The opioid crisis continues to evolve, and so must our approaches to combating it. With the face of this crisis changing, it is imperative that treatments catch up to meet the shifting needs of those affected.
From prescription painkillers to illicit drugs like fentanyl, the opioid epidemic has devastated communities and claimed countless lives. However, as the crisis deepens, new trends are emerging. Drug use has surged among different age groups and demographics, including seniors and minority populations. Additionally, there is a growing concern over the misuse of opioids in combination with other substances such as benzodiazepines or cocaine.
In order to effectively address these changing dynamics, we need to re-evaluate and enhance our treatment strategies. Traditional approaches may not be sufficient or appropriate for the diverse range of individuals affected by the crisis today. By embracing a comprehensive and personalised approach that considers factors such as co-occurring disorders and social determinants of health, we can offer more effective solutions and greater hope for recovery.
Join us as we examine the evolving face of the opioid crisis and explore the pressing need for treatments to adapt and keep pace with these changes.
Case Study:
During her time in high school, Kelly Stevens first experienced back pain.
Though the cause was unknown, the pain persisted. Finally, an X-ray revealed a herniated disc, and her doctor informed her that she was developing degenerative disc disease. He prescribed Percocet for her. At home, Kelly noticed that taking more than one Percocet at a time provided significant relief. She would sometimes take five or six in a row.
“I always knew I should stay away from drugs,” she says. She had smoked cigarettes and marijuana with her mother, who struggled with substance use disorder, but she had never used anything stronger. “Taking something prescribed by my doctor, it didn’t register that there was a risk involved. I didn’t think something like that could happen to me.” When her prescription ran out, Kelly didn’t want to use opioids, but she remembered how good it had felt.
A few years later, she began experimenting with “bath salts” (synthetic cathinone’s), and later, with Xanax, meth, and heroin.
For years, Kelly struggled to find treatment for her opioid use disorder. She would detox, then purchase pills again, enrol in new programs, and relapse. In 2021, she crossed a line for the first time, snorting a Percocet before ending up in bed with her boyfriend. “He tried to turn me over, and I was blue,” she says. Her boyfriend called 911 and started performing CPR. What no one knew at the time was that Kelly was pregnant.
Kelly is one of the millions of women who have struggled with opioid use disorder over the past decade. But unlike the estimated 80,411 people who died from an opioid overdose in 2021, Kelly survived.
The Evolving Demographics of Opioid Addiction
The opioid crisis has historically been associated with younger populations, particularly those in their twenties and thirties. However, in recent years, the demographics of opioid addiction have shifted dramatically. Seniors, who may have been prescribed opioids for chronic pain management, are now experiencing higher rates of addiction. This is a concerning trend as older individuals may be more vulnerable to the harmful effects of opioids and face unique challenges in accessing appropriate treatment.
Additionally, minority populations have been disproportionately impacted by the opioid crisis. Factors such as socioeconomic disparities, limited access to healthcare, and cultural stigmas surrounding addiction contribute to the higher rates of opioid misuse and addiction within these communities. It is crucial that treatment approaches are tailored to address the specific needs and barriers faced by minority populations in order to ensure equitable access to care and better outcomes.
The changing demographics of opioid addiction necessitate a shift in our treatment strategies. A one-size-fits-all approach is no longer sufficient. Instead, treatment programs must be adaptable and responsive to the unique needs and circumstances of different populations.
Factors Contributing to the Changing Face of the Opioid Crisis
Several factors have contributed to the changing face of the opioid crisis. One significant factor is the overprescribing of opioids for pain management. In the past, healthcare providers may have been more liberal in prescribing opioids, leading to a larger number of individuals becoming dependent on these medications. Efforts to address this issue have led to stricter prescribing guidelines and increased awareness among healthcare professionals regarding the risks of opioid misuse and addiction.
Another contributing factor is the rise of synthetic opioids, such as fentanyl. These potent drugs have flooded the illicit drug market, resulting in a surge in overdose deaths. The increased availability and potency of opioids have fueled the crisis, making it even more challenging to combat.
Furthermore, the intersection between opioid addiction and other substances, such as benzodiazepines or cocaine, presents additional complexities in treatment. Polydrug use can exacerbate the health risks associated with opioid addiction and complicate the recovery process. It is crucial that treatment programs address these co-occurring substance use disorders comprehensively to improve outcomes and reduce the risk of relapse.
It has been 10 years since the U.S. Department of Health and Human Services declared opioid abuse a national epidemic and 10 years since opioids were prescribed freely and in large quantities. However, the same tragic overdose stories that were prevalent in the early 2000s are still occurring. For women, the situation is even worse.
The opioid epidemic has been steadily gaining momentum for women in recent years, although it tends to receive less media coverage and attention than what is happening among young men but it is now impossible to ignore.
From 1999 to 2021, opioid overdoses in women increased by 1,608%, compared to 1,076% in men. And during the COVID-19 pandemic alone, from 2019 to 2021, overdose deaths for women increased by 40%. (While men still outnumber women in overdose deaths by a ratio of almost three to one, women feel the epidemic’s burden in different and complex ways.)
It is crucial to understand just how much the pandemic’s impact on social support systems, combined with a growing supply of cheap, legal and illegal fentanyl in the U.S., has contributed to the current crisis. Women of colour and mothers have been particularly hard hit. From 2018 to 2021, overdose deaths tripled for pregnant and postpartum women between the ages of 35 and 44, according to a November 2023 survey from the National Institutes of Health. And overdose deaths for people of colour nearly tripled from 2015 to 2021, making overdoses the fourth leading cause of death for people of colour, after cancer, heart disease, and COVID-19, according to a survey from researchers at the University of Pennsylvania.
Yet, for the past decade, providers have not focused on treatment tailored for women, says Caitlin E. Martin, MD, MPH, an OB-GYN and addiction medicine provider at Virginia Commonwealth University. “We’re just catching up to what’s been going on the whole time.”
In the late 1800s, doctors began prescribing morphine – a strong opioid now primarily used in pain management, minor surgeries, and cancer care – to “hysterical” mothers. At that time, the drug was used to treat reproductive diseases, pain, and what would now be diagnosed as chronic fatigue. “Uterine and ovarian complications caused more women to become addicted than all other diseases combined,” wrote Dr. Frederick Heman Hubbard in a 1881 book on opioid addiction and alcoholism.
By the early 1900s, women made up 60% of people addicted to opioids. That epidemic subsided after the federal government began regulating drugs in 1906, but it resurfaced in the 1990s when drug companies began aggressively marketing opioids like OxyContin for quick, effective pain relief. By 2004, OxyContin had become a top drug of abuse in the US. And because women experience more chronic pain (such as that caused by fibromyalgia or endometriosis), doctors wrote them more prescriptions, says Dr. Martin. In fact, women were twice as likely as
In the United States, OxyContin became a widely abused medication by 2004. According to Dr. Martin, this was due to the fact that women experience more chronic pain, such as fibromyalgia and endometriosis, and were therefore prescribed more medications. In fact, a 2017 study by researchers at Brandeis College showed that women were twice as likely as men to be prescribed potentially addictive drugs.
However, during the first opioid epidemic, the government began cracking down on the illegal drug trade through the “War on Drugs,” which disproportionately affected women and mothers.
Chad Sabora, a well-known expert in harm reduction and drug policy, explains that society has used drugs to target specific communities, such as the “crack babies” of Black mothers during the 1980s. As drug policing increased, hospitals started drug-testing pregnant Black women for cocaine use, leading to reports of positive results to child protective services.
In 2016, when Congress passed a law to combat the opioid crisis, it once again targeted women by requiring doctors to report suspected child abuse, with many states interpreting positive drug screens as evidence of abuse. While the current opioid pandemic initially affected white rural communities the most, recent statistics show that Black Americans living in urban areas have also experienced high rates of overdose deaths.
In high school, Sue Watson turned to alcohol to cope with the challenges of being a biracial teenager. However, her senior year, she suffered a severe knee injury while playing volleyball, causing her to lose the athletic scholarship she was relying on. Her doctor prescribed pain medication, which led to her alcohol use becoming secondary. When the prescription ran out, she started traveling to Florida with friends who knew about “pill mills,” loosely regulated clinics that prescribed opioids.
In her 20s, Sue was arrested multiple times on drug charges. While in jail, a family friend sent her a copy of The Big Book, the AA handbook, which ultimately led her to seek help and become sober for nine years. However, the pandemic has put a strain on her recovery, as her support group meetings were no longer in person, but over the phone.
The University of North Carolina Horizons Program, which provides treatment for pregnant and parenting women with substance use disorders, saw a decline in attendance and even some deaths among their patients who were attending support groups like Narcotics Anonymous.
Dr. Hendrée Jones, an OB/GYN professor and senior consultant at UNC Horizons, explains that during the pandemic, there was a focus on physical health and safety, leaving mental health as a secondary concern. This, coupled with other factors such as the closure of treatment and harm reduction programs and the added stress of caring for children at home, led to a tragic combination. As a result, overdose rates and fatalities have skyrocketed, particularly among women. The pandemic has shed light on the fact that addiction is not a moral failing, but a chronic disease that affects the brain.
Opioids flood the brain with dopamine, a neurotransmitter responsible for feelings of pleasure, creating a hormonal response that can be 10 times stronger than natural rewards like food and social interaction. While not everyone who tries drugs will become dependent, genetics and traumatic experiences can increase the risk. However, with a better understanding of the biological mechanisms involved and efforts to reduce the stigma surrounding opioid use disorder, treatment centres have been able to develop effective programs.
“We have life-saving medications for opioid use disorder,” says Dr. Martin, referring to opioid agonists such as buprenorphine and methadone, which, when used correctly, can help individuals recover from addiction.
Challenges in Treating the New Demographics of Opioid Addiction
The changing demographics of opioid addiction bring forth unique challenges in treatment. For seniors, there may be additional considerations such as age-related health conditions, polypharmacy, and social isolation. It is essential to develop specialized treatment programs that address the physical, emotional, and social needs of older individuals.
Minority populations face barriers to accessing treatment due to various factors, including language barriers, cultural stigmas, and lack of representation in healthcare systems. To effectively treat these populations, efforts must be made to increase cultural competency among healthcare providers, improve language access services, and engage with community organizations that can help bridge the gap between individuals and treatment resources.
Another challenge is the stigma associated with opioid addiction. Many individuals, regardless of their demographic background, may be hesitant to seek treatment due to fear of judgment or societal repercussions. It is crucial to create a supportive and non-judgmental environment that encourages individuals to seek help and engage in treatment without fear of stigma.
The Need for Personalised and Comprehensive Treatment Approaches
To address the changing face of the opioid crisis, personalized and comprehensive treatment approaches are essential. Each individual’s journey through addiction and recovery is unique, and treatment programs must reflect this reality.
Personalized treatment involves tailoring interventions to meet the specific needs of each person. This may include considering co-occurring mental health disorders, addressing underlying trauma, and incorporating holistic approaches to support overall well-being. By taking a person-centered approach, treatment providers can better understand the factors contributing to addiction and develop targeted strategies for recovery.
Comprehensive treatment means addressing the various aspects of addiction and recovery. This includes not only detoxification and withdrawal management but also ongoing therapy, relapse prevention, and support for reintegration into society. By providing a continuum of care that extends beyond the immediate crisis, individuals have a higher chance of achieving long-term recovery.
Promising Treatments for Different Populations Affected by the Opioid Crisis
As the face of the opioid crisis changes, innovative treatment approaches are emerging to meet the diverse needs of affected populations. For seniors, specialized programs that integrate pain management strategies, geriatric care, and addiction treatment have shown promise. These programs focus on reducing opioid use while providing alternative pain management techniques and comprehensive support for older individuals.
Within minority populations, community-based initiatives that incorporate culturally sensitive approaches have been effective in engaging individuals in treatment. These programs recognize the importance of representation, language access, and community involvement in overcoming barriers to care. By working closely with community leaders and organizations, treatment providers can build trust and establish meaningful connections with individuals seeking help.
Additionally, medication-assisted treatment (MAT) has proven to be an effective approach for many individuals struggling with opioid addiction. MAT combines FDA-approved medications, such as methadone, buprenorphine, or naltrexone, with counseling and behavioral therapies. This comprehensive approach not only helps manage withdrawal symptoms but also addresses the underlying issues contributing to addiction.
Overcoming Barriers to Accessing Effective Treatments
While effective treatments exist, barriers to accessing them remain a significant challenge. One barrier is the lack of healthcare coverage or insurance that includes addiction treatment. Many individuals face financial constraints that prevent them from accessing the care they need. Addressing this barrier requires expanding insurance coverage and advocating for policies that prioritize addiction treatment as an essential component of healthcare.
Geographical barriers also play a role, particularly in rural areas where treatment resources may be limited. Telemedicine and telehealth initiatives have emerged as a promising solution to overcome this challenge. By leveraging technology, individuals in remote areas can access virtual consultations, counseling, and support groups, expanding the reach of treatment services.
Another barrier is the shortage of adequately trained healthcare professionals in the field of addiction medicine. To address this, it is crucial to invest in training programs and increase the number of healthcare providers specializing in addiction treatment. By expanding the workforce, more individuals can receive timely and quality care.
The Role of Education and Awareness in Combating the Opioid Crisis
Education and awareness play a vital role in preventing and addressing the opioid crisis. It is essential to educate healthcare professionals on safe prescribing practices, early intervention strategies, and the importance of addressing addiction as a chronic disease. By equipping healthcare providers with the necessary knowledge and skills, we can prevent unnecessary opioid prescriptions and identify individuals at risk of addiction early on.
Public education campaigns are also crucial in raising awareness about the risks associated with opioid use and the available resources for prevention, treatment, and recovery. These campaigns should be tailored to reach different demographics, addressing the specific needs and concerns of each population. By increasing awareness, we can reduce the stigma surrounding addiction and encourage individuals to seek help without fear of judgment.
Government Initiatives and Policies to Address the Changing Face of the Opioid Crisis
Government initiatives and policies play a crucial role in addressing the changing face of the opioid crisis. This includes implementing measures to reduce the availability of illicit opioids, improving access to treatment services, and supporting research and innovation in addiction treatment.
One important initiative is the expansion of naloxone distribution programs. Naloxone is a medication that can reverse opioid overdoses and save lives. By ensuring widespread availability of naloxone, more individuals have the opportunity to receive immediate intervention in the event of an overdose.
Additionally, policies that promote integrated care models, such as the integration of addiction treatment into primary care settings, can help increase access to treatment and reduce barriers. By incorporating addiction treatment into routine healthcare, individuals are more likely to receive timely intervention and ongoing support.
Government funding for research and innovation is also necessary to develop new treatment modalities and improve existing interventions. This includes supporting the development of non-opioid pain management alternatives, exploring new pharmacological approaches, and investing in the training of healthcare professionals specializing in addiction medicine.
As the face of the opioid crisis continues to change, it is crucial that treatment approaches adapt and keep pace with these changes. The evolving demographics of opioid addiction demand a personalized and comprehensive approach that addresses the unique needs and challenges faced by different populations.
By expanding access to effective treatments, overcoming barriers to care, and promoting education and awareness, we can make significant strides in combating the opioid crisis. Through collaborative efforts between healthcare professionals, policymakers, and community organizations, we can provide hope and support to those affected by addiction and work towards a future where opioid addiction is no longer a devastating force in our communities.
Let us join forces in embracing these necessary changes and ensuring that treatments evolve to meet the shifting needs of those affected by the opioid crisis. Together, we can make a difference and pave the way for a brighter future.