support of third parties. About this content.

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Tracing the US opioid crisis to its roots

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Understanding how the opioid epidemic arose in the United States could help to predict how it might spread to other countries. Understanding how the opioid epidemic arose in the United States could help to predict how it might spread to other countries.

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The Sackler family, owners of Purdue Pharma, have faced thousands of lawsuits as a result of their involvement in the opioid crisis. The family recently agreed to pay $6 billion towards communities negatively impacted by the epidemic (U.S.News, 2022).

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THURSDAY, March 3, 2022 (HealthDay News) -- A deal has been reached between members of the Sackler family and their company, Purdue Pharma, to settle thousands of lawsuits over their role in the U.S. opioid epidemic.

In return for an end to all current and future civil claims against them over the company's prescription opioid business, the Sacklers will pay as much as $6 billion to assist communities harmed by the opioid crisis, according to a court filing on Thursday, the New York Times reported.

However, that liability protection does not extend to criminal prosecutions linked to the marketing of Purdue's prescription opioid painkiller OxyContin.

The settlement has to be approved by Judge Robert Drain, who has presided over the company's bankruptcy proceedings, and the U.S. Court of Appeals for the Second Circuit would have to approve, reversing a December ruling that rejected an earlier settlement deal for $4.55 billion. A federal judge had vacated that plan, questioning the legality of the protections from liability granted to the Sacklers, the Times reported.

Also, the immunity shield for the Sacklers from civil suits is being challenged by the U.S. Trustee program, which serves as a watchdog over the bankruptcy system.

"This settlement is both significant and insufficient -- constrained by the inadequacies of our federal bankruptcy code," said Connecticut Attorney General William Tong, who helped lead the effort to get the new deal, the Times reported.

"But Connecticut cannot stall this process indefinitely as victims and our sister states await a resolution. This settlement resolves our claims against Purdue and the Sacklers, but we are not done fighting for justice against the addiction industry and against our broken bankruptcy code," Tong added.

Purdue pleaded guilty to criminal charges of misleading marketing and minimizing OxyContin's risk of addiction, but no individual Sackler has ever apologized or admitted wrongdoing, the Times reported.

"While the families have acted lawfully in all respects, they sincerely regret that OxyContin, a prescription medicine that continues to help people suffering from chronic pain, unexpectedly became part of an opioid crisis that has brought grief and loss to far too many families and communities," read a statement from two branches of the Sacklers, the Times reported.

Negotiations over the new settlement were mediated by Judge Shelley Chapman of U.S. federal bankruptcy court, who is recommending a hearing where people who suffered from addiction to OxyContin could describe the harm they suffered. At least one Sackler family member from each of two branches would have to attend.

Chapman also said if any medical centers and art or educational institutions bearing the Sackler name ask to have it removed, the Sacklers must agree.

"This bankruptcy needs to end. And the Justice Department needs to flex their muscle and investigate the Sacklers criminally, which is permissible under the bankruptcy plan," Ryan Hampton, who monitored the settlement proceedings on behalf of victims, told the Times.

Copyright © 2022 HealthDay. All rights reserved.

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Sackler Family & Purdue Pharma Reach Deal With U.S. States Over Opioid Crisis

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THURSDAY, March 3, 2022 (HealthDay News) -- A deal has been reached between members of the Sackler family and their company, Purdue Pharma, to settle thousands of lawsuits over their role in the U.S. opioid epidemic.

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The opioid epidemic is a significant financial burden. The CDC estimates the total cost of opioid misuse is $78.5 billion every year in the U.S. These costs are associated with the healthcare and criminal justice systems.

Beyond economic costs, such a serious drug crisis has other consequences. Opioids have torn apart communities, and such an interaction can produce negative mental health effects. Opioid addiction is not just an individual problem, but one that affects families, communities, and the nation as a whole. (NIDA, 2021).

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The National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention collects information on deaths involving drugs commonly associated with fatal overdose. This information is available in a searchable database called CDC Wonder. The NCHS also provides 12-month-ending Provisional Drug Overdose Death Counts by state and drug category.

The CDC also provides timely data related to unintentional and undetermined intent drug overdose deaths by participating jurisdiction through the State Unintentional Drug Overdose Reporting System (SUDORS). Similar data related to nonfatal drug overdoses are reported through CDC's Drug Overdose Surveillance and Epidemiology (DOSE) system.

See the latest from NIDA on drug overdose research.

Figure 1. National Drug-Involved Overdose Deaths-Number Among All Ages, by Gender, 1999-2021. More than 106,000 persons in the U.S. died from drug-involved overdose in 2021, including illicit drugs and prescription opioids. The figure above is a bar and line graph showing the total number of U.S. drug overdose deaths involving select illicit or prescription drugs from 1999 to 2021. The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2021 (Source: CDC WONDER).

Figure 2. National Drug-Involved Overdose Deaths by Specific Category-Number Among All Ages, 1999-2021. Overall, drug overdose deaths rose from 2019 to 2021 with more than 106,000 drug overdose deaths reported in 2021. Deaths involving synthetic opioids other than methadone (primarily fentanyl) continued to rise with 70,601 overdose deaths reported in 2021. Those involving stimulants, including cocaine or psychostimulants with abuse potential (primarily methamphetamine), also continued to increase with 32,537 overdose deaths in 2021 (Source: CDC WONDER).

Figure 3. National Overdose Deaths Involving Any Opioid-Number Among All Ages, by Gender, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving any opioid from 1999 to 2021. Any opioid includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin, and synthetic opioids other than methadone (primarily fentanyl). Opioid-involved overdose deaths rose from 21,089 in 2010 to 47,600 in 2017 and remained steady through 2019. This was followed by a significant increase in 2020 with 68,630 reported deaths and again in 2021 with 80,411 reported overdose deaths. The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2021 (Source: CDC WONDER).

Figure 4. National Overdose Deaths Involving Prescription Opioids, by other Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving prescription opioids (including natural and semi-synthetic opioids and methadone) from 1999 to 2021. Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139. This was followed by a slight increase in 2020, with 16,416 reported deaths. In 2021, the number of reported deaths involving prescription opioids totaled 16,706. The bars are overlaid by a line showing the number of deaths involving prescription opioids in combination with synthetic opioids other than methadone (primarily fentanyl) from 1999 to 2021 (Source: CDC WONDER).

Figure 5. National Overdose Deaths Involving Heroin, by Other Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving heroin from 1999 to 2021. Drug overdose deaths involving heroin rose from 1,960 in 1999 to 15,482 in 2017 before trending down to 13,165 deaths in 2020 and 9,173 deaths in 2021. The bars are overlaid by lines showing the number of deaths involving heroin in combination with synthetic opioids other than methadone (primarily fentanyl) or without any other opioid from 1999 to 2021 (Source: CDC WONDER).

Figure 6. National Overdose Deaths Involving Stimulants (cocaine and psychostimulants), by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving stimulants from 1999 to 2021. Drug overdose deaths rose from 12,122 in 2015 to 53,495 in 2021. The bars are overlaid by lines showing the number of deaths involving stimulants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths involving stimulants has increased steadily since 2014 regardless of opioid involvement (Source: CDC WONDER).

Figure 7. National Overdose Deaths Involving Psychostimulants With Abuse Potential (Primarily Methamphetamine), by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving psychostimulants with abuse potential from 1999 to 2021. Drug overdose deaths involving psychostimulants with abuse potential rose from 547 in 1999 to 23,837 in 2020 and continued to increase to 32,537 deaths in 2021. The bars are overlaid by lines showing the number of deaths involving psychostimulants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths involving psychostimulants has increased steadily since 2014 regardless of opioid involvement (Source: CDC WONDER).

Figure 8. National Drug Overdose Deaths Involving Cocaine, by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving cocaine from 1999 to 2021. Drug overdose deaths involving cocaine rose steadily from 6,784 in 2015 to 15,883 in 2019. From 2019 to 2021, cocaine-involved deaths rose nearly 54% to 24,486 deaths. The bars are overlaid by lines showing the number of deaths involving cocaine in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths in combination with synthetic opioids other than methadone has increased significantly since 2015 and is the main driver of cocaine-involved overdose deaths (Source: CDC WONDER).

Figure 9. National Drug Overdose Deaths Involving Benzodiazepines, by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving benzodiazepines from 1999 to 2021. Drug overdose deaths involving benzodiazepines steadily increased from 1,135 in 1999 to 11,537 in 2017 and declined to 9,711 in 2019. Between 2019 and 2021, deaths rose again to 12,499. The bars are overlaid by lines showing the number of deaths involving benzodiazepines in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid (Source: CDC WONDER).

Figure 10. National Drug Overdose Deaths Involving Antidepressants, by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving antidepressants from 1999 to 2021. Drug overdose deaths involving antidepressants rose steadily from 1,749 in 1999 to 5,269 in 2017. Since then, deaths have slightly risen with 5,859 in 2021. The bars are overlaid by lines showing the number of deaths involving antidepressants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid involvement (Source: CDC WONDER).

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Description of Figures

The figures above are bar charts showing the number of U.S. overdose deaths involving select illicit or prescription drugs from 1999 through 2021. The bars are overlaid by lines representing gender or concurrent opioid involvement. Please note the y-axis scale varies by bar chart and caution should be applied when comparing graphs side-by-side.

There were 106,699 drug-involved overdose deaths reported in the U.S. in 2021 (Figure 1); 69% of cases occurred among males (yellow line). Synthetic opioids other than methadone (primarily fentanyl) were the main driver of drug overdose deaths with a nearly 7.5-fold increase from 2015 to 2021 (Figure 2).

Drug overdose deaths involving any opioid―prescription opioids (including natural and semi-synthetic opioids and methadone), other synthetic opioids other than methadone (primarily fentanyl), and heroin―continued to rise through 2021 with 80,411 deaths. More than 70% of deaths occurred among males (Figure 3). From 2020 to 2021, the number of deaths involving prescription opioids remained steady (Figure 4).

Overdose deaths involving heroin have trended down since 2016 with 9,173 deaths reported in 2021 (Figure 5). Nearly 75% of overdose deaths in 2021 involving heroin also involved synthetic opioids other than methadone (primarily fentanyl).

Drug overdose deaths involving stimulants, cocaine, or psychostimulants with abuse potential (primarily methamphetamine) have significantly increased since 2015 from 12,122 to 53,495 in 2021 (Figure 6).

Since 2015, the number of deaths involving psychostimulants with abuse potential (primarily methamphetamine) has risen significantly each year-with 32,537 deaths in 2021 (Figure 7). The number of deaths involving cocaine has also increased steadily since 2015 with 24,486 deaths reported in 2021 (Figure 8).

The final two charts show the number of overdose deaths involving benzodiazepines (Figure 8) or antidepressants (Figure 9). Benzodiazepines were involved in 12,499 deaths in 2021-steadily increasing since 2015. The proportion of deaths involving synthetic opioids other than methadone (primarily fentanyl) has increased significantly since 2015. Of the 8,791 deaths involving benzodiazepines in 2015, 20% also involved fentanyl. In 2021, this proportion increased to 70% of all deaths involving benzodiazepines. Antidepressant-involved deaths have also risen steadily, driven by fentanyl, with 5,859 deaths reported in 2021.

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Drug Overdose Death Rates | National Institute on Drug Abuse

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The National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention collects information on deaths involving drugs commonly associated with fatal overdose. This information is available in a searchable database called CDC Wonder. The NCHS also provides 12-month-ending Provisional Drug Overdose Death Counts by state and drug category.

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This column discusses the interaction between opioid misuse and the criminal justice system.

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According to Hagan and Daigle (2020), crime associated with addiction is largely due to illegal means of obtaining money to afford expensive illicit drugs. Two perspectives on the connection between drug use and crime are the psychopharmacological and systemic effects. The former states that drugs alter the body in ways that encourage criminal activity, while the latter postulates that crime results from a lack of formal resolutions to solve disputes.

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The West Virginia House of Delegates passed HB 2184 in January of this year, which harshens penalties for exposing emergency responders and government representatives to fentanyl. Fentanyl or "other harmful drug" exposure would result in a misdemeanor and fine of $500, while exposure that causes "physical harm" would result in a felony charge, up to five years in jail, and a fine of $2,000. Proponents of the bill argue that it will protect first responders; however, opponents state the bill will be difficult to implement and could create more harm than good. The bill will now go to the Senate.

According to Dr. Robin Pollini, a West Virginia University School of Medicine associate professor, passive fentanyl exposure cannot result in toxicity. Further, a 2018 study found that skin absorption of the drug is highly unlikely to result in toxicity (Coyne, 2022).

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West Virginia House of Delegates OKs Penalties for Exposing Responders to Fentanyl

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Members of the West Virginia House of Delegates passed a bill Monday providing additional penalties for people charged with exposing police or other emergency responders to fentanyl. House Bill 2184, increasing the penalties for exposure of governmental representatives to fentanyl or an…

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Bills like HB 2184 ignore both current medical knowledge of opioid exposure and our understanding of addiction. Not only is medical misinformation placed into policy, but those suffering from overdoses are treated with a stigma of criminality, which is associated with ideas behind labeling theory.

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Research has indicated that individuals who use opioids are much more likely to be arrested compared to those who do not. For those suffering from the effects of opioids, opioid agonist treatment is often used. However, a 2014 study found that only 6 percent of criminal justice cases involving individuals who abuse opioids received opioid agonist treatment. Furthermore, only 15 percent of counties across the U.S. are equipped with licensed opioid treatment programs that provide methadone, an agonist drug (Galoustian, 2022).

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Only a fraction of justice-involved individuals received opioid agonist treatment for opioid use disorder even though its effectiveness is well-established.

About 4 million people who reported use or misuse of prescription opioids or heroin in 2014 also reported having a concurrent arrest or active probation or parole status. Individuals who report opioid use are significantly more likely to have been arrested compared to those who do not use opioids.

Opioid agonist treatment, which includes federally approved medications such as methadone, buprenorphine and naltrexone, reduce withdrawal symptoms, cravings, block the effects of opioid use and reduce the risk of death by 33 percent. Yet, this treatment among justice-involved individuals is relatively rare.

Researchers from Florida Atlantic University's College of Social Work and Criminal Justice and collaborators conducted a study on the differences between criminal justice-involved individuals who received opioid agonist treatment as part of their treatment plan and those who did not. They compared demographics, substance use severity, and access to treatment and identified predictors of treatment to account for disparities within a criminal justice population in the United States.

The nationally representative database they used comprised of 105,988 admissions referred to treatment by the criminal justice system who reported heroin or other opiate as their primary, secondary, or tertiary substance used.

Results of the study, published in the journal Substance Use & Misuse, showed that fewer than 6 percent of criminal justice cases received opioid agonist treatment as part of the treatment plan. Those with daily substance use, comorbid psychiatric problems, prior treatment, females, Latinos, and those who were older and those who were living independently were more likely to receive this treatment, as were those living in the Northeast and with government health insurance.

"The criminal justice system is well-positioned to facilitate an individual's engagement in effective care at several intervention points including contact with first responders, case adjudication, sentencing, supervision and reentry," said Wendy P. Guastaferro, Ph.D., senior author, director and professor, FAU School of Criminology and Criminal Justice. "We know that opioid agonist treatment is related to better outcomes for justice-involved individuals, including reduced opioid use, reduced overdose deaths, improved treatment engagement, reduced criminal behavior, and lower crime costs. However, only a fraction of justice-involved individuals receive this treatment even though its effectiveness is well-established."

Among the study findings:

The majority of the sample were poly-drug users who reported heroin as a drug of choice and had previously received substance use treatment. Yet, opioid agonist treatment was not part of the treatment plan for the overwhelming majority of these cases (95 percent).

In 2014, more than 100,000 criminal justice system cases had an opioid use disorder diagnosis, but 15 states did not have a certified opioid treatment program.

Only 15 percent of U.S. counties were reported to have licensed opioid treatment programs that dispense methadone and nearly half of all U.S. counties do not have a physician approved to prescribe or dispense buprenorphine.

The opioid agonist treatment group included more individuals who were covered by government-issued insurance or did not have any insurance compared to those with private insurance.

Older individuals had significantly greater odds of receiving treatment compared to young adults. These findings lend some support to the notion that treatment is reserved for those who are more likely to be successful or are considered more "deserving" of treatment as age often is associated with reduction of criminal behavior.

For women, 5 percent of those who received treatment in their treatment plan were pregnant at the time of admission compared to 1.5 percent of those who did not have opioid agonist treatment in their treatment plan.

Even in states where opioid agonist treatment is available, criminal justice system-referred cases in the West and Midwest regions of the U.S. were markedly less likely to receive opioid agonist treatment than their counterparts in the Northeast.

Latinos were statistically more likely to receive opioid agonist treatment as part of their treatment plan.

Nearly 26 percent of the study sample were flagged for alcohol use at intake, but were less likely to be in an opioid agonist treatment program.

Although largely framed as a problem that affects white individuals, opioid use has had significant and growing impact on nonwhite communities as well. Between 2010 and 2018, opioid overdose deaths increased 355 percent among black individuals and 218 percent for Hispanic individuals.

"Dismantling barriers to treatment can improve both public health and community safety," said Guastaferro. "The criminal justice system must reduce regulatory burdens and systemic resistance to opioid agonist treatment while increasing funding for access to treatment to effectively serve those struggling with opioid use disorder."

Other study co-authors are Deborah Koetzle, Ph.D., professor, John Jay College of Criminal Justice, the City University of New York; Laura Lutgen-Nieves, Ph.D., assistant professor, Department of Criminal Justice, University of Southern Indiana; and Brent Teasdale, Ph.D., professor and chair, Department of Criminal Justice Sciences, Illinois State University.

-FAU-

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Under 6 Percent of Criminal Justice Cases Get Treatment for Opioid Use

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Only a fraction of justice-involved individuals received opioid agonist treatment for opioid use disorder even though its effectiveness is well-established. About 4 million people who reported use or misuse of prescription opioids or heroin in 2014 also reported having a concurrent arrest or active probation or parole status.

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Those incarcerated with opioid use disorders rarely receive treatment, and they frequently resume opioid use following release. Within the first two weeks of release, risk of death is 12 times higher due to overdose. Additionally, research has shown that untreated opioid use disorders are associated with returns to criminal activity and reincarceration (NIDA, 2021).

These statistics illustrate the importance of providing treatment for opioid use disorder within the criminal justice system. Many states do not provide inmates with access to medications targeted toward treating opioid use disorder, despite the evidence supporting their use (NIDA, 2021).

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Opioid use disorders are highly prevalent among criminal justice populations. According to data from the U.S. Department of Justice, approximately half of state and federal prisoners meet criteria for substance use disorder. Even so, there has been reticence in criminal justice settings to using methadone, buprenorphine, and naltrexone to treat opioid use disorder. In national surveys, utilization of these medications is very low in criminal justice settings, including drug courts, jails, and prisons. Thus, opioid use disorder goes largely untreated during periods of incarceration, and opioid use often resumes after release.

A former inmate's risk of death within the first 2 weeks of release is more than 12 times that of other individuals, with the leading cause of death being a fatal overdose. Overdoses are more common when a person relapses to drug use after a period of abstinence due to loss of tolerance to the drug. One study found a reduction in post-incarceration deaths from overdose among individuals who had received medication for opioid use disorder in correctional facilities. Untreated opioid use disorders also contribute to a return to criminal activity, reincarceration, and risky behavior contributing to the spread of HIV and hepatitis B and C infections (see " What is the impact of medication for opioid use disorder treatment on HIV/HCV outcomes?").

The World Health Organization's Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence recommends that incarcerated individuals should receive adequate healthcare and that opioid withdrawal, agonist maintenance and naltrexone treatment should all be available in prison settings, and prisoners should not be forced to accept any particular treatment."

Many states currently do not offer appropriate access to or utilize medications to treat opioid use disorder among arrestees or inmates even though research has shown many benefits of incorporating medication-assisted treatment into criminal justice treatment programs. Inmates who receive buprenorphine treatment prior to release are more likely to engage in treatment after their release than inmates who only participate in counseling. Participants who engage in methadone treatment and counseling in prison are more likely to enter community-based methadone treatment centers after their release (68.6 percent) than those receiving only counseling (7.8 percent) or those in counseling and referred to a treatment center (50 percent).

In one study, inmates who began buprenorphine treatment while incarcerated engaged in post-release treatment sooner, averaging 3.9 days after release, compared to 9.2 days for participants referred to treatment post-release. They were also likely to stay in treatment longer if they were initiated in treatment prior to release (20.3 weeks on average) than if they began treatment after their release (13.2 weeks).

Inmates who participate in methadone treatment and counseling while in prison are less likely to test positive for illicit opioids at one month following their release (27.6 percent) compared to those who only receive counseling (62.9 percent) and those who receive counseling and a referral to a treatment center (41 percent).

A randomized controlled trial was published in 2016, comparing prison-initiated extended-release naltrexone (XR-NTX) treatment to standard counseling protocols for prevention of opioid relapse. During the treatment phase, relapse was significantly lower in the group receiving XR-NTX (43 percent vs. 64 percent). The XR-NTX group also experienced no overdose events, while there were seven overdose events in the control group.

A survey of community correction agents' views on using medications to treat opioid use disorder showed that more favorable attitudes toward medication use are associated with greater knowledge about the evidence base for these medications and greater understanding of opioid use disorder as a medical disorder. Organizational linkage between correctional stakeholders and community treatment providers, along with training sessions, can be an effective way to change perceptions and increase knowledge about the efficacy of these medications, and can increase the intent within correctional facilities to refer individuals with opioid use disorder to treatment that incorporates medications.

A mechanism to reduce recidivism and divert nonviolent offenders from traditional jail and prison settings is the drug treatment court model, which provides treatment services in combination with judicial supervision. Still, resistance to medications persists even in this area of the criminal justice system; a survey published in 2013 reported that 50 percent of drug courts did not allow agonist treatment for opioid use disorder under any circumstances. In 2015, the Office of National Drug Control Policy announced that state drug courts receiving federal grants must not: 1) deny any appropriate and eligible client for the treatment drug court access to the program because of their use of FDA-approved medications that is in accordance with an appropriately authorized prescription; or 2) mandate that a drug court client no longer use medications as part of the conditions of the drug court if such a mandate is inconsistent with a medical practitioner's recommendation or prescription.

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How is opioid use disorder treated in the criminal justice system? | National Institute on Drug Abuse

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Opioid use disorders are highly prevalent among criminal justice populations. According to data from the U.S. Department of Justice, approximately half of state and federal prisoners meet criteria for substance use disorder.78 Even so, there has been reticence in criminal justice settings to using methadone, buprenorphine, and naltrexone to treat opioid use disorder.

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This TEDTalk discusses how the perception of addiction needs to change in order to make progress. It is fueled by a lack of connections, rather than a desire for drugs. Solutions to the opioid epidemic require a new lens that focuses less on criminalization and more on harm reduction strategies.

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Johann Hari: Everything you think you know about addiction is wrong | TED Talk

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What really causes addiction -- to everything from cocaine to smart-phones? And how can we overcome it? Johann Hari has seen our current methods fail firsthand, as he has watched loved ones struggle to manage their addictions. He started to wonder why we treat addicts the way we do -- and if there might be a better way. As he shares in this deeply personal talk, his questions took him around the world, and unearthed some surprising and hopeful ways of thinking about an age-old problem.

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This column will highlight relevant theories and perspectives regarding drug abuse and addiction.

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According to Luo et al., (2021), in 2017, West Virginia experienced a cost of over $13,000 million for both opioid use disorder and fatal opioid overdose. They also reported that per capita cost of fatal opioid overdose was highest for West Virginia at $5,298.

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Centers for Disease Control and Prevention

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Summary
What is already known about this topic?
The U.S. economic cost of opioid use disorder ($471 billion) and fatal opioid overdose ($550 billion) during 2017 totaled $1,021 billion.
What is added by this report?
In the 39 jurisdictions studied, combined costs of opioid use disorder and fatal opioid overdose varied from $985 million in Wyoming to $72,583 million in Ohio. Per capita combined costs varied from $1,204 in Hawaii to $7,247 in West Virginia. States with high per capita combined costs were located mainly in the Ohio Valley and New England.
What are the implications for public health practice?
Federal and state public health agencies can use these data to help guide decisions regarding research, prevention and response activities, and resource allocation.

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Approximately 47,000 persons in the United States died from an opioid-involved overdose in 2018 ( 1), and 2.0 million persons met the diagnostic criteria for an opioid use disorder in 2017 ( 2). The economic cost of the U.S. opioid epidemic in 2017 was estimated at $1,021 billion, including cost of opioid use disorder estimated at $471 billion and cost of fatal opioid overdose estimated at $550 billion ( 3). CDC used national-level cost estimates to estimate the state-level economic cost of opioid use disorder and fatal opioid overdose during 2017. Cases and costs of state-level opioid use disorder and fatal opioid overdose and per capita costs were calculated for each of the 38 states and the District of Columbia (DC) that met drug specificity requirements for mortality data ( 4). Combined costs of opioid use disorder and fatal opioid overdose (combined costs) varied substantially, ranging from $985 million in Wyoming to $72,583 million in Ohio. Per capita combined costs also varied considerably, ranging from $1,204 in Hawaii to $7,247 in West Virginia. States with high per capita combined costs were mainly in two regions: the Ohio Valley and New England. Federal and state public health agencies can use these data to help guide decisions regarding research, prevention and response activities, and resource allocation.

Estimated case counts of state-level opioid use disorder were extracted from the National Survey on Drug Use and Health (NSDUH) 2-Year Restricted-Use Data Analysis System (2016-2017) provided by the Substance Abuse and Mental Health Services Administration ( 5). NSDUH is a nationally representative sample of the U.S. civilian noninstitutionalized population aged ≥12 years. Cases of opioid use disorder were identified by using questions on opioid abuse or dependence during the past year.* Case counts of state-level fatal opioid overdose and population estimates in 2017 were extracted from CDC's WONDER database ( 6). Cases of fatal opioid overdose were identified using International Classification of Diseases, Tenth Revision underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14 and then multiple causes-of-death codes T40.0-T40.4 and T40.6. † This report is limited to DC and the 38 states that met the requirement that at least one specific drug is named on the death certificate ( 4).

Cost per case of opioid use disorder ($221,219) was derived by dividing the total U.S. cost of opioid use disorder ($470,975 million) during 2017 by the number of opioid use disorder cases the same year (2.129 million) ( 3). Cost per case of fatal opioid overdose ($11.548 million) was derived by dividing the total cost of fatal opioid overdose ($549,691 million) by the number of fatal opioid overdose cases (47,600) ( 3). State-level cost of opioid use disorder was calculated by multiplying the U.S. cost of opioid use disorder per case by the number of cases of opioid use disorder in each state. State-level cost of fatal opioid overdose was calculated by multiplying the U.S. cost of fatal opioid overdose per death by the number of deaths in each state. To facilitate comparison across states, CDC divided state-level combined costs of opioid use disorder and fatal opioid overdose by state population to generate per capita costs. The 38 states and DC were ranked by per capita combined costs. Cost components of opioid use disorder and fatal opioid overdose include the costs of health care, substance use treatment, criminal justice, lost productivity, reduced quality of life, and the value of statistical life lost. These components were calculated by multiplying the number of state cases of opioid use disorder or fatal opioid overdose by national cost estimates per case for each component ( 3). §

Cases of opioid use disorder and fatal opioid overdose varied substantially among states, and the combined costs ranged from $985 million in Wyoming to $72,583 million in Ohio ( Table 1). Per capita combined costs also varied widely among states, ranging from $1,204 in Hawaii to $7,247 in West Virginia. The state-level per capita combined costs exhibited geographic patterns ( Figure); states with high per capita combined costs were located mainly in the Ohio Valley and New England. Three adjacent states in the Ohio Valley (West Virginia, Ohio, and Kentucky) had the first, second, and fourth highest per capita combined costs ($7,247, $6,226, and $5,491, respectively). Per capita costs of fatal opioid overdose were highest in West Virginia ($5,298) and Ohio ($4,252). Per capita combined costs in four neighboring New England states were among the eight highest: New Hampshire (third highest, $5,953), Massachusetts (fifth highest, $5,381), Maine (sixth highest, $5,099), and Connecticut (eighth highest, $4,800).

States with lower per capita combined costs were mainly in western regions: California, Hawaii, and Wyoming in the West; Minnesota in the Midwest; and Texas in the Southwest. Combined per capita costs were lowest in Hawaii ($1,204) and Minnesota ($1,509). Per capita cost of fatal opioid overdose was the lowest in Hawaii ($429), and per capita cost of opioid use disorder was the lowest in Minnesota ($635). The two most populous states (California and Texas) and the least populous state (Wyoming) were among the states with the lowest per capita combined costs: California, third lowest ($1,566), Wyoming, fourth lowest ($1,701) and Texas, fifth lowest ($1,736).

Reduced quality of life was the largest component of the cost of opioid use disorder, and the value of statistical life lost was the largest component of the cost of fatal opioid overdose ( Table 2). These two components together accounted for approximately 84% of combined costs, followed by lost productivity.

Discussion

The opioid overdose epidemic had a substantial economic impact on the United States during 2017. Individual states differed widely in overall and per capita economic cost. Per capita combined costs of opioid use disorder and fatal opioid overdose were highest in states in the Ohio Valley and New England regions. Three states in New England (Connecticut, Maine, and Massachusetts) had high per capita combined costs in 2017. However, previous reports have shown that these states had low per capita lifetime medical and work-loss costs from all fatal injuries (including opioid overdose) in 2014 ( 7). Further investigation is needed to ascertain why states that have relatively low costs for other types of injuries have relatively high costs related to opioid use disorder and fatal overdose.

Several effective strategies have been identified to improve opioid prescribing consistent with clinical guidelines, treat opioid use disorder, and prevent fatal overdose. Pain clinic laws and combined implementation of mandated provider review of state-run prescription drug monitoring program data have reduced the amounts of opioids prescribed and prescription opioid overdose death rates ( 8). Treatment with Food and Drug Administration-approved medications (methadone, buprenorphine, or naltrexone) is the most effective form of treatment for opioid use disorder ( 9). Overdose education and nasal naloxone distribution programs reduced opioid overdose mortality rates in Massachusetts ( 10).

The findings in this report are subject to at least four limitations. First, this study is limited to the 38 states and DC that met drug specificity requirements for mortality data, so the rankings of combined costs and per capita costs do not apply to all 50 states. Second, the cost of opioid use disorder was measured for a single year rather than a lifetime, even though opioid use disorder might have a long-lasting effect on a person's life. Third, the estimated case counts of opioid use disorder likely underrepresent the true prevalence of opioid use disorder because NSDUH does not include persons who are incarcerated or experiencing homelessness, two groups that often have high rates of opioid use disorder. Finally, this study did not directly calculate state costs per case of opioid use disorder and fatal opioid overdose but rather applied the national costs per case of opioid use disorder and fatal opioid overdose to individual states. Population characteristics of opioid use disorder and fatal opioid overdose cases at the state level might differ from those at the national level, potentially biasing state cost estimates.

These estimated costs of opioid use disorder and fatal opioid overdose and their per capita costs at the state level can assist federal and state decision makers in understanding the magnitude of opioid use disorder and fatal opioid overdose in their jurisdictions. Federal and state public health agencies can use these data to help guide decisions regarding research, prevention and response activities, and resource allocation.

Corresponding author: Feijun Luo, hto1@cdc.gov, 770-488-3896.

¹ Division of Injury Prevention, National Center for Injury Prevention and Control, CDC.

References

1. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999-2018. NCHS data brief, no 356. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2020. https://www.cdc.gov/nchs/data/databriefs/db356-h.pdfpdf icon

2. Center for Behavioral Health Statistics and Quality. Results from the 2018 National Survey on Drug Use and Health: detailed tables. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2019. https://www.samhsa.gov/data/report/2018-nsduh-detailed-tablesexternal icon

3. Substance Abuse and Mental Health Services Administration. National survey on drug use and health: 2-year RDAS (2016 to 2017). Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2021. https://rdas.samhsa.gov/#/survey/NSDUH-2016-2017-RD02YRexternal icon

4. CDC. CDC WONDER: about multiple cause of death, 1999-2019. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://wonder.cdc.gov/mcd-icd10.html

5. National Academies of Sciences, Engineering, and Medicine. Medications for opioid use disorder save lives. Washington, DC: The National Academies Press; 2019.

Jurisdiction†

Estimated case count of opioid use disorder

Case count of fatal opioid overdose

Cost of opioid use disorder, $ (millions)

Cost of fatal opioid overdose, $ (millions)

Combined cost of opioid use disorder and fatal opioid overdose, $ (millions)

Per capita cost of opioid use disorder, $

Per capita cost of fatal opioid overdose, $

Per capita combined cost of opioid use disorder and fatal opioid overdose, $

FIGURE. Per capita combined costs* of opioid use disorder and fatal opioid overdose - United States, 2017

Abbreviation: DC= District of Columbia.

* Per capita combined costs are combined costs of opioid use disorder and fatal opioid overdose divided by state population and are expressed in 2017 U.S. dollars.

Jurisdiction†

Estimated case counts of opioid use disorder

Cost components of opioid use disorder, $ (millions)

Case counts of fatal opioid overdose

Cost components of fatal opioid overdose, $ (millions)

Health care

Substance use treatment

Criminal justice

Lost productivity

Reduced quality of life

Health care

Lost productivity

Value of statistical life lost

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state-level costs of opioid use disorders

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economic costs of opioid use disorder by state

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state-level costs of fatal opioid overdose

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State-Level Economic Costs of Opioid Use Disorder...

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What is already known about this topic? The U.S. economic cost of opioid use disorder ($471 billion) and fatal opioid overdose ($550 billion) during 2017 totaled $1,021 billion. What is added by this report? In the 39 jurisdictions studied, combined costs of opioid use disorder and fatal opioid overdose varied from $985 million in Wyoming to $72,583 million in Ohio.

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One harm reduction strategy that has made great strides in West Virginia is the distribution of naloxone. Naloxone is an overdose reversal drug that can be used to save lives. Campuses across the state have implemented "Naloxboxes" that contain two doses of the drug and instructions on how to administer it. Additionally, many campuses have begun naloxone trainings to increase awareness. This strategy is a great way to prevent unnecessary overdose deaths (Carassco, 2022).

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To prevent overdoses, campuses in West Virginia will install 50 boxes containing the opioid-reversal drug naloxone, along with instructions, the Herald-Dispatch reported.

The Be the One initiative, sponsored by the West Virginia Collegiate Recovery Network and the West Virginia Drug Intervention Institute, aims to minimize opioid overdose deaths and aid recovery efforts among students, faculty and staff on West Virginia's campuses. Each "Naloxbox," which the organizations will distribute and mount on campus walls, contains two doses of naloxone and training materials on how to administer the medication during an active overdose. The institutions receiving the Naloxboxes are BridgeValley Community and Technical College, Concord University, New River Community and Technical College, West Virginia State University, West Virginia School of Osteopathic Medicine, Southern West Virginia Community and Technical College, West Virginia University, and the Erma Byrd Center for Higher Education.

"As we kick off the spring semester, we are holding naloxone training for our staff and faculty, and we can have Naloxboxes on all our campuses thanks to this program," said Bonny Copenhaver, the president of New River Community and Technical College. "Participating in the Be the One initiative is a way that we can be prepared to support our students in a moment of crisis and hopefully save a life."

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W.V. Campuses Will Install Naloxone Kits to Prevent Overdoses

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To prevent overdoses, campuses in West Virginia will install 50 boxes containing the opioid-reversal drug naloxone, along with instructions, the Herald-Dispatch reported. The Be the One initiative, sponsored by the West Virginia Collegiate Recovery Network and the West Virginia Drug Intervention Institute, aims to minimize opioid overdose deaths and aid recovery efforts among students, faculty and staff on West Virginia's campuses.

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A growing field in the area of treatment for opioid abuse is telemedicine, which uses technology to provide treatment access. Many apps are on the market that offer support, physician consultations, or even ways to mail medications to one's home. Although this may offer more options for those who can afford it, it also raises concerns for the populations most hard-hit by the opioid crisis who lack such access. Those struggling with financial hardships and housing accessibility may not benefit from such apps. However, telemedicine may provide more access to help and bring awareness to this issue (Rinker, 2022).

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David Sarabia had already sold two start-ups by age 26 and was sitting on enough money to never have to work another day in his life. He moved from Southern California to New York City and began to indulge in all the luxuries his newly minted millionaire status conveyed. Then it all went sideways, and his life quickly unraveled.

"I became a massive cocaine addict," Sarabia said. "It started off just casual partying, but that escalated to pretty much anything I could get my hands on."
" READ MORE: Fatal overdoses are rising fastest among Black drug users nationally, mirroring Philly trend
At one particularly low point, Sarabia was homeless for three months, sleeping on public transportation to stay warm. Even with plenty of money in the bank, Sarabia said, he'd lost the will to live. "I'd given up," he said.

He got back on his feet, sort of, and for the next three years lived as a "functional cocaine addict" until his best friend, Jay Greenwald, died after a night of partying. Finally, Sarabia checked himself into a rehab in Southern California - ostensibly a luxurious one, although Sarabia didn't find it to be so.

Still, the place saved his life. The clinicians really cared, he recalled, although their efforts were hampered by clunky technology and poor management. He had the feeling that the owners were more interested in profits than in helping people recover.

Just days off cocaine, the tech entrepreneur was scribbling designs for his next start-up idea: a digital platform that would make clinician paperwork easier, combined with a mobile app to guide patients through recovery. After he left treatment in 2017, Sarabia tapped his remaining wealth - about $400,000 - to fund an addiction tech company he named inRecovery.

With the nation's opioid overdose epidemic hitting a record high of more than 100,000 deaths in 2021, effective ways to fight addiction and expand treatment access are desperately needed. Sarabia and other entrepreneurs in the realm they call addiction tech see a$42 billion U.S. market for their products and an addiction treatment field that is, in tech-speak, ripe for disruption.

It has long been torn by opposing ideologies and approaches: medication-assisted treatment versus cold-turkey detox; residential treatment versus outpatient; abstinence versus harm reduction; peer support versus professional help. And most people who report struggling with substance use never manage to access treatment at all.
" READ MORE: Overdose deaths in Philadelphia likely to reach new heights in 2021
Tech is already offering help to some. Those who can pay out-of-pocket, or have treatment covered by an employer or insurer, can access one of a dozen addiction telemedicine start-ups that allow them to consult with a physician and have a medication such as buprenorphine mailed directly to their home. Some of the virtual rehabs provide digital cognitive behavior treatment, with connected devices and even mail-in urine tests to monitor compliance with sobriety.

Plentiful apps offer peer support and coaching, and entrepreneurs are developing software for treatment centers that handle patient records, personalize the client's time in rehab, and connect them to a network of peers.

But while the founders of for-profit companies may want to end suffering, said Fred Muench, clinical psychologist and president of the nonprofit Partnership to End Addiction, it all comes down to revenue.

Start-up experts and clinicians working on the front lines of the drug and overdose epidemic doubt that the flashy Silicon Valley technology will ever reach people in the throes of addiction who are unstably housed, financially challenged, and on the wrong side of the digital divide.

"The people who are really struggling, who really need access to substance use treatment, don't have 5G and a smartphone," said Aimee Moulin, a professor and behavioral health director for the Emergency Medicine Department at UC Davis Health. "I just worry that as we start to rely on these tech-heavy therapy options, we're just creating a structure where we really leave behind the people who actually need the most help."

The investors willing to feed millions of dollars on start-ups generally aren't investing in efforts to expand treatment to the less privileged, Moulin said.

Besides, making money in the addiction tech business is tough, because addiction is a stubborn beast.

Conducting clinical trials to validate digital treatments is challenging because of users' frequent lapses in medication adherence and follow-up, said Richard Hanbury, founder and CEO of Sana Health, a start-up that uses audiovisual stimulation to relax the mind as an alternative to opioids.

There are thousands of private, nonprofit, and government-run programs and drug rehabilitation centers across the country. With so many bit players and disparate programs, start-ups face an uphill battle to land enough customers to generate significant revenue, he added.

After conducting a small study to ease anxiety for people detoxing off opioids, Hanbury postponed the next step, a larger study. To sell his product to the country's sprawling array of addiction treatment providers, Hanbury decided, he would need to hire a much larger sales team than his budding company could afford.

Still, the immense need is feeding enthusiasm for addiction tech.

Employers, insurers, providers, families, and those suffering addiction themselves are all demanding better and affordable access to treatment, said Unity Stoakes, president and managing partner of StartUp Health.

The investment firm has launched a portfolio of seed-stage start-ups that aim to use technology to end addiction and the opioid epidemic. Stoakes hopes the wave of new treatment options will reduce the stigma of addiction and increase awareness and education. The emerging tools aren't trying to remove human care for addiction, but rather "supercharge the doctor or the clinician," he said.

While acknowledging that underserved populations are hard to reach, Stoakes said tech can expand access and enhance targeted efforts to help them. With enough start-ups experimenting with different types of treatment and delivery methods, hopefully one or more will succeed, he said.

Addiction telehealth start-ups have gained the most traction. Quit Genius, a virtual addiction treatment provider for alcohol, opioid, and nicotine dependence, raised $64 million from investors last summer, and in October, $118 million went to Workit Health, a virtual prescriber of medication-assisted treatment. Several other start-ups - Boulder Care, Groups Recover Together, Ophelia, Bicycle Health, and Wayspring, most of which have nearly identical telehealth and prescribing models - have landed sizable funding since the pandemic started.

Some of the start-ups already sell to self-insured employers, providers, and payers. Some market directly to consumers, while others are conducting clinical trials to get FDA approval they hope to parlay into steadier reimbursement. But that route involves a lot of competition, regulatory hurdles, and the need to convince payers that adding another treatment will drive down costs.

Sarabia's inRecovery plans to use its software to help treatment centers run more efficiently and improve their patient outcomes. The start-up is piloting an aftercare program, aimed at keeping patients connected to prevent relapse after treatment, with Pennsylvania's Caron Treatment Centers, a high-end nonprofit treatment provider based in Berks County.
" READ MORE: Caron Treatment Centers cuts readmissions under unusual contract with Independence Blue Cross
His long-term goal is to drive down costs enough to offer his service to county-run treatment centers in hopes of expanding care to the neediest. But for now, implementing the tech doesn't come cheap, with treatment providers paying anywhere from $50,000 to $100,000 a year to license the software.

"Bottom line, for the treatment centers that don't have consistent revenue, those on the lower end, they will probably not be able to afford something like this," he said.
K HN (Kaiser Health News) is a national newsroom that produces journalism about health issues.

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Money flows into addiction tech, but will it curb soaring opioid overdose deaths?

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David Sarabia had already sold two start-ups by age 26 and was sitting on enough money to never have to work another day in his life. He moved from Southern California to New York City and began to indulge in all the luxuries his newly minted millionaire status conveyed.

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Medication-Assisted Treatment (MAT) programs allow those suffering from opioid use disorder to obtain a stable dose in a supervised environment, thus reducing cravings for illicit opioid use. In combination with therapy, treatments help to reach recovery with the support of professionals. MATs have been linked to a reduction in criminal activity, reliance on illicit opioids, less engagement in behaviors that increase the risk for HIV, and lower overdose rates (Prevention Solutions, 2022).

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To address the opioid epidemic, West Virginia has enacted several laws meant to reduce overdose deaths. The 911 Good Samaritan Law prevents those who witness or aid an overdose victim from being arrested after notifying the police. The law has resulted in an increase in 911 calls and fewer deaths.

Huntington, West Virginia has been active in attempts to reduce overdose deaths and opioid abuse. They created the first needle exchange program in the state, established a center for babies born with addictions, and programs for students affected by parents who have been arrested for drug use (Leavitt Partners, 2017).

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According to the National Institute on Drug Abuse and the CDC, in 2015 over 33,000 people died from opioid overdose in the United States, and in 2013 prescription opioid abuse cost the U.S. economy approximately $78.5 billion in costs related to health care, crime, and loss of productivity. Opioid abuse and the related overdose deaths are harming individuals, families, the health care field, the economy, and society as a whole. With the opioid epidemic growing at a rapid pace, President Trump formed The President's Commission on Combating Drug Addiction and the Opioid Crisis. The commission recently published an interim report that outlined the current status of the opioid crisis in the United States, issued recommendations for the President, and called upon President Trump to declare it a national emergency, which he subsequently did. Additionally, many states have been implementing plans to address the opioid crisis. Some states have even started to place limits on the number of opioid painkillers that doctors can prescribe. West Virginia and Ohio, two of the states with the highest opioid overdose death rates, have been investing in reversing their current growth of opioid abuse and subsequent death.
West Virginia
West Virginia has the highest rate of opioid related overdose deaths, and drug overdose is the top cause of death for people under the age of 45 in the state. Since 2015, West Virginia has sought to address the opioid epidemic through various pieces of legislation, including:

West Virginia Code 16-47-4: Also known as the "911 Good Samaritan" law, this legislation protects witnesses of an overdose from arrest when they call 911.

West Virginia Code 16-46-3a: Allows pharmacists to dispense and provide education about naloxone.

HB 2195: Requires the implementation of opioid prevention/awareness programs into school curriculum.

HB 4347: Prioritizes substance abuse treatment for pregnant women.

Collectively, the enactment of West Virginia Codes 16-46-3a and 16-47-4 have been associated with more 911 overdose calls and fewer overdose deaths. The legislature is currently considering other bills to help fight the opioid epidemic. West Virginia also applied for a Medicaid waiver to specifically address substance abuse disorder and decided to use $24 million from their settlement with opioid distributors to expand the availability of treatment for people struggling with addictions.

Huntington, a small city in West Virginia, has been hit hard by the opioid epidemic. According to Pew Charitable Trusts, Huntington's overdose death rate is 10 times the national rate, which has prompted the city to make several changes to combat the crisis and reduce its harmful effects. In 2014 Huntington opened an Office of Drug Control Policy that coordinates with a coalition of law enforcement, public health leaders, first responders, and local groups to combat opioids. Huntington has emphasized harm reduction by opening the first needle exchange in the state, a center for weaning babies off drugs, and a school program for children with parents who have been arrested for drugs. They are also training drug users how to administer naloxone to prevent overdose deaths. Finally, Huntington has been trying to send drug users to treatment instead of jail. Recovery Point, a 100-bed facility, has a long-term recovery program with a 68 percent sobriety rate for graduates one-year post-program.
Ohio
Although West Virginia has the highest opioid overdose death rate in the U.S., Ohio is not far behind. According to the Ohio Department of Health, Ohio had 3050 overdose deaths in 2015, which gave it the 3rd highest rate of overdose deaths in the U.S. Thus, Ohio has been taking legislative steps to combat the opioid epidemic. Governor Kasich established the Governor's Cabinet Opiate Action Team (GCOAT) in 2011. Five of the areas that GCOAT has focused on are: (1) decreasing drug trafficking through law enforcement; (2) preventing youth from using drugs through education programs; (3) ensuring pain medication is available and used appropriately by improving prescribing guidelines, utilizing the Ohio Automated Rx Reporting System (OARRS), decreasing the amount of drugs prescribed, and setting up a drug take back program; (4) helping people get treatment and recover by investing millions of dollars into research and treatment programs; and (5) expanding access to naloxone through Project DAWN and legislation. Additionally, Ohio has spearheaded an Ohio Opioid Technology Challenge. Thus far, 44 organizations, including universities, hospitals, pharmaceutical organizations, and medical device companies, have submitted project proposals to apply for grant funding to create innovative solutions to the opioid crisis.

Although it is too early to determine if long-term success against opioids in Ohio will be achieved, the state is seeing some promising results since the formation of GCOAT in 2011. First, the number of opioid doses dispensed in Ohio have decreased from 782 million in 2011 to 701 million in 2015. Second, prescriber queries of OARRS increased by 9.5 million between 2011 and 2015. Finally, the number of people receiving a prescription from five or more clinicians within one month decreased from 2,205 individuals in 2011 to 720 in 2015.

Other states have also found some success through initiatives like the prescription drug monitoring program (PDMP), which has helped New York and Tennessee decrease the number of individuals seeing multiple providers for prescriptions by 75 percent and 36 percent, respectively. There is no single way to battle the opioid epidemic, but West Virginia and Ohio have demonstrated several key factors that can be applied in other states:

1. Involve multiple stakeholders in the policy development and decision-making processes to improve the quantity and quality of ideas.

2. Partner with law enforcement efforts, as it cannot tackle the issue alone.

3. Invest in prevention and treatment.

4. Expand access to naloxone to decrease overdose deaths.

5. Don't quit; fighting addictions is not easy for an individual or society, but that does not mean states should give up.

By combatting the opioid epidemic, states can improve the health and safety of their citizens and help health care systems focus resources on other aspects of health.

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The Opioid Epidemic and State Responses - Leavitt Partners

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According to the National Institute on Drug Abuse and the CDC, in 2015 over 33,000 people died from opioid overdose in the United States, and in 2013 prescription opioid abuse cost the U.S. economy approximately $78.5 billion in costs related to health care, crime, and loss of productivity.

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Jan Rader, a firefighter from Huntington, West Virginia, discusses how the opioid epidemic has impacted her city and the lives of first responders. She emphasizes the importance of making positive change and eliminating the stigma associated with substance use disorder.

Her statements highlight the important role of first responders in combatting the opioid problem. First responders are in direct contact with the community, and they have the power to go beyond just saving lives.

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In the opioid crisis, here's what it takes to save a life | Jan Rader

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A major theory in analyzing drug abuse is labeling theory. The theory states that people are deviant because they are labeled as such. The labels that are attached to an act, rather than the act itself, dictate what is considered crime. Some of the major assumptions of labeling theory as explained by Schrag (1971) include that an individual only becomes a criminal once they have been designated as such by authorities, not by breaking the law, as well as how getting caught begins the process of labeling (Hagan & Dailge, 2020). In terms of the opioid epidemic, labeling those who abuse drugs as criminals may further push abusers away from getting help. Laws that label drug users as criminals affect their ability to reenter soceity.

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Social Learning Theory rests on the ideas of positive and negative reinforcement. Positive reinforcement refers to rewards given in response to a particular behavior, while negative reinforcement refers to the removal of something negative in response to a behavior (Hagan & Daigle, 2020).
Drug use may be positively reinforced through the desired physiological effects, or it may be negatively reinforced through withdrawal symptoms to encourage another dose (Mosher & Akins, 2021). For example, opioids release dopamine, which induces a pleasurable feeling, thus positively reinforcing the behavior. However, withdrawal symptoms, such as vomiting or sweating, may encourage more drug use (Smith, 2020).

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What Is Opioid Withdrawal?

Opioid withdrawal is what happens when you stop taking opioid drugs after your body has come to rely on them to feel OK. It can affect you in many ways.

Opioids attach to things called receptors on nerve cells in your brain, spinal cord, and other places to block pain messages that your body is sending to your brain. They also trigger your brain to release dopamine, a chemical that makes you feel good.

Opioid drugs, like oxycodone or morphine, can help with pain when you have surgery or when you've been injured. Some people also use illegal forms of them, like heroin.

Prescription opioids are usually safe to use for a short time and as directed by your doctor. If you need to stop taking long-term opioids, talk with your doctor. To do it safely, you need to take less of the drugs slowly over time as a medical team keeps a close watch over you.

Opioid Withdrawal Causes

Opioids include:

Codeine

Fentanyl

Heroin

Hydrocodone (alone or with acetaminophen)

Morphine

Oxycodone (alone or with acetaminophen)

Oxymorphone

Over time, your body can become dependent on an opioid. The neurons in your brain change to the point where, without the drug, they don't work the way they should. You might also become addicted, which is when you can't control your cravings for the drug despite your harmful behavior.

If your body doesn't get the drug it has come to rely on, you go into withdrawal.

Opioid Withdrawal Diagnosis

Your doctor may diagnose withdrawal based on your symptoms and a physical exam. They might also do a urine test to see which drugs you've used.

The American Psychiatric Association has four criteria for withdrawal:

You've stopped or cut back after heavy opioid use for several weeks or more, OR you've received an opioid antagonist, a drug that reverses the effects of opioids, such as naloxone.

You have three or more withdrawal symptoms within minutes or days of stopping, cutting back, or getting the antagonist.

These symptoms cause serious problems with your daily life.

The symptoms aren't happening because of another medical condition or mental disorder.

A test called the Clinical Opioid Withdrawal Scale (COWS) can give your doctor an idea of how serious your case is. It involves 11 common symptoms. Each is given a score, and they're added up for a total of up to 47.

Opioid Withdrawal Treatment and Home Remedies

Because it can be hard to give up opioids safely, most people should get a doctor's help to quit. They may:

Give you drugs, like methadone or buprenorphine, that make your symptoms easier to deal with and help with cravings. Your doctor will give you smaller doses over time until you no longer need it.

Give you drugs to settle your stomach, if you have vomiting or diarrhea, and recommend fluids to replace the water your body's losing

Give you drugs to control your blood pressure if it's high because of withdrawal

You can treat other symptoms, like fever, headaches or joint pain, with common over-the-counter drugs like ibuprofen.

Some other things may help you through:

Moderate exercise, like walking

Small, frequent meals or snacks of healthy foods

Plenty of water or other fluids

Meditation or something else that helps you stay calm

A distraction to keep your mind off your symptoms, like talking with a friend

Opioid Withdrawal Symptoms

Common signs of opioid withdrawal include:

These can show up within 12 hours after you take the last dose of the drug.

Many people feel so bad that they can't give up the drug without help. How serious your symptoms are depends on several things, like:

How long you've been using the drug

How long the drug stays in your system

How healthy you are

Whether you're quitting "cold turkey" or using other drugs to help you stop taking opioids

How long does withdrawal last?
The symptoms can last a few days to more than 2 weeks. For most people, the worst symptoms get better after a few days.

If a doctor or paramedic gave you a drug to reverse an opioid overdose, your withdrawal symptoms may come on faster and feel worse. They also may cause changes in your blood pressure or heart rate that need medical attention.

Opioid Withdrawal Complications

Opioid withdrawal isn't typically life-threatening. But if you have other health conditions, the effects can lead to serious problems. For example, a higher pulse or blood pressure can cause issues if you have a heart condition.

Other complications of withdrawal include:

Vomiting and diarrhea that lead to dehydration, high blood sodium levels (hypernatremia), and heart failure

Bleeding or leaking amniotic fluid in pregnant women

Higher risk of overdosing on an opioid after withdrawal because your tolerance is lower. If you start using the opioid again, you'll need a smaller dose than usual.

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If you take or use opioids for more than a few weeks, you may start to need them to feel OK. Your body can be affected in many ways if you stop them suddenly. That's known as withdrawal. Learn more about the symptoms, treatment, diagnosis, and causes of opioid withdrawal.

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Some theories posit that a biological or genetic basis exists that predisposes individuals towards addiction. One theory, sensitization theory, argues that chronic drug use can alter brain activity and increase risk for continued use, cravings, and relapse. Areas of the brain responsible for reward and punishment are changed by the drugs, and this alters the natural motivation system (Mosher & Akins, 2021).

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This Google Doc contains a list of all references used for this project.

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

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The opioid epidemic has drastically affected the nation, as well as West Virginia. This column will discuss the opioid epidemic broadly and in terms of how it has impacted the state.

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The opioid epidemic has been an ever-present issue for over three decades. What once began as an effort to increase pain management has become a public health threat. As the third wave continues, action is necessary in order to reduce overdose deaths. Additionally, costs related to the crisis are exceedingly high, particularly for West Virginia.

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Overall, I found labeling theory to be most associated with current approaches to opioid addiction and abuse. Removing the stigma surrounding drug addiction is vital in order to move forward with reducing overdose deaths and increasing treatment options.

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Not only is the opioid epidemic a public health issue, but it also affects the criminal justice system. A correlation exists between opioid addiction and involvement in the criminal justice system, and it is necessary to address how to best treat these individuals. Often, these individuals must undergo complete withdrawal while incarcerated, and this can often lead to relapse and fatal overdose upon release. MATs have shown to be effective in reducing this potential.

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Research has shown that although opioids have swept the nation, certain areas and populations across the country are affected differently. I feel that community-based solutions are necessary in order to curb the climbing fatality statistics. For example, in the state of West Virginia, Huntington has created their own approach to solve the issue locally. More access to healthcare and treatment for the underprivileged, as well as an emphasis on community care, is needed.

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Medication-assisted treatment (MAT) has yet to be embraced by the criminal justice system. Many jails require withdrawal of all opioids while in custody. In fact, only around half of all drug courts allow MATs to be used for treatment. Concerns about cost, regulations, and availability have contributed to its slow incorporation. However, studies have indicated that using MAT can decrease drug use, overdoses, and reincarcerations (SAMHSA, 2019).

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Dopesick, aired in 2021, explores the origins of the opioid crisis from the perspective of a small town doctor in rural Virginia. The community quickly becomes addicted to the "miracle drug" OxyContin, and overdoses and crime rates climb. The show consists of 8 episodes and is available to watch on Hulu (Hulu, 2021).

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Opioids have taken the public spotlight in recent years. The drugs are highly addictive, and this drives misuse of both prescribed and illicit opioids. In 2017, the opioid crisis was declared a public health emergency. Between 1991 and 2011, the number of opioid prescriptions tripled and overdose fatalities climbed (Nolan & Amico, 2016).

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The epidemic didn’t happen overnight. Here’s a brief look at how it evolved and who is most affected.

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The staggering issue of opioid misuse and overdose is a concern for both public health and criminology. Opioid abuse is costly to communities, can be exacerbated by the criminal justice system, and requires comprehensive reform. The opioid epidemic has become a looming figure over the nation, particularly in the state of West Virginia. I will first examine the prevalence and origins of the problem, theories and perspectives that may explain the issue, its interaction with the criminal justice system, and finally proposed reforms.

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This infographic from the U.S. Department of Human Services (2021) describes statistics from 2019-2020 regarding opioid misuse. The effects of opioids are widescale and harmful. 1.6 million people suffered from opioid use disorder, which is a problem that needs to be better addressed.

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According to NIDA (2021), of patients prescribed opioids for pain management:

21-29% abuse them

8-12% develop an opioid use disorder

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The National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention collects information on deaths involving drugs commonly associated with fatal overdose. This information is available in a searchable database called CDC Wonder. The NCHS also provides 12-month-ending Provisional Drug Overdose Death Counts by state and drug category.

The CDC also provides timely data related to unintentional and undetermined intent drug overdose deaths by participating jurisdiction through the State Unintentional Drug Overdose Reporting System (SUDORS). Similar data related to nonfatal drug overdoses are reported through CDC's Drug Overdose Surveillance and Epidemiology (DOSE) system.

See the latest from NIDA on drug overdose research.

Figure 1. National Drug-Involved Overdose Deaths-Number Among All Ages, by Gender, 1999-2021. More than 106,000 persons in the U.S. died from drug-involved overdose in 2021, including illicit drugs and prescription opioids. The figure above is a bar and line graph showing the total number of U.S. drug overdose deaths involving select illicit or prescription drugs from 1999 to 2021. The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2021 (Source: CDC WONDER).

Figure 2. National Drug-Involved Overdose Deaths by Specific Category-Number Among All Ages, 1999-2021. Overall, drug overdose deaths rose from 2019 to 2021 with more than 106,000 drug overdose deaths reported in 2021. Deaths involving synthetic opioids other than methadone (primarily fentanyl) continued to rise with 70,601 overdose deaths reported in 2021. Those involving stimulants, including cocaine or psychostimulants with abuse potential (primarily methamphetamine), also continued to increase with 32,537 overdose deaths in 2021 (Source: CDC WONDER).

Figure 3. National Overdose Deaths Involving Any Opioid-Number Among All Ages, by Gender, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving any opioid from 1999 to 2021. Any opioid includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin, and synthetic opioids other than methadone (primarily fentanyl). Opioid-involved overdose deaths rose from 21,089 in 2010 to 47,600 in 2017 and remained steady through 2019. This was followed by a significant increase in 2020 with 68,630 reported deaths and again in 2021 with 80,411 reported overdose deaths. The bars are overlaid by lines showing the number of deaths by gender from 1999 to 2021 (Source: CDC WONDER).

Figure 4. National Overdose Deaths Involving Prescription Opioids, by other Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving prescription opioids (including natural and semi-synthetic opioids and methadone) from 1999 to 2021. Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139. This was followed by a slight increase in 2020, with 16,416 reported deaths. In 2021, the number of reported deaths involving prescription opioids totaled 16,706. The bars are overlaid by a line showing the number of deaths involving prescription opioids in combination with synthetic opioids other than methadone (primarily fentanyl) from 1999 to 2021 (Source: CDC WONDER).

Figure 5. National Overdose Deaths Involving Heroin, by Other Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving heroin from 1999 to 2021. Drug overdose deaths involving heroin rose from 1,960 in 1999 to 15,482 in 2017 before trending down to 13,165 deaths in 2020 and 9,173 deaths in 2021. The bars are overlaid by lines showing the number of deaths involving heroin in combination with synthetic opioids other than methadone (primarily fentanyl) or without any other opioid from 1999 to 2021 (Source: CDC WONDER).

Figure 6. National Overdose Deaths Involving Stimulants (cocaine and psychostimulants), by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving stimulants from 1999 to 2021. Drug overdose deaths rose from 12,122 in 2015 to 53,495 in 2021. The bars are overlaid by lines showing the number of deaths involving stimulants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths involving stimulants has increased steadily since 2014 regardless of opioid involvement (Source: CDC WONDER).

Figure 7. National Overdose Deaths Involving Psychostimulants With Abuse Potential (Primarily Methamphetamine), by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving psychostimulants with abuse potential from 1999 to 2021. Drug overdose deaths involving psychostimulants with abuse potential rose from 547 in 1999 to 23,837 in 2020 and continued to increase to 32,537 deaths in 2021. The bars are overlaid by lines showing the number of deaths involving psychostimulants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths involving psychostimulants has increased steadily since 2014 regardless of opioid involvement (Source: CDC WONDER).

Figure 8. National Drug Overdose Deaths Involving Cocaine, by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving cocaine from 1999 to 2021. Drug overdose deaths involving cocaine rose steadily from 6,784 in 2015 to 15,883 in 2019. From 2019 to 2021, cocaine-involved deaths rose nearly 54% to 24,486 deaths. The bars are overlaid by lines showing the number of deaths involving cocaine in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid. The number of deaths in combination with synthetic opioids other than methadone has increased significantly since 2015 and is the main driver of cocaine-involved overdose deaths (Source: CDC WONDER).

Figure 9. National Drug Overdose Deaths Involving Benzodiazepines, by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving benzodiazepines from 1999 to 2021. Drug overdose deaths involving benzodiazepines steadily increased from 1,135 in 1999 to 11,537 in 2017 and declined to 9,711 in 2019. Between 2019 and 2021, deaths rose again to 12,499. The bars are overlaid by lines showing the number of deaths involving benzodiazepines in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid (Source: CDC WONDER).

Figure 10. National Drug Overdose Deaths Involving Antidepressants, by Opioid Involvement-Number Among All Ages, 1999-2021. The figure above is a bar and line graph showing the total number of U.S. overdose deaths involving antidepressants from 1999 to 2021. Drug overdose deaths involving antidepressants rose steadily from 1,749 in 1999 to 5,269 in 2017. Since then, deaths have slightly risen with 5,859 in 2021. The bars are overlaid by lines showing the number of deaths involving antidepressants in combination with synthetic opioids other than methadone (primarily fentanyl) or without any opioid involvement (Source: CDC WONDER).

Download Links

Description of Figures

The figures above are bar charts showing the number of U.S. overdose deaths involving select illicit or prescription drugs from 1999 through 2021. The bars are overlaid by lines representing gender or concurrent opioid involvement. Please note the y-axis scale varies by bar chart and caution should be applied when comparing graphs side-by-side.

There were 106,699 drug-involved overdose deaths reported in the U.S. in 2021 (Figure 1); 69% of cases occurred among males (yellow line). Synthetic opioids other than methadone (primarily fentanyl) were the main driver of drug overdose deaths with a nearly 7.5-fold increase from 2015 to 2021 (Figure 2).

Drug overdose deaths involving any opioid―prescription opioids (including natural and semi-synthetic opioids and methadone), other synthetic opioids other than methadone (primarily fentanyl), and heroin―continued to rise through 2021 with 80,411 deaths. More than 70% of deaths occurred among males (Figure 3). From 2020 to 2021, the number of deaths involving prescription opioids remained steady (Figure 4).

Overdose deaths involving heroin have trended down since 2016 with 9,173 deaths reported in 2021 (Figure 5). Nearly 75% of overdose deaths in 2021 involving heroin also involved synthetic opioids other than methadone (primarily fentanyl).

Drug overdose deaths involving stimulants, cocaine, or psychostimulants with abuse potential (primarily methamphetamine) have significantly increased since 2015 from 12,122 to 53,495 in 2021 (Figure 6).

Since 2015, the number of deaths involving psychostimulants with abuse potential (primarily methamphetamine) has risen significantly each year-with 32,537 deaths in 2021 (Figure 7). The number of deaths involving cocaine has also increased steadily since 2015 with 24,486 deaths reported in 2021 (Figure 8).

The final two charts show the number of overdose deaths involving benzodiazepines (Figure 8) or antidepressants (Figure 9). Benzodiazepines were involved in 12,499 deaths in 2021-steadily increasing since 2015. The proportion of deaths involving synthetic opioids other than methadone (primarily fentanyl) has increased significantly since 2015. Of the 8,791 deaths involving benzodiazepines in 2015, 20% also involved fentanyl. In 2021, this proportion increased to 70% of all deaths involving benzodiazepines. Antidepressant-involved deaths have also risen steadily, driven by fentanyl, with 5,859 deaths reported in 2021.

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Drug Overdose Death Rates | National Institute on Drug Abuse

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The National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention collects information on deaths involving drugs commonly associated with fatal overdose. This information is available in a searchable database called CDC Wonder. The NCHS also provides 12-month-ending Provisional Drug Overdose Death Counts by state and drug category.

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At the peak of the opioid crisis in 2010, white Americans made up the majority of overdose deaths. Now, however, Black Americans are facing the fastest overdose death rates. The rise in deaths has been attributed to Mexican cartels mixing fentanyl into street drugs. A recent study stated that African Americans are at higher risk for exposure to fentanyl as they most often rely upon street drug supplies (Mann, 2022).

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When the first phase of the opioid epidemic was cresting in 2010, driven largely by prescription pain medications, white Americans were dying of fatal drug overdoses at rates twice that of Black Americans.

In the decade that followed, drug deaths surged again. But this time Black communities faced the brunt of the carnage.

"Overdose rates have been growing fastest among Black communities," says Joseph Friedman, an addiction researcher at UCLA. "For the first time we see them overtaking the overdose rate among white individuals."

It's a devastating milestone, documented in a peer-reviewed study published Wednesday in the journal JAMA Psychiatry.

The research is based on drug deaths from 1999 through 2020, the most recent comprehensive overdose data available.

The biggest factor leading to overdose deaths among Black people is a more toxic illicit drug supply

Preliminary data from the Centers for Disease Control and Prevention suggests the situation has grown even worse over the past year as fatal overdoses topped 100,000 for the first time in 2021.

Friedman says the biggest factor leading to dramatically higher overdose deaths among Black people with substance use disorder is pretty simple: "The illicit drug supply, the street drug supply, is becoming more and more toxic," he says.

That's because of fentanyl, the potent synthetic opioid, which Mexican drug cartels now mix into many of the street drugs sold in the U.S.

Fentanyl has made drug use far deadlier for all Americans, across all demographics.

But this new study suggests African Americans are more vulnerable because they often rely on illicit drug supplies that are even more high-risk.

"People who are lower down on the social hierarchy tend to be exposed to fentanyl and other highly potent synthetic opioids at disproportionate rates," says Dr. Helena Hansen, a co-author of the report.

As a consequence, "You find Black Americans are exposed to fentanyl more often than white Americans," she says.

Black Americans with addiction more vulnerable to fentanyl

Hansen, who is Black, is also a researcher at UCLA. She says African Americans with substance use disorder also frequently lack access to healthcare and drug treatment. They're arrested and incarcerated at a far higher rates.

This means they tend to have fewer chances to get healthy and the avoid relapses that expose drug users to fentanyl.

"We have in this country two tiers, a criminalized tier which still over-polices and over-arrests and over-incarcerates Black and brown Americans," Hansen says. "And then we have a medicalized tier" that's more available in white communities.

Another 1.2 million drug deaths forecast across all demographics

This research follows a study published last month in the medical journal the Lancet that forecast more than 1.2 million additional drug overdose deaths in the U.S. in the coming decade.

On reviewing the demographic study conducted at UCLA, Dr. Stephen Taylor with the American Society of Addiction Medicine says the data suggest the Black community may bear the brunt of the next phase of the opioid epidemic.

"As a member of the Black community and as an addiction treatment specialist ... I'm terrified of that prospect, but that's exactly what we could be facing," Taylor says.

"A larger percentage of this next million [deaths] will be Black and other people of color."

Researchers say the way to prevent many of those deaths in the Black community is well documented in scientific and medical literature: provide better healthcare and more access to addiction treatment.

"All of this needs to be done with a real sense of urgency," Taylor says.

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Black Americans are now dying from drug overdoses at a higher rate than whites

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New research shows drug overdose deaths continue to surge among Black Americans. For the first time since 1999, Black Americans are dying at a higher rate per capita than white Americans.

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Shocking increases have been seen in opioid overdose death rates in the last decade. It was reported that Black Americans experienced an increase in opioid deaths by 355 percent between 2010 and 2018. In the same time frame, deaths increased by 218 percent for Hispanic Americans (Galoustian, 2022).

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Only a fraction of justice-involved individuals received opioid agonist treatment for opioid use disorder even though its effectiveness is well-established.

About 4 million people who reported use or misuse of prescription opioids or heroin in 2014 also reported having a concurrent arrest or active probation or parole status. Individuals who report opioid use are significantly more likely to have been arrested compared to those who do not use opioids.

Opioid agonist treatment, which includes federally approved medications such as methadone, buprenorphine and naltrexone, reduce withdrawal symptoms, cravings, block the effects of opioid use and reduce the risk of death by 33 percent. Yet, this treatment among justice-involved individuals is relatively rare.

Researchers from Florida Atlantic University's College of Social Work and Criminal Justice and collaborators conducted a study on the differences between criminal justice-involved individuals who received opioid agonist treatment as part of their treatment plan and those who did not. They compared demographics, substance use severity, and access to treatment and identified predictors of treatment to account for disparities within a criminal justice population in the United States.

The nationally representative database they used comprised of 105,988 admissions referred to treatment by the criminal justice system who reported heroin or other opiate as their primary, secondary, or tertiary substance used.

Results of the study, published in the journal Substance Use & Misuse, showed that fewer than 6 percent of criminal justice cases received opioid agonist treatment as part of the treatment plan. Those with daily substance use, comorbid psychiatric problems, prior treatment, females, Latinos, and those who were older and those who were living independently were more likely to receive this treatment, as were those living in the Northeast and with government health insurance.

"The criminal justice system is well-positioned to facilitate an individual's engagement in effective care at several intervention points including contact with first responders, case adjudication, sentencing, supervision and reentry," said Wendy P. Guastaferro, Ph.D., senior author, director and professor, FAU School of Criminology and Criminal Justice. "We know that opioid agonist treatment is related to better outcomes for justice-involved individuals, including reduced opioid use, reduced overdose deaths, improved treatment engagement, reduced criminal behavior, and lower crime costs. However, only a fraction of justice-involved individuals receive this treatment even though its effectiveness is well-established."

Among the study findings:

The majority of the sample were poly-drug users who reported heroin as a drug of choice and had previously received substance use treatment. Yet, opioid agonist treatment was not part of the treatment plan for the overwhelming majority of these cases (95 percent).

In 2014, more than 100,000 criminal justice system cases had an opioid use disorder diagnosis, but 15 states did not have a certified opioid treatment program.

Only 15 percent of U.S. counties were reported to have licensed opioid treatment programs that dispense methadone and nearly half of all U.S. counties do not have a physician approved to prescribe or dispense buprenorphine.

The opioid agonist treatment group included more individuals who were covered by government-issued insurance or did not have any insurance compared to those with private insurance.

Older individuals had significantly greater odds of receiving treatment compared to young adults. These findings lend some support to the notion that treatment is reserved for those who are more likely to be successful or are considered more "deserving" of treatment as age often is associated with reduction of criminal behavior.

For women, 5 percent of those who received treatment in their treatment plan were pregnant at the time of admission compared to 1.5 percent of those who did not have opioid agonist treatment in their treatment plan.

Even in states where opioid agonist treatment is available, criminal justice system-referred cases in the West and Midwest regions of the U.S. were markedly less likely to receive opioid agonist treatment than their counterparts in the Northeast.

Latinos were statistically more likely to receive opioid agonist treatment as part of their treatment plan.

Nearly 26 percent of the study sample were flagged for alcohol use at intake, but were less likely to be in an opioid agonist treatment program.

Although largely framed as a problem that affects white individuals, opioid use has had significant and growing impact on nonwhite communities as well. Between 2010 and 2018, opioid overdose deaths increased 355 percent among black individuals and 218 percent for Hispanic individuals.

"Dismantling barriers to treatment can improve both public health and community safety," said Guastaferro. "The criminal justice system must reduce regulatory burdens and systemic resistance to opioid agonist treatment while increasing funding for access to treatment to effectively serve those struggling with opioid use disorder."

Other study co-authors are Deborah Koetzle, Ph.D., professor, John Jay College of Criminal Justice, the City University of New York; Laura Lutgen-Nieves, Ph.D., assistant professor, Department of Criminal Justice, University of Southern Indiana; and Brent Teasdale, Ph.D., professor and chair, Department of Criminal Justice Sciences, Illinois State University.

-FAU-

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Under 6 Percent of Criminal Justice Cases Get Treatment for Opioid Use

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Only a fraction of justice-involved individuals received opioid agonist treatment for opioid use disorder even though its effectiveness is well-established. About 4 million people who reported use or misuse of prescription opioids or heroin in 2014 also reported having a concurrent arrest or active probation or parole status.

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A recent study predicted over 1.2 million more overdose deaths in the next ten years, indicating the need for more resources and healthcare options (Mann, 2022).

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When the first phase of the opioid epidemic was cresting in 2010, driven largely by prescription pain medications, white Americans were dying of fatal drug overdoses at rates twice that of Black Americans.

In the decade that followed, drug deaths surged again. But this time Black communities faced the brunt of the carnage.

"Overdose rates have been growing fastest among Black communities," says Joseph Friedman, an addiction researcher at UCLA. "For the first time we see them overtaking the overdose rate among white individuals."

It's a devastating milestone, documented in a peer-reviewed study published Wednesday in the journal JAMA Psychiatry.

The research is based on drug deaths from 1999 through 2020, the most recent comprehensive overdose data available.

The biggest factor leading to overdose deaths among Black people is a more toxic illicit drug supply

Preliminary data from the Centers for Disease Control and Prevention suggests the situation has grown even worse over the past year as fatal overdoses topped 100,000 for the first time in 2021.

Friedman says the biggest factor leading to dramatically higher overdose deaths among Black people with substance use disorder is pretty simple: "The illicit drug supply, the street drug supply, is becoming more and more toxic," he says.

That's because of fentanyl, the potent synthetic opioid, which Mexican drug cartels now mix into many of the street drugs sold in the U.S.

Fentanyl has made drug use far deadlier for all Americans, across all demographics.

But this new study suggests African Americans are more vulnerable because they often rely on illicit drug supplies that are even more high-risk.

"People who are lower down on the social hierarchy tend to be exposed to fentanyl and other highly potent synthetic opioids at disproportionate rates," says Dr. Helena Hansen, a co-author of the report.

As a consequence, "You find Black Americans are exposed to fentanyl more often than white Americans," she says.

Black Americans with addiction more vulnerable to fentanyl

Hansen, who is Black, is also a researcher at UCLA. She says African Americans with substance use disorder also frequently lack access to healthcare and drug treatment. They're arrested and incarcerated at a far higher rates.

This means they tend to have fewer chances to get healthy and the avoid relapses that expose drug users to fentanyl.

"We have in this country two tiers, a criminalized tier which still over-polices and over-arrests and over-incarcerates Black and brown Americans," Hansen says. "And then we have a medicalized tier" that's more available in white communities.

Another 1.2 million drug deaths forecast across all demographics

This research follows a study published last month in the medical journal the Lancet that forecast more than 1.2 million additional drug overdose deaths in the U.S. in the coming decade.

On reviewing the demographic study conducted at UCLA, Dr. Stephen Taylor with the American Society of Addiction Medicine says the data suggest the Black community may bear the brunt of the next phase of the opioid epidemic.

"As a member of the Black community and as an addiction treatment specialist ... I'm terrified of that prospect, but that's exactly what we could be facing," Taylor says.

"A larger percentage of this next million [deaths] will be Black and other people of color."

Researchers say the way to prevent many of those deaths in the Black community is well documented in scientific and medical literature: provide better healthcare and more access to addiction treatment.

"All of this needs to be done with a real sense of urgency," Taylor says.

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Black Americans are now dying from drug overdoses at a higher rate than whites

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New research shows drug overdose deaths continue to surge among Black Americans. For the first time since 1999, Black Americans are dying at a higher rate per capita than white Americans.

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In order to fully address the problem, we must provide treatment to individuals who are incarcerated. Ignoring the problem does nothing to bring about change.

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Although biological theories are not inherently criminological, they can be used to explain why individuals may commit crimes or act in deviant ways contrary to societal norms.