In 2018, in the US, 2 out of every 3 drug overdose deaths involved an opioid, which includes prescription opioids, heroin, and synthetic opioids like fentanyl. According to the Tennessee Department of Health, each day, at least three people die from an opioid-related overdose which is more than the number of daily traffic accident-related deaths. The number of opioid-related overdose deaths continues to rise in the United States, and Tennessee has been one of the hardest-hit states when it comes to the opioid epidemic. Despite efforts from the state through their Prescription for Success and Prescription Safety Act, Tennessee ranks in the top fifteen states for the number of drug overdose deaths each year. Unfortunately, the number of opioid overdose deaths has nearly doubled from 698 in 2012 to 1,186 deaths in 2016, and most recently 2089 deaths in 2019. Deaths involving synthetic opioids (mostly fentanyl and fentanyl analogs) have increased and heroin-related deaths are also trending upwards according to the NIH’s National Institute on Drug Abuse. The most recent Annual Overdose Report (2021) released by the Tennessee Department of Health shows that the opioid overdose epidemic continues to worsen.
What Are Opioids?
Opioid medications are commonly prescribed for pain and they have an analgesic and relaxant effect. Prescription opioids are often used to treat moderate to severe acute and chronic pain, coughing and some forms of diarrhea. Opioids are a commonly abused medication because of its relaxant effect and can produce a high in the short term. However, in the long term opioids are highly addictive and can also cause drowsiness, confusion, and slowed breathing which can lead to hypoxia. A striking statistic is that there are more opioid prescriptions written than there are people living in the state, with more than 1 million prescriptions left over. According to the National Institute on Drug Abuse, Tennessee health care providers wrote 81.8 prescriptions for every 100 persons, which is the third highest prescribing rate in the country (the US average is 51.4 prescriptions for every 100 persons).
Heroin is one of the most dangerous forms of opioids and while not used for medicinal purposes it can produce a similar high since its chemical structure is similar. Unfortunately, in many cases heroin is cheaper and easier to acquire than opioids so people switch to using heroin once they have developed a dependence to their prescription opioid.
Fentanyl is a potent synthetic opioid that is similar to but 50-100 times stronger than morphine. It is also prescribed for severe pain, especially post-operatively, however it has now commonly been involved in overdose deaths in the US. Unfortunately, many drug dealers will lace fentanyl with other drugs like cocaine, heroin, methamphetamine and MDMA, since it produces a high easily thus making it cheaper to produce the drugs. This has a dangerous impact on users because if they do not realize their drugs have fentanyl, they may take higher doses than their body is capable of handling, resulting in overdose.
Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS)
Neonatal Abstinence Syndrome (NAS) or Neonatal Opioid Withdrawal Syndrome (NOWS) occurs when a woman uses opioids while pregnant. The rates of reporting vary by state, but in 2017, the incidence rate of NAS/NOW in Tennessee was approximately 16.4 cases per every 1000 hospital births. This compares to the national incidence which was reported as 7 cases per every 1000 hospital births.
According to the NIH, in Tennessee, there were 1307 drug overdoses in 2018.
- Deaths involving synthetic opioids other than methadone (mostly fentanyl and fentanyl analogs) increased from 590 in 2017 to 827 in 2018.
- Heroin deaths were trending upwards with 369 deaths in 2018
- Prescription opioids related overdose deaths declined from 739 deaths in 2016 to 550 in 2018.
As previously mentioned, fentanyl is a potent synthetic opioid that is similar to morphine but can be exponentially stronger than morphine. In particular, many states are reporting exponential increases in fentanyl-related overdose deaths. This often occurs because users of illicit drugs are unaware that their drugs may have been adulterated with fentanyl. This has been particularly the case with heroin, methamphetamine, cocaine, counterfeit Xanax, and Oxycodone. This has a dangerous impact on users because if they do not realize their drugs have been laced with fentanyl, they may take higher doses than their body is able to metabolize, causing an overdose. The Tennessee Department of Health has issued an advisory concerning fentanyl and fentanyl laced substances. From 2013 to 2015 in Tennessee, the appearance of fentanyl in drugs associated with overdose deaths has more than doubled, from 5% in 2013 to 12% in 2015.
The CDC reports that most of this occurs in the black market and is added to the drug supply prior to entering the US leaving domestic sellers unaware that their drug products might be contaminated with fentanyl. Unfortunately, fentanyl overdoses can occur very rapidly, sometimes with the needle still inserted. Naloxone or Narcan is a safe and effective antidote to opioid-related overdoses and can be a critical life saving measure. Many states have expanded who can administer naloxone in the case of a suspected overdose and have also conducted training for naloxone use as a part of harm reduction. In 2015, the U.S. Drug Enforcement Administration, issued a nationwide alert on fentanyl as a threat to health and public safety as well because fentanyl is also extremely dangerous to law enforcement and first responders who come in contact with the drug.
If you or someone you know has a problem with opioids or substance abuse, it may be helpful to seek professional help. At Detox Nashville, addiction treatment specialists are able to work with you or your loved one to assess your situation and determine an individualized treatment plan that will suit your needs. A professional will be able to take a thorough substance use history and determine if alcohol treatment is recommended and the best therapeutic course of action is warranted.