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Opioid Abuse On The Rise, But Are We Missing A Much Bigger Problem?

It has become impossible to ignore the mainstream media coverage of the seemingly out of control opiate abuse epidemic.  There is good reason since in 2014 almost 30,000 overdose deaths were related to either prescription pain relievers or heroin. This represents a staggering 300% increase of the number of people that suffered from opioid related overdose deaths compared to 2002.   No wonder the Center of Disease Control (CDC) recently published the CDC Guideline for Prescribing Opioids for Chronic Pain in an effort to slow down this rapidly growing epidemic. In May of this year both houses of the “gridlocked” US Congress passed the Comprehensive Opioid Abuse Reduction Act by a surprising show of bi-partisan cooperation.

However, despite experiencing a 145% rise of opioid abusers since 2002, within the larger context of all substance use disorders that only represents 2.5 million or 12% of the total universe of people in the US that abuse substances.  If it is such a small percentage of the total problem, why is it receiving so much of the media attention?  Could it be because we are winning the war on drugs and alcohol with the exception of the rampant opioid epidemic?  Maybe.  The overall number as well as the overall percentage of people that abuse alcohol and drugs has gone down consistently over the past decade.  Remarkably, we have seen a 6% drop in the number of people afflicted with alcohol use disorder (AUD) from 18.1 million to 17 million people.  Shouldn’t that give us reason to celebrate?

Number of people in US age 12+ afflicted with Substance Use Disorder (SUD)
2002 2006 2010 2014
Alcohol Only 14.9M 15.6M 15.0M 14.4M
Alcohol & Drugs  3.2M  3.2M  2.9M  2.6M
Total Alcohol    18.1M 18.8M 17.9M 17.0M
Drugs Only  3.9M  3.8M  4.2M  4.5M
Total Drugs  7.1M  7.0M  7.1M  7.1M
Total Drugs & Alcohol 22.0M 22.6M 22.1M 21.5M
% of Pop 12+ 9.4% 9.2% 8.8% 8.1%

Results from 2002, 2006, 2010 and 2014 SAMHSA National Survey on Drug Use and Health

And while the overall number of people suffering from drug and alcohol abuse declined by “only” 500,000 people from 22 million in 2002 to 21.5 million in 2014 that represented more than a full point drop in the percentage of people that are affected in the US population 12 and older.  If nothing else, this significant reduction from 9.4% to 8.1% should serve as a source of encouragement that significant change on a large scale is possible.

However, when one examines the trends by drug of choice it becomes evident that while the total number of drug abusers in the US has been stable at approximately 7 million people the explosive growth of heroin abusers stands out, especially compared to the steep drop in the number of people that abuse cocaine.  One explanation could be that it is just a natural market phenomenon where a lower priced and more widely distributed product (heroin) is gaining market share at the expense of its higher priced, less available competition (cocaine).

Number of people in US afflicted with Drug Use Disorder (DUD)
2002 2006 2010 2014
Marijuana 4.3M 4.2M 4.5M 4.2M
Pain Medication 1.5M 1.6M 1.9M 1.9M
Heroin   .2M  .3M  .4M    .6M
Cocaine 1.5M 1.7M 1.0M .90M

Results from 2002, 2006, 2010 and 2014 SAMHSA National Survey on Drug Use and Health

Regardless of what has been driving the much publicized rapid rise of heroin abuse we would argue that a different number deserves at least as much, if not more attention.  It’s a number that is 34 times larger than the 586,000 people that abused heroin in 2014 and has barely changed since 2002. It is the number of people that suffered from substance use disorder and did not receive treatment. And that number is 20 million, actually 20.2 million to be exact for the year 2013.  Even though SAMSHA has not yet published the official survey results for 2014 and 2015 it would be very surprising if this number has dipped below 20 million.

Number of People Needed/Received Treatment for Sud at Specialty Facility
2002 2006 2010 2013
Needed Treatment 22.8M 23.6M 23.1M 22.7M
Received Treatment  2.3M  2.5M  2.6M  2.5M
% of SUD 10% 10.6% 11.2% 11%
Needed Treatment, Didn’t Receive It 20.5M 21.1M 20.5M 20.2M

Results from 2002, 2006, 2010 and 2013 SAMHSA National Survey on Drug Use and Health

As a society and as health care providers we have to ask ourselves: Is it acceptable that year in and year out we stand by while 20 million US citizens and their families suffer from this debilitating, chronic illness without ever providing them the treatment they need?  And if our answer is no, that it is not acceptable, what are we going to do about it?  There is not a simple solution, especially since the primary reason for not seeking treatment is that people that need treatment tend to be in denial and refuse to believe that they need it.  The challenge the C.A.R.I. team has posed themselves and we would like to pose to all of you is the following:  How can we use technology, specifically digital technology, to help more people realize that they have this chronic illness and encourage them to seek treatment?

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