What Contributes to the Heightened Rate of Prescription Opioid-Related Deaths?

Significant numbers of people in the U.S. die as a result of overdosing on a prescription opioid medication, and current figures indicate that the number of prescription opioid-related deaths is on the rise. In a large-scale study review published in June 2014 in the American Journal of Public Health, researchers from Canada’s McGill University explored the underlying factors that contribute to this increased mortality rate. The researchers found 17 such factors; all of these factors have an independent role in increasing the prescription opioid-related death rate and also have an added combined impact.

Prescription Opioid Abuse

A federal agency called the Substance Abuse and Mental Health Services Administration (SAMHSA) tracks the number of American teenagers and adults who abuse a prescription opioid medication (or any other common substance of abuse) each year. The latest figures from SAMHSA show that prescription opioid abuse is clearly the most common form of prescription medication abuse in the U.S. In the average month, roughly 1.9 percent of all adults and teens will misuse oxycodone, hydrocodone or some other opioid painkiller. This is more than double the rate of monthly abuse for any other prescription medication. Generally speaking, illicit and illegal intake of drugs or medications spikes among older teenagers and younger adults in their early 20s. However, in part because opioid medications are commonly prescribed to older adults as well as younger adults, abuse of these medications can easily occur among adults of any age.

Opioid Overdoses

Whether they’re illegal drugs or legally prescribed medications, all opioid substances enter the bloodstream and access the brain and spinal cord (i.e., the central nervous system) through chemical gateways called opioid receptors. In addition to producing euphoria and pain relief, these substances slow down the rate of interaction between the central nervous system’s main nerve cells. This slowdown triggers a decrease in the rate of certain critical processes controlled by the brain and spinal cord, including the normal urge to breathe. In a person experiencing an opioid overdose, decreased function in the central nervous system reaches a critical tipping point and the body can no longer keep all of its essential systems running properly. The specific symptoms of an overdose vary with the amount of a drug or medication consumed. Fatal opioid overdoses commonly center on a loss of consciousness and a complete disruption of the body’s built-in breathing reflex. Some victims also experience lethal changes in their normal heart function.

What Are the Contributing Factors?

In the study review published in the American Journal of Public Health, the McGill University researchers analyzed the results of 47 previous studies that addressed the rate of prescription opioid-related deaths between the years 1990 and 2013. They conducted their review, in part, in response to the steadily rising number of such deaths during the indicated timeframe. After completing their analysis, the researchers found 17 separate factors that help explain why people in the U.S. and Canada are dying so often from prescription opioid overdoses. Five of these factors relate to the ways in which doctors prescribe opioid medications. Six of these factors relate to the actions and personal characteristics of people who consume prescription opioids, while another five relate to public health policies regarding opioid use and other social/environmental considerations.

The five prescriber-based factors that have contributed to the rise in prescription opioid-related deaths are the overall number of prescriptions written for opioid medications, the amount of opioids contained in the average prescription dosage, the rise in the popularity of prescriptions for the opioid medication oxycodone, the rise in the popularity of prescriptions for the opioid medication methadone and the rise of “pill mills” that write unusually large numbers of opioid prescriptions.

The six consumer-based factors that contribute to opioid-related deaths are the basic demographics (gender, age, financial standing, etc.) of the people who receive opioid prescriptions, the combination of prescription opioids with other drugs or medications, the practice of obtaining opioid prescriptions from multiple doctors, preexisting problems with substance abuse, the practice of giving other people access to one’s prescribed opioids and the practice of using opioid medications as replacements or substitutes for other non-opioid medications. The five social/environmental factors are the general guidelines that govern doctors who prescribe opioid medications, the size and socioeconomic standing of specific urban and rural areas, the region of the country in which a person resides, the interventions provided for people experiencing opioid overdoses and the relative impact of programs established to monitor prescription opioid abuse.

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