Researchers expect opioid overdose deaths to rise across North America unless treatment and prevention strategies are implemented. Photo by jorono/Pixabay
Feb. 2 (UPI) -- More than 1.2 million people will die from drug overdoses across North America by the end of the decade unless governments institute public health policies that treat drug addiction as a chronic condition and prioritize prevention, a report published Wednesday by the Lancet found.
Opioid overdose deaths are also expected to increase worldwide as the epidemic expands beyond this continent, the report authors said.
The COVID-19 pandemic has both worsened and overshadowed the opioid epidemic by limiting access to care services, overwhelming healthcare systems and adding to stressors such as unemployment, disability and loss of loved ones that can lead to increased drug use and addiction, they said.
In the United States, there is a lack of accessible, high-quality, non-stigmatizing and integrated health and social care services for people who experience opioid use disorder, or addiction, and that needs to change to reverse these upward trends in deaths, according to the authors.
"Over the past quarter-century, the opioid epidemic has taken nearly 600,000 lives and triggered a cascade of public health catastrophes such as disability, family breakdown, unemployment and child neglect in North America," co-author Keith Humphreys said in a press release.
"If no action is taken, by the end of this decade, we are predicting the number of deaths to be twice as high as it has been over the last 20 years," said Humphreys, who serves as chair of the Stanford-Lancet Commission on the North American Opioid Crisis, which produced the report.
Opioids are a class of prescription pain medications that were originally designed to manage discomfort in people who are dying, particularly those with cancer, who experience intense pain, according to the National Institute on Drug Abuse.
These drugs are both medically necessary because of the symptom relief they provide. But they're also potentially dangerous because of the risk for addiction that comes with their use, the commission report authors said.
However, from the late-1990s until recently, doctors have increasingly prescribed them to treat pain in people with short-term and chronic conditions, ranging from lower back pain to headaches to sprained ankles, the Stanford-Lancet Commission report showed.
This has helped fuel an increase in opioid addiction and overdoses nationally, known as the opioid epidemic, with the drugs accounting for the majority of the more than 100,000 overdoses deaths across the country in 2020.
A NIDA report published Wednesday by the American Journal of Psychiatry found that while overdose deaths have declined in some age and demographic groups, they have increased in people ages 15 to 24 years and Black women.
Based on the findings, Dr. Nora Volkow, co-author of the NIDA report and director of the agency, said that prescribers must "screen for suicidality among [patients] who use opioids or other drugs" and provide treatment and support for those who need it.
Since 1999, nearly 600,000 people in the United States and Canada have died from an opioid overdose, a rate of deaths that exceeds the worst of the HIV/AIDS epidemic in the 1980s, according to the Stanford-Lancet Commission.
Opioid overdose deaths in Canada increased by 72% 2019 to 2020, while in the United States, they rose by 37% over the same period, the data from the commission's report showed.
These spikes might be partly attributable to the effects of the COVID-19 pandemic, though a rising trajectory of deaths was evident in both countries before the pandemic, the report authors said.
In 2020, men accounted for 71% of overdose deaths in the United States and 75% of those in Canada, they said.
In both countries, nearly 90% of opioid overdose deaths occurred in people ages 20 to 59 years, according to the report authors.
Most of these deaths were fueled by the rise in opioid prescriptions seen in both countries since 1999, with the report authors laying the blame at the feet of the pharmaceutical and healthcare industries, as well as regulatory failures at the Food and Drug Administration, among other agencies.
"Our analysis clearly lays out how lack of effective regulation and an unchecked profit motive created the opioid epidemic," report co-author Howard Koh said in a press release.
"We must end the pharmaceutical and healthcare industry's undue influence on the government and its unregulated push for opioid use," said Koh, a professor of the practice of public health leadership at Harvard T.H. Chan School of Public Health in Boston.
Without additional safeguards in place, the opioid epidemic will spread to other countries, Koh and his colleagues said.
As an example, between 2009 and 2015, opioid prescriptions in Brazil increased by 465%, they said.
To limit these trends, the World Health Organization and donor nations should provide free, generic morphine for pain management to hospitals and hospices in low-income countries, according to the report authors.
"Opioids should not be viewed as good or bad, but instead as a class of medications essential to the management of pain, [but they] come with serious risks, some of which can be difficult to recognize," commission report co-author David Juurlink said in a press release.
"Clinicians should begin learning about responsible pain management prescribing in medical school and continue to learn about it" as they practice, said Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Center in Toronto.