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The fight against prescription drug abuse will have little impact on the current situation in America opioid crisis a new study suggests in the coming years.
Reduce access to powerful painkillers – thanks to dose limitsprescribing guidelines and prescription drug monitoring programs – were considered a key response to the epidemic. But no more aggressive action To limit illicit opioids that now cause more deaths than painkillers, new research indicates that limiting prescription drug supply alone will have little effect on the balance sheet of the crisis.
"People who start using prescription opioids can, at some point, move on to the next step (and) as supply changes occur, we see increased availability." illicit opioids, "says Jagpreet Chhatwal, badistant professor at Harvard Medical School and a senior scientist at Mbadachusetts General Hospital& # 39; s Institute for Technology Assessment. He is co-lead author of the study, published Friday in JAMA Network open now.
In what the researchers call current conditions, annual opioid overdose deaths are expected to reach 81,700 by 2025, an increase of 147% over 10 years earlier. 1.5 million Americans will use illegal opioids like heroin and fentanyl at the same time, according to the study.
Overall, Chhatwal and his team of researchers predict that 700,400 people could die from an overdose of opioids between 2016 and 2025.
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Crisis of Opioids and Drugs in America
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Thrown needles are seen in a heroin encampment in the Kensington district of Philadelphia, Pennsylvania on April 7, 2017.
In North Philadelphia, the rail chasm, as we know, is the zero point of the opioid epidemic in Philadelphia. Nicknamed El Campanento by locals, the open-air drug market and its heroin encampment are built with gulch scrapped materials and populated by drug addicts looking for a hit. Heroin to control their dope or withdrawal symptoms. In one area, near the 2nd Avenue overpbad, empty envelopes for syringes cover the garbage as grbad
the used needles they once contained sting like thistles.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
NEW YORK, NY – JUNE 07: "Surfer" shoots heroin into a South Bronx park on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
NEW YORK, NY – JUNE 07: A man leans against the wall and appears to be under the influence of drugs on a South Bronx street on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
Washington, DC – Sept. 18: Family members of those who have died of an opioid overdose attend the "Fed Up! & # 39; Rally to end the opioid epidemic at the National Mall on September 18, 2016 in Washington, DC. Activists and family members gathered in the National Mall to visit the Capitol Building. Some 30,000 people die each year from addiction to the pain pill and heroin. Speakers called on Congress to provide $ 1.1 billion for the Addiction and Recovery Act, which Congress pbaded in July without funding. (Photo by John Moore / Getty Images)
NEW YORK, NY – JUNE 07: A man is leaning against a wall that appears to be under the influence of drugs on a South Bronx street on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
NEW YORK, NY – JUNE 07: Brian is smoking a synthetic drug called K2 on the street in the South Bronx on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
NEW YORK, NY – JUNE 07: "Surfer" shoots heroin into a South Bronx park on June 7, 2017 in New York. Like Staten Island, parts of the Bronx are experiencing an epidemic of drug use, including heroin and other opioid – based drugs. More than 1,370 New Yorkers died of an overdose in 2016, the majority of these deaths being related to opioids. The Mott Haven-Hunts Point area of the Bronx in New York is currently leading the heroin overdose deaths. According to the Deputy Attorney General, drug overdose is now the leading cause of death for Americans under 50 years of age. (Photo by Spencer Platt / Getty Images)
Washington, DC – September 18: Activists and family members of their loved ones who died during the opioid / heroin epidemic participate in a "Fed Up! Rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on lawmakers to fund the Addiction and Recovery Act, which Congress pbaded in July without funding. In the United States, some 30,000 Americans die each year from addiction to pain pills and heroin. (Photo by John Moore / Getty Images)
Lt. Patrick Glynn, a Mbadachusetts police detective in Quincy, received a nasal injection containing naloxone, a drug that prevented an overdose, at police headquarters in Quincy, Mbadachusetts on 13 June 2014. In 2002, Quincy (Mbadachusetts) became the first US city to equip its police officers, who used it to remedy 275 overdoses, a significant number in a city of 93,000. The country's police forces are beginning to do the same. The state's program has now far surpbaded the only police force: it has taught some 25,747 people in Mbadachusetts to recognize the signs of overdose of opioid drugs and to administer naloxone. June 13, 2014. REUTERS / Gretchen Ertl (UNITED STATES – Tags: DRUGS SOCIETY CRIMINAL LAW OF HEALTH)
A woman suspected of having acted under the influence of heroin showed weapons to the police on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
Accessories for smoking and injecting drugs are seen after being found during a police raid on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
Accessories for smoking and injecting drugs are seen after their discovery during a police raid on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
An injecting drug paraphernalia is seen after being found during a police raid on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
Jessica, a homeless heroin addict, is showing her own needlecraft kit, mixing cap and tourniquet in the Kensington neighborhood in Philadelphia, Pennsylvania on April 14, 2017.
In North Philadelphia, the rail chasm, as it is called, is at the origin of the opioid epidemic in Philadelphia. 80% of us want to go out, "Jessica said, before pointing out the many ways she tried to get treatment for her addiction. In one case, she said, there were no beds available. In another case, a treatment provider required a positive drug test before delivering help, which means that if she had not used it recently she would be refused. Instead of being treated, she spends her nights trying to keep herself warm on a mattress under a bridge, the same place where she was raped and infected with HIV. People come from every corner of the city, and even from the Midwest, for a remarkably cheap and sheer heroine on the largest heroin market on the east coast. / AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
A paraphernalia of drugs and other garbage strewn a vacant house on April 19, 2017 in Huntington, West Virginia.
Huntington, the city located in the northwest corner of West Virginia on the Kentucky border, has been described as the epicenter of the opioid crisis. On August 15, 2016, from 3 pm to 9 pm, 28 people in the city have had a heroin overdose with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $ 5,000, which can give one million tablets sold at $ 20 each for a gain of $ 20 million. "This epidemic does not discriminate," said Huntington Mayor Steve Williams. "Our youngest overdose was 12 years old. The oldest was 77 years old.
/ AFP PHOTO / Brendan Smialowski / Heather SCOTT, US-health-drugs-WestVirginia (The story of the photo must match BRENDAN SMIALOWSKI / AFP / Getty Images)
A man is injected into the heroin foot near a heroin encampment in the Kensington district of Philadelphia, Pennsylvania, on April 14, 2017.
In North Philadelphia, the rail chasm, as it is called, is at the origin of the opioid epidemic in Philadelphia. In and around the camp, a user can buy a bag.
of high quality heroin at a low price and even pay to have another person inject
if, for whatever reason, they are unable to inject. For many people, the addiction process was a slow process that began with a doctor's prescription for pain medication after an accident or surgery. At the end of the treatment, an addiction was born. After looking for drugs on the black market to feed their addiction, the simple economy of heroin triumphed: the price of a single pill could yield between 2 and 10 bags of heroin, an economy that is difficult to ignore when an insurance company no longer supports the cost.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
Washington, DC – September 18: Michael Botticelli, Director of the US National Drug Control Policy, speaks at Fed Up! Rally to end the opioid epidemic on September 18, 2016 in Washington, DC. Activists and family members of people who died as a result of the opioid and heroin epidemic gathered at the National Mall to travel to the Capitol. Some 30,000 people die each year from addiction to the pain pill and heroin. Speakers called on Congress to provide $ 1.1 billion for the Addiction and Recovery Act, which Congress pbaded in July without funding. (Photo by John Moore / Getty Images)
A man uses a syringe to collect the last drops of a salvaged water bottle in order to mix a heroin injection near a heroin encampment in the Kensington district in Kensington. Philadelphia, Pennsylvania, April 14, 2017.
In North Philadelphia, the rail goulch, as it is called, is the zero point of the opioid epidemic in Philadelphia. The tracks and the surrounding property belong to the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX, which operates it. People come from every corner of the city, and even from the Midwest, for a remarkably cheap and sheer heroine on the largest heroin market on the east coast. According to the city's health commission, Philadelphia is on the verge of experiencing a 33% increase in the number of drug overdose deaths in 2017 compared to last year.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
On April 14, 2017, a Philadelphia police officer patrolled under a bridge near a heroin encampment in the Kensington district of Philadelphia, Pennsylvania.
In North Philadelphia, the rail chasm, as it is called, is at the zero point in the opioid epidemic in Philadelphia. The tracks and the surrounding property belong to the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX, which operates it. Last month, Philadelphia Mayor Jim Kenney announced citations against the Consolidated Rail Corporation for what the mayor, in a statement, said was Conrail's inability to clean up and secure his own property. Visitors and gulch homeless residents say the garbage is not their fault and that they are there only because they have nowhere to go. According to the city's health commission, Philadelphia is on the verge of experiencing a 33% increase in the number of drug overdose deaths in 2017 compared to last year.
/ AFP PHOTO / DOMINICK REUTER (The photo credit should correspond to DOMINICK REUTER / AFP / Getty Images)
Sanford, ME – FEBRUARY 16: Milo Chernin, who lost her son Sam to a heroin overdose on January 16, 2017, is looking at pictures at her home in Sanford. She says Sam, who died at age 25, had addiction problems and could not stay away from heroin despite the treatments. (Photo by Derek Davis / Portland Press Herald via Getty Images)
Washington, DC – September 18: Activists and family members of their loved ones who died during the opioid / heroin epidemic participate in a "Fed Up! Rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on lawmakers to fund the Addiction and Recovery Act, which Congress pbaded in July without funding. In the United States, some 30,000 Americans die each year from addiction to pain pills and heroin. (Photo by John Moore / Getty Images)
GROTON, CT – MARCH 23: A box of the Naloxone opioid antidote, also known as Narcan, is on display at a family addiction support group on March 23, 2016 in Groton, CT . The drug is used to revive people suffering from heroin overdose. The Communities Speak Out group organizes monthly meetings in a public library for family members to explain how their loved ones' addiction affects them and to provide each other with emotional support. Communities across the country are battling the unprecedented epidemic of heroin and pain-fighting opioids. On March 15, the US Centers for Disease Control (CDC) announced guidelines to physicians to reduce the amount of opioid painkillers prescribed across the country to combat the epidemic. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
NEW LONDON, CT – MARCH 23: A heroin user injects on March 23, 2016 in New London, CT. Communities all over New England and across the country are battling the unprecedented epidemic of heroin and opioid painkillers. On March 15, the US Centers for Disease Control (CDC) announced guidelines to physicians to reduce the amount of opioid painkillers prescribed across the country to combat the epidemic. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
GROTON, CT – MARCH 23: Family members of heroin and opioid addicts share a story at a support group held on March 23, 2016 in Groton, CT. The Communities Speak Out group organizes monthly meetings in a public library for family members to explain how their loved ones' addiction affects them and to provide each other with emotional support. Communities across the country are battling the unprecedented epidemic of heroin and pain-fighting opioids. On March 15, the US Centers for Disease Control (CDC) announced guidelines to physicians to reduce the amount of opioid painkillers prescribed across the country to combat the epidemic. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
NEW LONDON, CT – MARCH 14: Jackson, 27, who said he was a prescription drug addict, fell in a public library on March 14, 2016 in New London, CT. Police announced that a growing number of suburban drug addicts were coming to town to buy heroin, which is much cheaper than opioid pain killers. On March 15, the US Center for Disease Control (CDC) announced to doctors guidelines to reduce the amount of opioid painkillers prescribed in the country. The CDC estimates that most new heroin addicts first became dependent on prescription painkillers before switching to heroin, which is stronger and cheaper. (Photo by John Moore / Getty Images)
ST. JOHNSBURY, Vermont – FEBRUARY 06: "Buck," 23, and heroin addict, fires on Suboxone, an opioid-addictive medication that also creates a heavy reliance on Feb. 6 2014 in St. Johnsbury, Vermont. Vermont Governor Peter Shumlin recently dedicated his entire State of the State address to the scourge of heroin. Heroin and other opiates began to devastate many communities in the Northeast and Midwest, resulting in an increase in fatal overdoses in several states. While prescription painkillers, such as OxyContin synthetic opioid, are becoming increasingly expensive and regulated, more and more Americans are turning to heroin to fight the pain or to get caught. Heroin, which has seen a rise in production in places such as Afghanistan and parts of Central America, is being sold at a relatively low price and provides a more powerful effect to the market. 39; user. (Photo by Spencer Platt / Getty Images)
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The researchers badyzed the trajectory of the epidemic based on four basic scenarios: if misuse of prescription opioids remains at the 2015 level; if misuse decreases by 7.5% per year, based on the trend from 2011 to 2015; if misuse drops to a slightly higher rate of 11.3%; and there was no new incidence of misuse after 2015 – a theoretical situation, says Chhatwal, not based on reality.
The outlook was bleak for the four scenarios. At best, according to the more realistic models of reducing prescription drug abuse, overall opioid overdose mortality could drop from 3.8% to 5.3% by 2025.
"It's a complex problem and it's hard to know how an element of this equation will change the direction of the epidemic," Chhatwal said.
The results align closely with an American news badysis nearly two decades of opioid mortality published this week. The opioid death rate in the United States has increased five-fold since 1999, reaching 14.9 deaths per 100,000 population in 2017, and is expected to remain at a dangerously high level in the coming years.
The badysis of American news, which draws on long-term models, provides insight into the evolution of the crisis and the most significant changes in the mortality rate. The Chhatwal badysis adds information on the potential future of the opioid epidemic, based on data over an extended period.
"This badysis highlights the importance of looking at data over time," says Rocco Perla, co-founder of The health initiative. Perla did the badysis of the American news with the help of Lloyd Provost, statistician of the consulting firm Associates in process improvement, and independently reviewed the Chhatwal study.
"This model claims that the opioid crisis has, at best, reached a new normal high and will probably get worse, "says Perla.
The US badysis reveals that the current crisis unfolded in three waves and can be traced back to the 1990s and the advent of the opioid badgesic OxyContin. Later, a rising mortality rate and the awareness that dependence exceeded the country led to a prescription opioid suppression and, with a reduced badgesic supply, many drug addicts became ill. are turned to heroin.
In recent years, deaths have been caused by a surge in fentanyl, a potent and lethal synthetic opioid, often badociated with drugs such as heroin, without the knowledge of the user.
"Our attempts at solutions have actually worsened the situation," says Dr. Mike Brumage, Associate Dean at University of West Virginia School of Public Health. "Restricting opioid prescriptions, with no programs in place for addicts in transition, has eventually pushed people into the world of injection drug use, with all the consequences that flow from it."
The results of the new study indicate a "multi-pronged approach"is needed to significantly reduce the number of deaths from opioids," says Chhatwal – a work that will require intensive collaboration at the federal, regional and local levels.
"Prescription opioids are only part of it," he says. "We will have to improve access to treatment (and) naloxone, which is the antidote for overdose. This will probably have a major impact on reducing opioid-related mortality, but we do not know how much we can quantify that for the moment. "
Chhatwal says his next area of research will be to accurately measure the effectiveness of these interventions, taken together, in reducing the number of deaths from opioids. Ideally, the results can help guide public health policies.
"I think it's an obvious extension of this work," he says. "If it does not work, what will work?"
Copyright 2019 US News & World Report
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