The New York Times calls it “America’s 50-state epidemic.” The Washington Post says “the crisis appears to have left no community untouched.” And CNN reports that it’s the “leading cause of accidental death in this country.”

It is opioid abuse – an epidemic that causes nearly 100 overdose deaths each day.

Dr. Joel Holiner, executive medical director of HCA Healthcare’s Medical City Green Oaks Hospital, a behavioral health facility in North Texas, believes the opioid crisis is this generation’s HIV epidemic.

“Both the HIV and opioid crises caused and are continuing to cause a significant number of deaths and suffering. At its peak in 1995, HIV claimed 51,000 lives in the United States, and we appear to approach that number with opioid deaths,” he said. “But while the HIV epidemic centered primarily to specific populations, opioid abuse crosses all geographic, demographic and socioeconomic groups.”

The addiction specialist is front and center in the fight against opioid abuse and shares his thoughts on how opioids became an epidemic and what physicians, like him, can do to reverse this devastating trend.

What are opiate drugs?

Opiate drugs are used to treat both active and chronic pain and include prescription medications such as oxycodone, hydrocodone (Vicodin) and codeine.  But there are other opiates like heroin and fentanyl – the drug that resulted in the accidental overdose of musician Prince – that are available with a prescription or can be obtained illegally on the street.

How big of a problem is the opiate epidemic?

Opioids misuse is a real public health emergency. Opiate-related deaths have been sharply rising in recent years, killing more Americans under age 50 than any other cause. In 2015, there were 33,000 opioid-related deaths reported across the country, and some experts believe it could spike up to 250 deaths daily. It’s not a stretch to think that the death rate could rise up to 500,000 individuals in the next decade. So, it’s a huge health concern in every community, not to mention, it’s costing our economy $83 billion annually.

And what about heroin specifically?

It’s estimated that nearly half of young heroin addicts turned to the narcotic drug after losing access to prescription pain pills. The cheaper drug, heroin, resulted in more overdose deaths than gun-related fatalities in 2015 and six times more deaths than reported in 2002. Prescription medications like buprenorphine and naltrexone – both recommended by the American Academy of Pediatrics – are helpful to treat heroin addiction and decrease drug cravings.

How did the opioid issue get so out of control?

Prescription opioid disorders affects nearly 2 million Americans.  The root of this crisis began in the 1980s when pharmaceutical companies first marketed opiates and claimed minimal risk for addiction. Kind of like the advertisement in the 1950’s for Camel cigarettes that alleged “more doctors smoke Camels than any other cigarette”!

The bottom line is that there are 100 million people who have chronic pain and we, as doctors, want to help patients to relieve that pain. That’s what we were trained to do. So, the number of opiates prescribed quadrupled in less than two decades, yet reported pain by Americans did not change. The good news is that recent report shows that physicians are prescribing opioids less often, according to the Centers for Disease Control and Prevention. There is still much work to be done and physicians will be on the front line to help turn this crisis around.

What needs to be done to start reducing overdoses/deaths?

Physicians must be educated and re-educated to use safer pain management and non-medication treatments such as physical therapy, cognitive therapy, pain blocks and non-opiate medications. If opiates are needed:

  • use for short period of time,
  • avoid long acting opiates,
  • use lowest appropriate doses,
  • avoid using with alcohol and benzodiazepines, prescribed drugs used to treat anxiety and panic disorders, and,
  • monitor pharmacy logs.

Healthcare providers also should be encouraged to prescribe buprenorphine and naloxone, medications used to reverse opioid overdoses.

“Essentially, everyone for whom more than a brief opioid use was needed should be considered a potential abuser,” Dr. Holiner said. “Physicians must be cautious not to over-prescribe opioid medications for pain, and patients should talk about other options for pain relief.”

It could mean life or death.

Dr. Joel Holiner is a psychiatrist at Medical City Green Oaks Hospital, part of the Medical City Healthcare hospital network in the Dallas-Fort Worth, Texas area. Medical City Healthcare treats more than 26,000 patients a year and is one of the busiest psychiatric emergency rooms in the country.