Contributed by John Bringuel, MA, ICPS
The Situation
The United States has seen an epic explosion in the rates of prescription opioid and heroin overdoses over the last several years, as reported by numerous public and private agencies, from public health to law enforcement. The CDC reported opioid-related deaths have reached an all-time high in the United States with more than 47,000 people dying in 2014 alone, and the numbers continue to rise. So what is happening? Organizations like the National Governors Association (NGA) have come out with reports identifying solutions to the prescription opioid and heroin epidemic.
According to their report, “Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States”, the NGA states, “Inappropriate opioid prescribing has fueled one of the deadliest drug epidemics in U.S. history.” This “inappropriate opioid prescribing” can be described as a “supply” problem. They also point out that, “Though most opioid related overdoses involve prescription opioids, an increasing number are linked to illicit opioids such as heroin and fentanyl.” Conversely, the ever “increasing number” of overdoses as a result of illicit opioids such as heroin and fentanyl can be described as a “demand” problem.
So while the burgeoning overdose deaths in Georgia may be fueled by “inappropriate prescribing” (a “supply” problem) one has to also recognize the impact of illicit opioids such as heroin and fentanyl and the public “demand” for such drugs being overwhelming. One of my colleagues has said for years, “We don’t have a ‘supply’ problem we have a ‘demand’ problem.” The infographic to the left illustrates the deadly connection between taking non-medical prescription pain relievers (demand) and the risk of heroin use. This infographic was created by Yale University (Susan Busch, Hongyu Zhang, Stephen McLaughlin, and Rosanna Smith) in 2010.
The History
According to historians the need to experience pleasure and/or avoid pain has always been an issue. We have been ingesting substances that make us “feel” relaxed, stimulated and or euphoric for thousands years. The “drug experiment” really began back around 6000 B.C. with the process of fermentation which gave us alcohol. Since then we have continually found “better ways” to get high, from “Grandma’s home remedies” to the most current drug compound. We have always found a new way to alleviate aches, pains and other ailments at the risk of side effects, including the ultimate side effects, abuse or addiction.
Some people’s drug use is rooted in “religious rites,“ while many others promote drug use, including drinking alcohol, as the core of a “party or celebration.” As the infographic below from the CDC illustrates, in 2011 we had more deaths in the U.S. from overdose than from falls, guns and even traffic accidents. 
Another way to look at this is it is safer to hike near a mountain cliff, have a gun or drive a car than take prescription drugs. Of course that is an over simplification of the problem, but one that illustrates three negative, false social norms: 1. If it’s legal, it must be safe. 2. Don’t deal with your pain or suffering directly because it could overwhelm you and 3. Pills are the answer to all human suffering and confusion. We want to be sure to stress here to please never stop taking prescription drugs prescribed to you by your doctor on your own without your doctor’s recommendation. The fact remains that for some, prescription pills are a legitimate way to maintain their mental or physical functioning.
The Solution
A full throttled attack on the overdose epidemic is simple, just not easy. Let me begin by saying that all three steps below need to be implemented at the same time. Although I list them as one, two and three, they are symbiotic, and each benefits from the other.
Here is the simple proposal:
First, education on opioid prescribing and addiction is crucial at all levels, from medical school and residency, through continuing education. This education must involve not only primary care physicians and medical specialists but also mental health providers, pharmacies, emergency room departments, first responders and clinics. This desire for increase opioid education must come from medical and pharmacy schools, academic medical centers, accrediting organizations/associations and even policy makers.
Second, I propose a multi-pronged, simultaneous public education campaign aimed at changing values and beliefs around opioids (pain medication) as well as an all-out effort to lock drugs up in the home. There needs to be controlled disposal of all expired or unwanted medication in a drug drop box at either a law enforcement location or a certified pharmacy.
Thirdly, the insurers along with state and federal governments help financially to provide substance abuse/addiction prevention and treatment alongside behavioral health, wraparound services and recovery supports to those that need it.
Through this comprehensive prevention and treatment approach, we as a nation and state can greatly reduce the numbers of opioid, heroin and fentanyl related deaths! Can we agree through education, prevention and treatment that we can change lives and save minds and futures?
John Bringuel is the Statewide Project Director of the Georgia Prescription Drug Abuse Prevention Initiative with the Council on Alcohol and Drugs. The Council on Alcohol and Drugs is a 47 year-old nonprofit, 501(c)3 substance abuse prevention and education agency that develops programs and materials based on the most current research on drug use and its impact on community. You can visit us at http://www.livedrugfree.org/.