Drug and Opioid Epidemic Report

Drug overdose is a serious public health problem that now constitutes the leading cause of injury death in the United States.1 In fact, overall life expectancy in the United States decreased for a second consecutive year in 2016, largely due to younger people dying of drug overdose. Opioid abuse and misuse continues to drive the drug overdose epidemic. Calhoun County, like other communities in the United States, is also affected by the epidemic. This document provides a snapshot of the opioid epidemic in Calhoun County and briefly outlines a framework to address it from a public health perspective.

An opioid is a drug that eases pain and may also cause feelings of extreme pleasure. Opioids act on the brain and nerves and include both prescription medications and illegal drugs like heroin. Opioids can be addictive with regular use or misuse. An opioid overdose occurs when excess opioids act on the brain to decrease or stop a person’s breathing. Opioid dependence occurs when the brain adapts and only functions normally when opioids are present; when opioids are not present, a reaction known as withdrawal occurs. Opioid addiction is a long- term, relapsing disease of the brain characterized by compulsive drug seeking and use despite harmful consequences.2 Opioid addiction affects not only the lives of addicted individuals but families and communities as well. It is possible to be opioid dependent without being addicted since dependence and addiction occur within different parts of the brain.

Like most public health challenges, the opioid epidemic’s origins are multifactorial. First, an increase in supply of both prescription opioids and illicit opioids increased the risk for overdose in the population. With respect to prescription opioids, long term treatment with opioids, often for chronic pain, led to people spending more time at risk for overdose. In other words, both increased exposure and increased exposure duration to prescription opioids contributed to an increased risk of overdose. The misperception of opioids being low-risk medications for developing dependence or addiction also contributed to the rationalization of increased prescription opioid supply and the outcome of overdose. It is now well established that prescription opioids can be addictive with regular use or misuse. With respect to illicit opioids, increased potency of heroin and fentanyl made it much easier for a person to overdose as well. For persons who develop opioid dependence or addiction, fragmented systems of care between substance use treatment providers, healthcare systems, behavioral and mental health services, insurance providers and social services continues to hinder access and coordination of treatment. Finally, the perception of addiction as a moral defect continues to be counterproductive,3 because research, resources, interventions and treatment are then not aligned to address addiction for what it really is – a long- term, relapsing disease of the brain that has profound implications for families and communities.

The opioid epidemic can be quantified in several ways including fatal and nonfatal overdoses, the frequency of opioid overdose reversals with naloxone administration, substance abuse service utilization, law enforcement records, opioid prescription rates, behavioral risk factor surveys, rates of newborn opioid withdrawal, the incidence of drug-related infectious diseases, and personal testimony from community members. This report highlights the burden of opioid prescriptions, as well as fatal and nonfatal opioid-related overdoses in Calhoun County, Michigan.

Centers for Disease Control and Prevention , The National Institute on Drug Abuse , The United States Surgeon General