Map of life expectancy at birth from Global Education Project.

Thursday, April 30, 2015

More on The Opioid Abuse Epidemic -- it's really serious

Mostly what we hear about the epidemic is overdoses and overdose deaths. In Massachusetts, as the linked article tells us, the incidence of opioid-related deaths jumped by 33% from 2012 to 2014, and in fact killed more people than car crashes and guns combined.

This has happened due to an unfortunate confluence of two events. Back in the early '90s, the zeitgeist pendulum swung (I made up that phrase but I think it's okay) toward a perception that physicians had been too reluctant to prescribe opioids, backed by a factual belief that when people took them for pain, addiction rarely resulted. Alas, it does result unacceptably often if prescribing is not carefully managed and monitored. It is now contrary to consensus guidelines to prescribe opioids for chronic non-cancer pain, but it still happens quite often.

The second unfortunate event was the U.S. invasion of Afghanistan. The Taliban had banned cultivation of opium resulting in a constricted world supply, but once they were removed from power, Afghans started growing more opium than ever. As a result, heroin is abundant and cheap. It's expensive and relatively difficult to obtain illicit prescription opioids, so addicts often turn to heroin. But, you don't know the purity of what you buy on the street so overdoses are common.

A new study by Tolia et al identifies another ugly consequence. The proportion of babies born with "neonatal abstinence syndrome," i.e. born addicted to opioids due to their mother's use, increased from 7/1,000 births in 2004 to 27/1,000 in 2013. They didn't use a total national sample and they don't calculate the dollar cost, but neontal intensive care units are really expensive and the babies spent an average of 19 days there in 2013, accounting for 4% of NICU days, and more than 20% in some centers. (BTW, just to bust the stereotype, 76% of the mothers were white.)

Now, do get a grip. In the past there has been excessive hysteria over this. The babies generally recover without lasting harm, although their social circumstances may compromise their future health and well-being. They used to take the babies away from the mothers, but as far as I know doctors and child protection agencies are wiser now. In fact the rate of breast feeding in these circumstances has increased, according to the study. The babies do better when they are breast fed and that also implies that the mothers are immediately gotten into treatment. But . . .

That prevalence is really shocking. In more familiar terms it is 2.7%, in other words almost 3% of women giving birth in the U.S. are exposing their unborn babies to opioids. To me, there is definitely a wow factor to that.


Anonymous said...

I hope you don't mind if I steal your phrase 'zeitgeist pendulum'.

Cervantes said...

Go for it. I also coined Alcoa sombrero, seldom get credit.