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Medicine Interview Hot Topics: Opioid Crisis
In 2018, 128 people in the US died every day after overdosing on opioid drugs. The term opioids includes a vast array of different drugs, including prescription painkillers, synthetic opioids like fentanyl, heroin, and prescription drugs that have become ‘party drugs’ like oxycontin. The breadth of the opioid epidemic has been labelled a national crisis, affecting as it does public health, social health, and the economy. The CDC estimated the total economic burden of just prescription opioid abuse - ignoring other domains like the recreational use of heroin - as $78.5 billion a year. That cost includes healthcare, courts and criminal law costs, loss of productivity, and treatment for addiction.
Between 21% and 29% of patients prescribed opioid analgesics will go on to misuse them in some form, and between 8% and 12% will develop an opioid use disorder. Somewhere between four and six percent of those who misuse opioids will eventually move to using heroin.
80% of heroin addicts first misused prescription opioids.
2015 was the first year in which the average US life expectancy declined in the past 100 years - falling from 78.8 years in 2014 to 78.7 in 2015 - and onward to 78.5 in 2016 and 2017. This decline was directly linked to surging drug overdoses and suicides stemming from substance abuse problems - the opioid overdose rate increasing roughly sixfold from 1997-2017, and the overall drug overdose rate tripling.
How the Problem Developed
Doctors began to prescribe opioid analgesics with increasing frequency throughout the 1990s, leading to widespread misuse of the medications before it became clear just how addicted they were. Opioid overdose rates increased following increased prescriptions, with 47,000 US citizens dying from opioid overdoses in 2017 alone. However, the roots of the problem began in the 1980s, when pain became recognised as a problem that required adequate treatment, and US states began to pass pain treatment acts, which allowed physicians to aggressively treat pain with controlled substances. In 1995, the American Pain Society framed pain as a ‘vital sign’ that should be monitored, just as one monitors heart rate and blood pressure. Opioids were seen, around this time, as safer and less addictive than they previously had been and were prescribed for long term pain rather than short term issues - a use which they were largely inappropriate for in many instances.
The Situation Now, and the Future
Aiding the recognition of the opioid epidemic as a legitimate public health crisis are various related problems and disorders. Directly stemming from misuse come overdoses, and the increasing incidence of neonatal abstinence syndrome due to the abuse of opioids during pregnancy. Indirect problems include the spread of HIV/AIDS and Hepatitis C, through the sharing of needles. The US Department of Health and Human Services has therefore noted five priority areas that it seeks to treat or address. These are: improving the access to treatment and to recovery services, promoting the use of overdose-reversing drugs (notably naloxone), promoting better public health surveillance to strengthen our understanding of the problem and its scale, ensuring that research into pain and addiction has adequate support and investment, and advancing better practice in general for the management of pain. The National Institutes of Health (shortened to NIH) is the US’s primary research agency tasked with solving the opioid crisis through finding improved analgesic solutions, preventing misuse, and treating misuse and overdose. In April 2018, the HEAL initiative (Helping to End Addiction Long term) was launched, which is a trans-agency effort with the singular goal of developing and catalysing scientific solutions to the opioid epidemic.
Potential questions which may be asked in the interview
- Are you aware of the opioid epidemic?
- What caused the opioid epidemic here in the US?
- How might one go about trying to reverse the opioid epidemic?
- What factors have contributed to the scale of the opioid epidemic in the US?
- Why do you think that Europe has a far lesser problem with the misuse of opioid drugs?
- Why do you think that the death rate from opioids has increased so much in the last 20 years?
- What types of opioid drugs are most often abused?
- Why might someone legitimately be prescribed opioid drugs?
- Why might doctors feel a pressure to prescribe opioid analgesics to their patients?
How to answer questions on the opioid crisis
Be confident on the role of opioid drugs in healthcare, and try to have some statistics to hand that illustrate the scale of the epidemic. Have a clear answer on how the US can move forward and address this issue.