The Opioid Epidemic

Yngvild Olsen, MD, MPH, is Medical Director of the Institutes for Behavior Resources, Inc., a comprehensive addiction treatment center in Baltimore City. She is the current Vice President and former Chair for Public Policy of the American Society of Addiction Medicine. Olsen consults with governments and healthcare organizations on implementing evidence-based clinical care programs for opioid use disorder. In addition to caring for patients with complex substance use disorders and other medical conditions, she has written and lectured extensively on the opioid epidemic.Joshua M. Sharfstein, MD, is Vice Dean for Public Health Practice and Community Engagement and Professor of the Practice in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. He previously served as the Health Commissioner of Baltimore City, the Principal Deputy Commissioner of the U.S. Food and Drug Administration, and the Health Secretary of the State of Maryland.

"In The Opioid Epidemic, Drs. Olsen and Sharfstein lay out with clarity and eloquence the root causes and solutions to a crisis that has devastated communities across the United States. Whether you are a parent, a policymaker, a physician, or a concerned citizen, everyone should read this book." --Vivek Murthy, 19th Surgeon General of the United States"With clarity and keen insight, Drs. Olsen and Dr. Sharfstein trace the opioid overdose epidemic back to its roots, and lay out the steps that every community needs to take going forward to prevent overdoses and save lives. The Opioid Epidemic is absolutely essential reading for those who are just getting up to speed on this national health crisis and for seasoned public health and policy professionals alike." --Nicole Alexander-Scott, Commissioner ofHealth for Rhode Island and President, Association of State and Territorial Health Officials"Understanding the addiction epidemic in the US today is a daunting task. This is a complex issue crossing many disciplines-health services, criminal justice, law enforcement, and family systems. This book is excellent in offering the most up-to-date orientation of the history of the disease, laws, causes, treatment, and, most of all, hope. I wish this book had been available when my son was struggling for his life. A must read for those who suffer andthose who love them. Great primer for medical professionals, law enforcement and any others who want to be part of the solution of healing and hope." --Barbara Allen, Executive Director and Founder, JamesPlace and Chair, Howard County Opioid CouncilAs two of the most distinguished experts on addiction and the opioid epidemic, Drs. Olsen and Sharfstein have written a definitive guide to understanding the epidemic and arming readers with information backed by science and evidence to help themselves, their loved ones, and their communities." --Michael Botticelli, Executive Director, Grayken Center for Addiction Medicine and former Director, White House Office of National Drug Control Policy"This is a one-of-a-kind, comprehensive review of everything to know about the opioid epidemic. Drs. Olsen and Sharfstein have made complex issues accessible and digestible to the reader. This book should be read by everyone involved in the opioid epidemic-especially patients, family members, health care providers, and policy makers." --Chinazo Cunningham, Addiction Medicine Physician, Albert Einstein School of Medicine"Years into our nation's lethal and unrelenting opioid epidemic, we are still missing a level-setting work that equips us with the language, concepts, science, and tools to truly tackle the crisis together. Drs. Olsen and Sharfstein have given us just that: an accessible and compelling account of the opioid epidemic in all of its dimensions, including the best path out of it. It should be required reading for everyone contending with the crisis, in other words,for all of us." --Brandon del Pozo, Chief of Police, Burlington, Vermont"In highlighting the worst public health disaster facing Americans in a generation, Olsen and Sharfstein methodically provide riveting insights in a relentlessly logical manner. The book is the most comprehensive and insightful look at the opioid crisis from its origins to what it will take to solve this epidemic, written in a clear and concise manner. A must read for everyone." --Rahul Gupta, Former Commissioner and State Health Officer for West Virginia"In this pragmatic and accessible book Drs. Olsen and Sharfstein unrelentingly explain and hew to the science behind opioid addiction and related public policy. Their book will help people who use drugs and their families, health professionals, and policy makers make wiser and safer choices for themselves and their communities." --Hilary Kunins, Assistant Commissioner, Bureau of Alcohol and Drug Use, New York City Department of Health and Mental Hygiene"This highly informative book is a valuable resource to help families truly understand addiction. Most, if not all, of your questions will be answered." --Toni Torsch, Director, Daniel Carl Torsch Foundation"The Opioid Epidemic offers insightful life-saving educational information not only for health professionals but for the millions of individuals and families struggling to find answers in a sea of confusion and conflicting information. An important contribution from two of the most informed and practiced thought-leaders on solving the opioid crisis." --Greg Williams, Executive Vice President, Facing Addiction

• Preface Section 1: The Basics 1. The Basics of Opioids and Opioid Addiction What are opioids?How are opioids made?How do opioids affect the brain?How do opioids affect the body?What forms do opioids take?How do opioids differ from one another?What is tolerance to opioids?What is withdrawal?What is physical dependence on opioids?What is addiction to opioids?What is the stigma of addiction?Is there a cure for opioid addiction?Can the symptoms of opioid addiction improve without treatment?Is there effective treatment for opioid addiction?Is using an opioid medication for treatment just "replacing one addiction for another"?How do opioids cause overdose?What is naloxone?What are remission and recovery?What is relapse?What is the opioid epidemic?What can be done to respond effectively to the opioid epidemic? Section 2: Opioid Use in Individuals and Families 2. Use of Opioid Medications for Pain When is it appropriate for someone to receive opioids for pain? Should opioids be used for chronic, non-cancer pain?In what forms are opioid medications used for pain?Should people with a family history of addiction worry about taking opioids for pain?What should I discuss with my doctor before taking opioids for pain?Should I take an opioid medication if I am pregnant?What are the side effects of opioid medications for pain?Do all people who take opioids for pain develop an addiction?What are the signs of developing an addiction to opioid medications?How should my doctor monitor my use of opioids for pain?If I would like to reduce my use of opioid pain medications, what should I do?What are signs and symptoms of an overdose to opioid medications?Should I have naloxone on hand if I am taking an opioid medication for pain?Where should I store opioid medications at home?What should I do if I have opioid pills left over?Why do people keep unused opioids at home? 3. Illicit Use of Opioids What is the illicit use of opioids?What are the different ways of using opioids illicitly?What is fentanyl?How do people start using opioids illicitly?What is the connection between illicit opioid use and sex?Why do people use other illicit substances with opioids?What can people who use opioids illicitly do to reduce their risks? 4. Opioid Addiction What causes opioid addiction?What is happening in the brain of someone with an opioid addiction?What are triggers?What are drug dreams?Is opioid addiction a disease?How do doctors diagnose opioid addiction?What are the consequences of opioid addiction?How long does opioid addiction last?Do people with addiction want to stop using opioids? 5. Opioid Overdose What factors determine whether someone who uses opioids overdoses?How can I tell if someone is experiencing an opioid overdose?What should I do if suspect someone is experiencing an opioid overdose?What are the different forms of naloxone and how are they used?What happens after someone suffering an opioid overdose gets naloxone?Do I still need to call 911 if I have rescued someone with naloxone?How can I get naloxone? 6. Treatment for Opioid Addiction What are the goals of treatment for opioid addiction?What are effective ways to engaging people with opioid addiction in treatment?What is remission?What is effective treatment for opioid addiction?When is the right time to start treatment for opioid addiction?How are the needs of someone with opioid addiction assessed?What is methadone?Does methadone make people sleepy?Can I take other medications with methadone?What are Opioid Treatment Programs?What is buprenorphine?Why does buprenorphine come in a formulation mixed with naloxone?What is naltrexone?Which is the best medication to take for opioid addiction?How long should I take a medication for opioid addiction?Does evidence support the use of marijuana as an effective treatment for opioid addiction?Does evidence support the use of the botanical kratom as an effective treatment for opioid addiction?Does evidence support ibogaine as an effective treatment for opioid addiction?How is pain managed in someone being treated for an opioid addiction?What is "detox"?What is the role of counseling in the treatment of opioid addiction?What is the role of peers in the treatment of opioid addiction?What is the role of a residential (inpatient) setting in the treatment of opioid addiction?What is the role of drug testing in the treatment of opioid addiction?What is the role of a primary care practitioner in the treatment of opioid addiction?What should I expect from my specialty addiction treatment provider?What should I expect from other clinicians in the healthcare system?What confidentiality protections exist for treatment for opioid addiction? 7. Opioids and Pregnancy What are the risks of opioid exposure during pregnancy?How is opioid addiction treated during pregnancy?Which medication is most effective for pregnant women with opioid addiction?What is Neonatal Abstinence Syndrome?How is Neonatal Abstinence Syndrome treated?Is a baby with Neonatal Abstinence Syndrome "born addicted"?What are the long-term effects of opioid use during pregnancy?Should women exposed to opioids breastfeed? 8. Teens Has the opioid epidemic in the United States included teenagers?What are the characteristics of opioid addiction among teenagers?Is treatment effective for teens with opioid addiction?Should parents keep naloxone in the home?What should parents do in a crisis?Are there scams targeting parents of teens with addiction to opioids and other substances? 9. Opioids and Families What do I do if I suspect my family member is misusing opioids?How can I help connect my family member with opioid addiction to effective treatment?How can I tell if a treatment program is high quality?How can my family avoid scams?What is "enabling"?Does my family member first need to âhit rock bottomâ before getting better?How can I cope with the stress of having a family member with opioid addiction?What is the role of home drug testing?How can I help a family member who is in recovery from opioid addiction? 10. Recovery from Opioid Addiction What is recovery from opioid addiction?What are 12-step programs?How can peers assist with recovery?What kinds of supports do people in recovery need?What is recovery housing?What are threats to recovery?What is the role of treatment in the recovery process? 11. History and Current State of the Opioid Epidemic When did the opioid epidemic start?Why have historians called the opioid problem, "The American Disease"?What led to the increase in prescriptions of opioids for pain from 1990 to 2010?What was the response to the overprescription of opioids in the early 2000s? Have tighter regulations on opioid prescriptions led to a rise in use of heroin?What is fentanyl and what is the fentanyl crisis?What role does race play in the opioid epidemic? 12. Preventing Opioid Addiction in Communities What is the role of a community in preventing opioid addiction?Does reducing exposure to excessive prescribing of opioids prevent opioid addiction?What Are Prescription Drug Monitoring Programs?What are Take Back Days?What can the U.S. Food and Drug Administration do to prevent opioid addiction in communities?Do "abuse-deterrent" formulation of opioids work?What other technologies are under development to prevent misuse of opioid pain medications?What is the role of marijuana in preventing opioid addiction?Can communities go too far in restricting opioid prescribing?How can communities support resilience and create a safe environment to prevent opioid addiction? 13. Treatment and Recovery Policy for the Opioid Epidemic What is the relative importance of broad access to effective treatment for opioid addiction?What are the elements of a successful treatment system?What is the case for having hospital emergency departments provide treatment for opioid addiction?Other than emergency departments, what other types of providers would benefit from offering treatment for opioid addiction?Where are there gaps in payment and coverage for opioid addiction treatment?What happens when there is no financial support for effective opioid addiction treatment?What are the factors that limit expansions of access to effective treatment?What is "Not in My Backyard" Syndrome?Why is there resistance in some minority communities to treatment programs?Can treatment expansions backfire?How should the treatment system support pregnant women with opioid addiction?What is the controversy over forcing people with opioid addiction into treatment?What is the role of communities in supporting people in treatment and recovery? 14. Harm Reduction in the Opioid Epidemic What is harm reduction?What are naloxone programs?What is the case for making naloxone available without a prescription?What are good-Samaritan laws?What are syringe exchange programs?What are the controversies over how syringe exchange programs are managed?What are single-use syringes and what is the controversy over whether syringe exchange programs should exclusively distribute them?What is drug checking?What are supervised consumption facilities?What is the medical use of heroin?What limits the expansion of harm-reduction programs in the United States? 15. Criminal Justice and the Opioid Epidemic What is the war on drugs?Has the war on drugs failed?What is the role of race in the war on drugs?Is the war on drugs over?What is the role of police departments in addressing the opioid epidemic?What is the role of jails and prisons in addressing the opioid epidemic? 16. Surveillance, Evaluation, and Research and the Opioid Epidemic How well is the United States tracking the opioid epidemic?What trends related to the opioid epidemic are most useful to monitor?What other trends might make sense to track?What is the role of evaluation in assessing the response to the opioid epidemic?What are the most promising areas of current research related to opioids and opioid addiction?What are the challenges to moving research discoveries quickly into practice? 17. Future Considerations for the Opioid Epidemic What can the addiction field do to address the opioid epidemic?What can others in the healthcare system do to address the opioid epidemic?What can the criminal justice system do?What can litigation do?What can local communities do?What can cities and counties do?What can states do?What can the federal government do?What can individuals and families do? Index