Kelly O’Reilly was angry at her brother, Michael McGovern, when he died.
In February, their mother called to let her know that he was sick. But O’Reilly thought, “here we go again with the cycle,” a cycle of doctor visits, pain prescriptions and self-medicating overdoses. The next time O’Reilly and her mother would talk it would be over video chat showing a coroner and emergency medical team taking McGovern’s body away. That night, McGovern’s overdose had turned fatal.
The siblings were close friends; McGovern moved to Ireland to help O’Reilly raise her two daughters, and the two would joke and fight and watch movies together. But the family’s fun-loving “Peter Pan” turned into a monster when he was not high.
McGovern was prescribed his first opoid pill after his back was injured in a fight at the bar he worked. By the time he died, he had collected more than 250 bottles of OxyContin prescribed by multiple doctors. He kept them in his room along with his journal that had entries marking periods of anger and frustration when doctors wouldn’t prescribe pills and others of pain and depression that came from embarrassment with his addiction.
McGovern’s case underscores a growing challenge for public health care specialists: the substantial rise of opioid-related deaths among young adults around the world.
Individuals between 20 and 29 years old in high-income countries are between three and four times more likely to die due to opioid use disorders than they were 20 years ago, according to data from the Institute for Health Metrics and Evaluation, an independent research center at the University of Washington. In countries where abuse of the drug is worst — including Norway, Greece, Denmark and the U.S. — up to 30 percent of deaths in that age range are opioid-related.
Opioids encompass all natural, synthetic and combination versions of drugs from opium, an active ingredient in the poppy flower, including morphine, heroin and codeine. The compounds bind to receptors throughout the body, including the brain, relieving pain and creating a high.
Dr. Marla Kushner, medical director of the New Hope Recovery Center in Chicago, links the opioid abuse to the introduction of OxyContin, a brand-name oxycodone narcotic used to treat moderate to severe pain. OxyContin hit the market in 1996 and by 2001, the year it w as prescribed to McGovern, it was the best-selling narcotic pain reliever in the U.S.
“OxyContin is great for pain relief, but the doctors prescribing it did not realize how addictive it could be,” Kushner says. “Addiction needs to be viewed like any other potentially fatal disease, like cancer or diabetes, and doctors need to be even more careful with what they’re prescribing.”
Often, as with McGovern, dependence on opioids starts with a prescription to treat acute pain and, due to tolerance build-up, leads to overdose.
A study on prescription drug use in the European Union found that 16 percent of individuals using opioids without a prescriber’s authorization obtained them fraudulently from a doctor, by exaggerating pain symptoms, for example. More than half of those surveyed received or bought the prescription pills from a friend or family member who were prescribed them.
The U.S. is by far the largest market for prescription opioids. But prescriptions for OxyContin have fallen 40 percent since 2010, according to an in-depth study by the Los Angeles Times, and its drugmaker is turning its gaze abroad. An opinion piece from the Washington Post warns “the opioid epidemic could turn into a pandemic if we’re not careful.”
A combination of factors create a “monster” that young adults are most susceptible to, says Jason Shiers, a psychotherapist with Addiction Helper in the U.K. and former addict.
“When you grow up with the internet, you know you can find anything on there,” he says. “It’s easy to hide behind a computer,” and if caught, prescription opioids carry less stigma than many other drugs; it’s socially acceptable to say you’re struggling with pain or sleeping.
But it also comes down to biology.
The prefrontal cortex, the part of the brain that governs judgment and rational decision-making, isn’t fully developed until about age 25. This leaves young adults looking for “quick fixes,” says Kushner, in both using drugs and treatment.
“Young adults are lots of times still under support of their family members, so getting them to be more independent and do the things they need to do [to curb the addiction] can be very challenging,” she says.
Access to opioids and various treatment options for addiction can differ greatly between country borders.
In the U.S., “doctor hopping” is common among individuals who use opioids. A disjointed health system makes it difficult for doctors to review their patients’ comprehensive medical history and easy for addicts to collect a large number of prescriptions in a short period of time.
This is less common in Europe, where universal health-care systems cater to better electronic record-keeping and stricter access to medications.
The “doctor hopping” methods McGovern had relied on in the U.S. were impeded while he was living with his sister in Ireland. In that country, each patient has a unique identification number that links all of their doctor visits, prescriptions and other health records together in one place.
But there is little evidence to show that limiting the supply of opioids reduces use of the drugs.
Global opium production was nearly cut in half between 2014 and 2015 and more than 600 tons of opioids were seized, according to the United Nations 2016 World Drug Report, but the number of opioid-users has remained steady and kept market demand high.
While in Ireland, McGovern raided his uncle’s veterinary practice where he kept ketamine in doses large enough to tranquilize horses.
The key to curbing use, advocates say, lies in support from public officials who actively build awareness of the issue and fund treatment programs. Instead of focusing on the criminalization of illegal trade across borders and individual possession of opioids, they say better solutions lie in reforming addiction treatment options and attitudes toward them.
“It entails a lot of effort and, politically, is not always popular, but there has to be an effective evidence-based continuum of care that is supported by government officials and leaders,” says Gregory Bunt, president of the International Society of Addiction Medicine. This integrated effort includes dedicated funding, modifying laws and personally directing individuals toward treatment options.
In the 1980s and ’90s, the spread of HIV among heroin users had become a large problem in France. Prime Minister Alain Juppé made finding a solution to reduce associated harms a “very political issue,” encouraging policymakers to dedicate time and effort to productive discussions, says Jean-Michel Delile, senior clinical consultant with the European Monitoring Centre for Drugs and Drug Addiction.
Juppé and his budget minister, Alain Lamassoure, met with prominent addiction researcher Dr. Charles O’Brien , who convinced them to try something new. By 1996, France became the first country to offer opiate substitution treatment on a large scale by providing the opioid inhibitor buprenorphine. Rates of opioid-related deaths have stayed below 5 percent in France, as its neighbors have watched them rise dramatically.
In Greece, it wasn’t until 2010 that access to opiate substitution treatment programs was expanded under the Greek National Drug Action Plan. The Organisation Against Drugs, or OKANA, is the only group with legal permission to operate these programs, and there can be up to a three-year wait to enroll in the program in Athens, which is home to most of the country’s opioid users. Before 2010, opioid use disorders in the country accounted for nearly 20 percent of deaths among those between 20 and 29 years old.
In any case, experts are eager to shift the perception of addiction from a criminal issue to a medical one.
“Addiction is not willful misconduct,” Bunt says. “The addiction is so powerful it hijacks the individual’s mind, body and soul.”
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Millennials Especially Susceptible to Global Opioid Addiction originally appeared on usnews.com
