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The Opioid Octopus: The Epidemic’s Many Tentacles

The opioid octopus, with its various debilitating tentacles, may have more in common with the ones who suffer than we first thought...

One would had to have resided in a parallel universe in 2016 not to have heard, read, or watched a story about the ever-worsening opioid epidemic plaguing America. It has been described as the worst drug crisis in American history, with death rates rivaling those of AIDS in the 1990s.[1] The overall death statistics continue to shock: drug overdose was the leading cause of accidental death in the U.S. in 2015,[2] and in 2014 there were 40% more deaths from fatal drug overdoses than car crashes.[3]   For an explanation of that, one need look no farther than opioid abuse.


There were 55,403 lethal drug overdose deaths in 2015, of which 20,101 related to prescription pain relievers and 12,990 related to heroin.[4] Opioids seemingly played an outsized role in deaths from substance use disorders, given that “[of] the 20.4 million Americans 12 or older that had a substance use disorder in 2015, 2 million had a substance use disorder involving prescription pain relievers and 591,000 had a substance use disorder involving heroin.”[5] The year 2015 marked the first time that there were more deaths related to heroin than from gun homicides; as recently as 2007, gun homicides led heroin deaths by a margin of over 5 to 1.[6]


The data from 2015 also shows the continuing strong connection between the misuse of the two principal types of opioids. Four in five of new heroin users started out misusing prescription painkillers, and the great majority of them switched to heroin because it was cheaper and easier to obtain.[7]


Although overdose deaths are the most serious consequence of opioid abuse, the opioid octopus has destructive tentacles touching many beyond the users themselves. There are severe emotional, psychological, and financial consequences borne by parents, siblings, and children of opioid addicts. Furthermore, there are billions of dollars of societal financial costs relating to healthcare, lost productivity, and criminal justice.


Parents and Siblings

Every addict comes from a family, so virtually every opioid addiction claims more than one victim. The heartbreak and anxiety experienced by parents of addicts is of a type unto itself. As one mother of an opioid addict put it, “You almost wake up and get this haunting feeling, the horrible feeling that my God, I just wish I wasn’t going to live today… Not that you would take your life but you’re so scared.”[8]


My oldest son lost his battle with addiction, and I cannot possibly convey the helpless feeling of not being able to help your child. Parents are being caught completely off-guard, finding themselves thrown into the midst of the opioid epidemic, with no answers or solutions and a serious lack of resources. Parents are listening to staff in hospitals and rehab facilities who often have very little expertise regarding opioid addiction – but their advice flows freely nonetheless. Parents are grasping for information and advice and frequently paying for services they pray will work, only to find themselves right back in the throes of their child’s addiction.   


The suffering inflicted on siblings can be as great as that experienced by parents. “If you’re the sibling of an addict, you’d better buckle up and grow some thick skin, because it’s almost guaranteed that you’ll become part of the collateral damage caused by your brother or sister’s struggles.”[9] The following is one of my daughters’ description of her experience.

Being a sibling of an addict feels almost hopeless. My large family is everything to me – nothing else comes close to mattering as much. So when my brother replaced family time with drug time, it really hurt. It almost felt as if I was not entertaining enough or that he did not love me, because he would choose the drugs over my siblings and me each time. All I wanted was my big brother, and all my big brother wanted was a fix. I wish I had known sooner that it was not actually my big brother; it was someone with a a disease (one of the most unforgiving, I might add). There is not anything you can do but give all your love and support, because even when your sibling does not believe in himself or herself, you have to believe.


Children

When addicts are also parents, a new, frequently helpless, and often tragic class of victims comes into being: the children of addicts. “Because parents who abuse alcohol or other drugs are more likely to be involved with domestic violence, divorce, unemployment, mental illness, and legal problems, their ability to parent effectively is severely compromised.”[10]  Children of substance abusers are at higher risk for an array of emotional, physical, mental health and other problems, including:

  • Physical and sexual abuse

  • Economic hardship

  • Stress-related health problems such as gastrointestinal disorders, migraines, and asthma

  • Psychiatric disorders such as anxiety and depression

  • Learning disabilities and difficulties in succeeding in school

  • Emotional issues ranging from mistrust of adults to shame of the “family secret” to fear of the parent’s death from the substance abuse.[11]

Of all of the consequences listed above, child abuse and neglect perhaps are the most disturbing. The opioid epidemic is making those consequences alarmingly more widespread. “Those on the front lines – doctors, judges, drug counselors – say they are seeing more and more cases… of opioid-addicted parents so focused on their next score that they neglect or abuse the children in their care.”[12] The Massachusetts Department of Children and Families has seen its caseload soar to record levels, and to many the obvious driver of that has been the opioid crisis in that state.[13] The number of children removed from their homes by Massachusetts’ DCF jumped 28 percent over the period from 2011-2014, and the Mass Memorial Children’s Medical Center in 2012 saw almost a doubling in the number of children admitted in both categories of serious physical abuse or less serious physical injuries.[14] Making all of this even more horrendous is that children of addicts who abuse them are more likely to become addicts and abuse their own children when they grow up.[15]


Thousands of children of addicts are now in foster care, having been taken away from abusive or neglectful addict parents. In 2016 the Georgia Division of Family and Children Services reported that as of mid-April that year, drug abuse had been a factor in about 40 percent of the nearly 2,400 cases in Georgia where a child had been removed from a family.[16] That represented a 25 percent increase from just two years prior.[17] The trauma experienced by children who are separated from siblings and forced to witness their families torn apart -- after already being subjected to significant troubles and hardships – is difficult to wrap one’s head around.    


Society at large

 The costs of the opioid epidemic extend far beyond the families of addicts. In a study completed in 2016, researchers concluded that the aggregate societal cost of prescription opioid overdose, dependence, and misuse was approximately $78.5 billion in 2013.[18] The study was based on the most recent set of data from the Centers for Disease Control and Prevention (covering 1999-2013) and was limited to prescription opioids because of limitations in the underlying data. In a previous study examining the same type of data from 2007, researchers pegged the estimate at $55.7 billion -- with the over $20 billion increase in 2013 reflecting the fact that from 2007 to 2013, the annual number of prescription opioid overdose deaths increased by over 1800, and the annual number of persons abusing or dependent on prescription opioids increased by over 200,000.[19] Approximately one-fourth of the estimated $78.5 billion was borne by the public sector in costs relating to health care, substance abuse treatment, and criminal justice costs.[20]


Over one-third of the $78.5 billion ($28.9 million) was due to health care and substance abuse treatment costs for non-fatal cases.[21] Approximately 90 percent of the funding from these costs comes from insurance, including substantial amounts from public health insurance programs (Medicare, Medicaid, and Champus/VA).


The remainder of the $78.5 billion fell into three categories: $20.4 billion for lost productivity in non-fatal cases, $7.7 for criminal justice, and $21.5 for lost productivity and health care in fatal cases.[22] The lost productivity costs related to reduced productive hours and time spent incarcerated. The criminal justice spending included costs for police protection, legal adjudication, incarcerations, and property lost due to crimes. Lost productivity costs from premature death in fatal opioid abuse cases were based on expected earnings from remaining lifespans.        

 

Society at large is affected not only financially by the upward spiral of opioid abuse, but also in everyday life. Two prime examples of that are the drug abuse-related increases in homelessness and driving under the influence. Substance use disorders are known risk factors for homelessness: In a recent survey by the United States Conference of Mayors, 68 percent of cities reported that substance abuse was the largest cause of homelessness for single adults.[23] Another study found that 25 percent of the homeless people surveyed pointed to drug use as the primary reason for homelessness.[24]


Homeless addicts generally are not a threat to public safety, but driving addicts are. For example, in 2015 drugged driving overtook drunken and distracted driving as a factor in Tennessee traffic fatalities.[25] Experts have attributed the increase to rising drug abuse, particularly of prescription medication, and the improved ability of law enforcement officers to detect drug-impaired drivers.[26] As of 2015, Tennessee led the nation in prescribing oxycodone, hydrocodone, and Percocet, and the state’s health care professional had the stunning distinction of writing more opioid prescriptions than the number of people in Tennessee – 1.18 prescriptions for every man, woman, and child in the state.[27]


Conclusion

 The opioid octopus, with its various debilitating tentacles, may have more in common with the ones who suffer than we first thought. Octopuses, like addicts, live fast and die young. Like most loving, suburbanite addicts I have met, an octopus has three hearts and the bluest of blood. Both are highly intelligent and can camouflage themselves to blend into their environment. Probably the most similar trait between the two is that their “arms” seemingly have a mind of their own – in the human case often betraying all logical thought and action. 


Opioid addiction is not just an individual disease, nor merely a family disease, it is a community disease afflicting many parts of America. It’s time for us to stand together and take charge.  


References

[1] Dan Nolan and Chris Amico, “How Bad is the Opioid Epidemic,” PBS (February 23, 2016)[2] "Opioid Addiction 2016 Facts & Figures,” American Society of Addiction Medicine

[3] Nolan and Amico, supra n. 1.

[4] ASAM, supra n. 2.

[5] Id.

[6] Christopher Ingraham, “Heroin deaths surpass gun homicides for the first time, CDC data shows,” The Washington Post ( December 8, 2016)

[7] ASAM, supra n. 2.

 [8] Kelly Wallace, “Being an addict’s mom: ‘It’s just a very, very sad place,’” cnn.com (August 28, 2014)

[9] Dean Dauphinais, “Siblings and the Ripple Effect of Addiction,’ heroesinrecovery.com (May 13, 2015)

[10]  “Effects of Parental Substance Abuse on Children and Families,” The American Academy of Experts in Traumatic Stress (2014)

[11] Id. See also Diane M. Hogan, “Annotation: The Psychological Development and Welfare of Children of Opiate and Cocaine Users: Review and Research Needs,” Journal of Child Psychology and Psychiatry, Vol. 39, No. 5, pp. 609-620 (1998).

[12] Michael Levenson, “Concern mounts on opioid crisis’ toll on children,” bostonglobe.com (October 17, 2015)

[13] Id.

[14] Id.

[15] Id.

[16] Michell Eloy, “Opioid Epidemic Drives More Ga. Kids Into State Care,” WABE 90.1 (June 3, 2016)

[17] Id.

[18]  Curtis S, Florence, Chao Zhou, Feijun Luo, and Likang Xu, “The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013,” The Journal of Medical Care, Vol. 54, No. 10, pp. 901-906 (2016).

[19]  Id.

[20]  Id.

[21]  Id.

[22]  Id.

[23] “Opioid Abuse and Homelessness,” National Alliance to End Homelessness (April 5, 2016)

[24] Id.

[25]   Mike Reicher, “Drugged driving overtakes alcohol in Tennessee road deaths,” The Tennessean (September 29, 2016)

[26]  Id.

[27] Holly Fletcher, “There are more opioid prescriptions than people in Tennessee,” The Tennessean (September 19, 2016)

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