*Written by Misti Blu Day McDermott for Epidemiology class
An epidemic is the occurrence of cases involving an illness in a community or region, specific to health-related events in excess of normal expectancy. When the rate of a specific disease exceeds the baseline in a particular time period and region, this would indicate an epidemic. When an epidemic reaches a worldwide status, involving millions of people globally, it is then considered a pandemic (Aschengrau & Seage, 2014).
Many postoperative patients are routinely prescribed opioids for pain management; however, there are many adverse effects involved. Opioids severely impair the function of the mu-opioid peptide receptors, which have a high affinity for enkephalins and beta-endorphins (Stephan, 2016). The release of beta-endorphins is also inhibited, which is responsible for producing certain neurons within the central nervous system and peripheral nervous system. Beta-endorphins elevate dopamine, which is a neurotransmitter that gives us the sensation of euphoria. This takes place by binding to cell receptors to block pain with a large amount of dopamine. People experience a “high” and want to repeat the experience, thus reinforcing the want to take the drug again. As their dopamine levels wash out, their new baseline is morphed and requires more dopamine, via opioids, in order to not get sick (or to get out of the post-opioid depressive mood).
The opioid epidemic has a greater impact and involvement in the US in comparison to other countries.
This widespread issue of addiction is an epidemic. In Bill Nye’s new Netflix show, he covers addiction and states, “The definition of a disease, to me, would be an abnormal physiological process brought on by a relationship between an individual and the environment that creates a set of signs and symptoms that progress in a predictable way, which we call ‘natural history;’ and by affecting the natural history, we can create a predictable response to treatment. That is a disease, and addiction does fit that.”
The epidemic of opioid misuse is when opioids are taken in a way or dose other than what is prescribed, taking opioids that were not prescribed, and/or taking opioids solely for the purpose of getting high. Misuse can lead to slowed breathing, hypoxia (too little oxygen reaching the brain), neurological effects, coma, brain damage, death, and other effects depending on how the opioids are taken. Drug tolerance requires more opioids in order to get the desired effect due to long-term prescription use. Drug dependence, due to repeated use, can cause the neurons to adapt in a way that they only function when the drug is in their system. This is why withdrawals can be potentially fatal when not under medical supervision. Addiction is when opioid user develops compulsive or uncontrollable drug seeking behavior.
Rapid increase in prescribed opioids is linked to the growth in opioid overdose. The US life expectancy has been affected by the opioid crisis, as deaths from opioids have risen 10-14 times in the last 20 years (Shipton, 2018). According to the National Center for Health Statistics at the Centers for Disease Control and Prevention, it is determined that more than 67,300 Americans died from drug-involved overdose in 2018. Drug overdose deaths from 1999 to 2018 had a decrease in 2018. There were 70,237 deaths in 2017 (NIH, 2020).
It is so important that more studies and data are complied to better understand opioid addiction: pharmacogenomics, molecular genetics in relations to addiction, environmental role, and to the comparison to other countries, which are less affected. Perhaps gene therapies, such as the use of CRISPR, could play a role in treatment in the future.
Aschengrau, A., & Seage, G. R. (2014). Essentials of epidemiology in public health. 3rd ed. Burlington, MA: Jones & Bartlett Learning.
“The Addiction Episode.” Bill Nye Saves the World.Netflix, 2018.
“Overdose Death Rates.” National Institute on Drug Abuse, 2020. National Institutes of Health, http://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates.
Shipton, E. A., Shipton, E. E., & Shipton, A. J. (2018). A Review of the Opioid Epidemic: What Do We Do About It?. Pain and therapy, 7(1), 23–36. https://doi.org/10.1007/s40122-018-0096-7
Stephan, B. C., & Parsa, F. D. (2016). Avoiding Opioids and Their Harmful Side Effects in the Postoperative Patient: Exogenous Opioids, Endogenous Endorphins, Wellness, Mood, and Their Relation to Postoperative Pain. Hawai’i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 75(3), 63–67.