The First Snapshot of the Opioid Crisis: A Series
In recent years, the opioid epidemic has gained considerable attention because of its existing link to the transmission of infectious diseases—most prominently HIV. Solutions being implemented must aim to target both facets of this issue whilst enforcing awareness for future generations.
Apoorva Sudini - Newsletter Director
Drug overdose remains as one of the top leading causes of death in the United States. The opioid epidemic, in particular, snapshots this worsening public health crisis. Death rates from opioid overdoses have doubled between 2012 and 2016, reaching 40,000 deaths annually, translating to about 115 deaths per day. This nationwide issue specifically puts middle-aged Americans at risk, as they are the ones with greater chances of undergoing surgical procedures that require post-surgical prescription medications, which can lead to eventual addiction. A significant trend was observed in the mechanism of opioid misuse, as users transitioned from oral administration to insufflation to injection, as their addictions worsened. In recent years, the opioid epidemic has gained considerable attention because of its existing link to the transmission of infectious diseases—most prominently HIV.
In fact, about one in every ten new HIV diagnoses can be traced to either IDU or male-male sexual contact and IDU.
Approximately 1.1 million people in the US are currently living with HIV. Of this number, fifteen percent are unaware of their infections, which poses a huge risk, as precautions would not be undertaken. Historically, gay/bisexual men, Blacks, Hispanics and transgendered women have been at high risk for developing HIV due to unsafe sexual practices. However, sharing needles, syringes or other injection equipment, as is characteristic of IDU, also serve as perfect springboards for contracting such an incurable infection, as HIV is spread through transmission of bodily fluids. When examining the population of drug abusers within the burgeoning opioid epidemic, an increased risk of developing such conditions is observed especially since there is a higher chance that a drug-abusing individual would engage in sharing injection equipment. This adds to the HIV epidemic. In fact, about one in every ten new HIV diagnoses can be traced to either IDU or male-male sexual contact and IDU. Clearly, unsafe needle practices are being sustained in a society, furthering the HIV epidemic. Injection drug users are also at risk of contracting Hepatitis B and C (HCV)—the former of which cannot be cured. A notable 2015 case in Scott County, Indiana diagnosed 181 opioid-abusing individuals with a co-infection of HIV and HCV, demonstrating that new outbreaks are emerging from the practice of unsafe administration. Thus, as can be seen and as is emphasized in the problem statement, one of the main sources of concern that exists with IDU is that it furthers two dangerous crises: drug use and the epidemic of blood-borne pathogens. This expands the demographic of the affected population to the greater public, as the at-risk populations of both crises will overlap. Solutions being implemented must aim to target both facets of this issue whilst enforcing awareness for future generations.
Such numbers can be extrapolated to estimate the costs associated with harboring two conditions: HIV and addiction, as both are lifetime conditions.
The IDU issue affects the at-risk populations for HIV and opioid addiction significantly as they are the individuals who are partaking in unsafe practices. The LGBTQ+ and Black populations are particularly vulnerable due to discrimination present within healthcare; thus, these individuals may not receive treatment for their addictions and/or HIV infections for fear of discrimination. Typically, these trends are observed in rural/low-income areas, where access to healthcare is a huge problem and ends up furthering the crisis. Additionally, a stigma against HIV/AIDS diagnosis and drug addiction continues to persist, which increasingly discourages individuals from seeking out help/diagnostic testing to support their conditions. From an economic standpoint, this issue bears a heavy financial burden, as these at-risk populations are also more likely to require hospital attention. In analyzing the costs associated with opioid use from the past two decades, a significant rise can be seen from $11.8 billion in 2001 to $78.5 billion in 2016. Medicaid beneficiaries, particularly, are an incredibly high-risk population for substance-abuse disorder when compared to the rates found in the general population. While Medicaid attempts to help out the low-income struggling individuals, which tend to constitute much of the at-risk population for IDU, it ends up covering anywhere between 25% to 33% of opioid treatment—a huge financial strain on the American market. In fact, between 2011 and 2016, spending on naltrexone, naloxone and buprenorphine (medications used to treat opioid addiction) increased by almost 136%, implying the ever-growing presence of these conditions. Such numbers can be extrapolated to estimate the costs associated with harboring two conditions: HIV and addiction, as both are lifetime conditions.
Dawson, Lindsey, and Jennifer Kates. “HIV and the Opioid Epidemic: 5 Key Points.” The Henry J. Kaiser Family Foundation, 12 Apr. 2018, www.kff.org/hivaids/issue-brief/hiv-and-the-opioid-epidemic-5-key-points/.
Leslie, Douglas L., et al. “The Economic Burden of the Opioid Epidemic on States: The Case of Medicaid.” AJMC, 30 July 2019, www.ajmc.com/journals/supplement/2019/deaths-dollars-diverted-resources-opioid-epidemic/the-economic-burden-opioid-epidemic-on-states-case-of-medicaid?p=1.
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