Methadone Maintenance Therapy is offered in Thailand to reduce harm for people dependent on injected opioids, like heroin. Credit: World Bank/Trinn Suwannapha
Opioids are a class of drugs that includes the illegal drug heroin as well as power pain relievers available by prescription, such as oxycodone (Oxycontin), hydrocodone (Vicodin), codeine, morphine, fentanyl, methadone, and many others.
By Geetika Chandwani and Purnaka L. de Silva
NEW YORK, Feb 10 2023 – The opioid addiction crisis in the United States is an acute public health emergency and a profound threat to national security – which is caused by the over-prescription, misuse, illegal production, and criminal trafficking and sale of opioid pharmaceutical drugs to Americans. It is estimated that over 130 people die every day from opioid overdoses in the U.S.
The crisis has been linked to the dramatic increase in the prescription of opioid pain relievers since the late 1990s, as well as the rise of the use of heroin and powerful, highly-addictive synthetic opioids, such as fentanyl.
The opioid addiction crisis has had a horrific impact at the individual, family, and community levels across the country, as well as on the U.S. healthcare system at the federal, state, and local level.
Opioid addiction in the U.S. has become a prolonged epidemic, threatening public health, economic output, and national security. Hundreds of people die every week from opioid-related overdoses, a toll that spiked across the country during the COVID-19 pandemic.
As communities, healthcare providers, and government agencies join forces in combating the epidemic of opioid overdose deaths and solving the opioid addiction crisis, it is not enough to focus all available resources on treating people already addicted to opioids.
The million-dollar question is how to prevent people that do not have opioid addiction disorders, from becoming addicted. In this equation, it is crucial to examine pain and its relationship with deficiencies for example as in the case of Vitamin D deficiency and its relationship to musculoskeletal health, and thereby address specific factors that may trigger the need for long-term opioid use.
Opioids are recognized as a legitimate medical therapy for selected patients with severe, chronic pain that does not respond to other treatments. However, there can be unintended consequences. According to Centers for Disease Control and Prevention (CDC) reports, nearly 500,000 people died from an overdose involving any type of opioid, including prescription and illicit opioids, from 1999-2019.
These overdose deaths are a direct cause of significant damage to the U.S. economy from lost spending, wages, and productivity, and indirectly from lower employment and other trickle-down effects.
Once seen as mainly affecting white people of Caucasian descent, the opioid crisis disproportionately harms people of color now. Unequally distributed insurance coverage, limited access to medical services, and serious racial disparities exist in the U.S. healthcare system.
According to the U.S. Department of Health and Human Services, African American and Hispanic and Latino American people receive worse pain care. And alarmingly, the number and proportion of Americans 65-years and older with Substance Use Disorders (SUDs) are increasing.
Musculoskeletal Disorders (MSDs) are the leading source of pain and disability globally but are especially prevalent in industrialized nations, including the United States. Pain associated with MSDs is prevalent among construction workers, which is followed by increased prescription opioid use.
Musculoskeletal injuries are also a severe problem in sports medicine. Chronic pain is more common among combat veterans than non-veterans and their injuries are often more catastrophic. According to the U.S. Department of Veterans Affairs, military veterans suffer long years of musculoskeletal injury-related limitations.
MSDs, such as degenerative spine, arthritic conditions, and osteoporosis, are the most common causes of chronic pain among the elderly. Approximately 10 million Americans have osteoporosis, and another 44 million have low bone density, placing them at increased risk. By 2050, the incidence of hip fracture is expected to increase by 240% and 310% in women and men, respectively.
Vitamin D affects muscle strength, muscle size and neuromuscular performance. Since Vitamin D is a crucial nutrient for bone health, it is critical to question whether Vitamin D deficiency contributes to chronic pain-related opioid addiction. Vitamin D deficiency is commonly seen in patients with chronic pain, and an even higher percentage of patients with musculoskeletal pain are found to be Vitamin D deficient.
The latest study by Massachusetts General Hospital proves that Vitamin D deficiency enormously exaggerates the craving for opioids, potentially increasing the risk of dependence and addiction. Vitamin D deficiency occurs when the body does not get enough Vitamin D from sunlight or diet.
About 42% of the U.S. population is Vitamin D deficient, with some people even having higher deficiency levels. This includes premenopausal women, those with poor nutritional habits, people over 65, and individuals who avoid even minimal sun exposure.
There are also concerns related to Vitamin D deficiency due to regular sunscreen usage. And many youngsters spend more time on computers, mobile phones and video games, and lack a regular exercise regime. National data shows that most American children over the age of eight do not get enough calcium, a deficiency that increases their risk of developing osteoporosis in adulthood.
Vitamin D is naturally present in some foods and available as a dietary supplement. Regardless of fortification, the amount of Vitamin D a person gets from food depends on the person’s choice of food or drinks. The skin’s ability to produce Vitamin D decreases with age. At over 65 years of age, a person generates only one-fourth as much Vitamin D compared to when they were in their 20s.
And people with darker skin typically have lower Vitamin D levels than lighter-skinned individuals. On average, African Americans have about half as much Vitamin D in their blood compared to white Americans of Caucasian descent. While vitamin supplements have surged in popularity, some people are overdoing it, which can be toxic.
The American case study can present a learning model on a global scale, since the opioid crisis in the U.S. displays an extraordinary heterogeneity in society, with large pockets of poverty, and the absence of comprehensive health care for every citizen.
According to the World Health Organization (WHO), an estimated 40 million people need palliative care each year and 78% live in middle and low-income countries. Regularized pain treatment is limited or non-existent in most parts of the world. Such suffering can be alleviated with access to pain relief treatment. Poorly managed pain and inadequate palliative therapy can lead people to turn to illicitly obtained prescriptions or street drugs.
Consumer appetite is what drives demand. MSDs are the most common cause of disability worldwide, and according to the World Health Organization (WHO), approximately 1.71 billion people have musculoskeletal conditions globally.
Changes in worldwide populations, global migration patterns, increase in communicable and non-communicable diseases, and environments where people tend to live and work indoors, impact upon nutrition and Vitamin D levels, with adverse knock-on effects on musculoskeletal health.
As populations age, chronic pain and diseases tend to increase, along with the need for pain relief medications. Vitamin D is crucial for bone health, a fact that probably half the world’s population may understand but does not consider such information to be crucial. A relatively simple step, such as paying attention to Vitamin D deficiency screening and treatment can lead to improved health, which in turn may decrease the need for and abuse of opioids.
For that reason alone, there should be a compulsory policy implemented nationwide in the U.S. for everyone to be screened for Vitamin D deficiency, starting from 10-years-old (middle school) to 60-years to identify and treat at-risk populations.
The opioid addiction crisis in the U.S. is undoubtedly a national security emergency. It has resulted in a manifold increase in opioid-related deaths, decline in national public safety, and given rise to transcontinental organized criminal enterprises that are involved in the production and trafficking of illegal prescription drugs, such as fentanyl.
The current opioid addiction epidemic has also had a profound economic impact, costing the U.S. economy an estimated $78.5 billion in 2015. The precise total financial burden of the opioid addiction crisis to the U.S. economy is not easy to quantify.
Some estimates indicate that the total economic costs of the opioid addiction crisis in the U.S. could be as high as $504 billion per annum – i.e., including costs associated with healthcare provision, lost productivity, addiction treatment, criminal justice funding, and other associated expenditures.
The opioid addiction crisis has created the perfect storm – i.e., public health emergency and a significant national security threat – where transnational drug cartels and associated national criminal organizations are profiteering from the situation, boosting their profits, and expanding and deepening their illegal operations and networks.
The U.S. government’s measures to rise to this challenge and combat the opioid addiction crisis, include increased resources and powers for law enforcement investigation and interdiction, as well as access to treatment, funding for research, public health awareness initiatives, education etc., all part and parcel of a national security strategy aimed at protecting the American public.
The U.S. government has also taken steps to strengthen border security, and combat the trafficking of opioids, including from China where the most amount of fentanyl is manufactured and smuggled into America. However, these measures alone are not enough to address the opioid addiction crisis in the U.S.
The opioid crisis is a complex dilemma that requires wide-ranging, concerted national health and security policies, strategies, and tactics – i.e., that must focus on prevention, treatment, public awareness, and education, together with more effective and robust law enforcement with teeth.
It requires a coordinated multistakeholder effort involving federal, state, and local governments working together with law enforcement, public health providers, the private sector, and not-for profit organizations, faith-based nongovernmental organizations and religious orders that are engaged in generating public health awareness.
The U.S. government and lawmakers on Capitol Hill must continue to take bipartisan steps to address the opioid addiction crisis in America and fully ensure that the national security of the United States is sacrosanct and not compromised in any way, shape, or form.
Geetika Chandwani recently graduated with a Master’s in International Relations and Diplomacy and is an alumnus of the School of Diplomacy and International Relations at Seton Hall University. She works as Program Officer at Religions for Peace. Dr. Purnaka L. de Silva is Faculty and University Adjunct Professor of the Year 2022 at the School of Diplomacy and International Relations at Seton Hall University.
IPS UN Bureau
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