Opioid Epidemic in the U.S.A.

An opioid epidemic has been declared in the United States, with opioid-related drug overdose deaths reaching 47,600 in 2017. In 1999, such deaths numbered 8,048. According to a CNBC report under the heading, “Americans consume vast majority of the world’s opioids” (April 27, 2016, https://cutt.ly/QF5da2), 80% of the roughly 300 million opioid medicines prescribed for pain around the world in 2015 was in the United States.
What are opioids? Opioids are substances that produce morphine-like effects by acting on opioid receptors in the body. In medicine, they are mostly used to relieve pain, with other uses being suppression of diarrhea, cough, and opioid-induced constipation, as well as replacement therapy for opioid use disorder and reversing opioid overdose. Besides itchiness, nausea, respiratory depression, and constipation, the side effects may also include sedation and euphoria. Tolerance (increased doses required to achieve the same effect) and physical dependence (abruptly discontinuing the drug leading to unpleasant withdrawal symptoms) can occur from long-term use. Frequent recreational use (for euphoric effect) results in addiction. Death from respiratory depression can result from overdose or concurrent use with other depressant drugs, such as benzodiazepines (minor tranquilizers like Valium).
Morphine is still one of the most widely used pain medications in hospital settings. Once used only in injectable form, it is now available as immediate- and extended-release tablets, oral solutions, and rectal suppositories (MS Contin and Kadian). Hydromorphone, as injectable solution, oral solution, and immediate release and controlled release tabs (Siaudid, Exalgo), is also widely prescribed as an effective pain reliever. One of the most prescribed prescription pain relievers in the U.S. is Oxycodone (OxyContin, Percocet, Roxicodone), and according to the DEA, hydrocodone (Lortab, Vicodin, Norco) is the most prescribed and most abused opioid pain reliever.
Fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Subsys) is a drug that is 50-100 times more potent than morphine. It is extremely addictive because it causes rapid and intense euphoria. Codeine is a milder opioid analgesic and a less potent pain reliever compared to morphine. It also has antitussive properties, because of which it is often prescribed to treat coughs. Methadone, a synthetic opioid with analgesic properties, may be more often used as part of a detox protocol to manage opioid withdrawal, as well as replacement therapy to treat opioid dependence. A high number of prescription opioid overdose fatalities have been attributed to its abuse.
Meperidine (Demerol) is another opioid drug used to relieve pain. A person can become dependent even at prescribed doses, and suffer withdrawal symptoms as the effect tapers off. Oxymorphone (Opana) is a painkiller that is almost twice as powerful as OxyContin, and is usually prescribed when alternative treatments are ineffective, or when the patient becomes tolerant to other opioids. It is extremely addictive. Tramadol (Ultracet, Ultram, Ryzolt) is considered to have comparatively low abuse and dependence potential, but is often abused by healthcare providers and chronic pain sufferers, as well as by already opioid-dependent people. It may lead to addiction, if misused.
Carfentanil is a powerful opioid narcotic developed for use as an anesthetic for large animals in veterinary medicine. It is about 10,000 times stronger than morphine, 5,000 times stronger than heroin, and 100 times more potent than its analog, fentanyl. Thus, it is highly addictive with extremely high potential for fatal overdose. Buprenorphine (Butrans, Buprenex, Probuphine) is an opioid agonist used as an analgesic, as well as treatment medication for opioid dependence. It is also available in combination with naloxone (Bunavail, Suboxone, Zubsolv). As naloxone is an opioid antagonist, the combination was made to deter the inherent abuse potential of buprenorphine. https://americanaddictioncenters.org/the-big-list-of-narcotic-drugs

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