Opioid Crisis - An FAQ
A New York State Office of Alcoholism and Substance Abuse Services Combat Addiction campaign poster warning about the dangers of fentanyl on the 5 train. Photo: Zein Jardaneh.
A few weeks after my college graduation in May 2011, I had minor surgery in New York City. It was an outpatient procedure: my mom and I were at the hospital at 8 a.m., and back home by 4 p.m. I was sent home with a few stitches, and a 30-day prescription of Vicodin. I’m almost sure if I search hard enough in my parents’ house, I’d be able to find the remaining 28 pills.
I’ve lost track of the number of times I’ve told this story since moving back to the U.S. in August, as conversations about the opioid epidemic have increased in frequency. Addiction counselors say I’m lucky that moment didn’t turn into a life-long, debilitating addiction. Bridget Brennan, the special narcotics prosecutor of New York City, threw her hands up in the air in frustration, saying, “I rest my case.”
My experience has left me, much like Brennan, unsurprised by the scale of the opioid crisis today. Over the next few months, I will explore how the opioid crisis has played out in New York City, with a particular focus on the Bronx and Staten Island, the two boroughs with the highest rates of opioid-involved overdose deaths.
Before zooming into these two boroughs, here are answers to a few questions that help break down the crisis – including definitions of terms, numbers, and the impact of the crisis nationally and in New York City.
How bad is the crisis?
According to the latest available data from the Centers for Disease Control (CDC), drug overdose is the leading cause of accidental death in America, with 63,632 lethal drug overdoses in 2016. Opioids were involved in 42,249 of those deaths in 2016, accounting for 66.4% of all drug overdose related deaths. That averages to about 116 opioid overdose deaths in the U.S. each day, up from 91 in 2015
Figure 1: Number of opioid overdose deaths across the US compared to all drug overdose deaths. Source: The Henry J. Keiser Family Foundation
The problem isn’t just overdoses. The number of babies born with a drug withdrawal symptom, primarily those exposed to opioids while in the womb, has quadrupled over the past 15 years. Economist Alan Kruger argues that the increase in opioid prescriptions from 1999 to 2015 accounts for about 20 percent of the decline in men’s labor force participation during that same period.
How do opioids differ from other drugs?
Opioids are a class of drugs, derived from the opium poppy plant, used to reduce pain. The CDC categorizes opioids as follows:
Natural opioid painkillers, which include morphine and codeine, and semi-synthetic opioid analgesics, which includes oxycodone (such as OxyContin) and hydrocodone (such as Vicodin);
Methadone, a synthetic opioid, mainly used to reduce dependence on opioids;
Synthetic opioid painkillers, which includes drugs such as tramadol and fentanyl; and
Heroin, the most commonly used illegally-made opioid, which is synthesized from morphine into a white or brown powder, or sticky substance.
In addition to relieving pain, opioids also activate what are known as reward regions in the brain causing euphoria, increasing the potential for addiction. This happens particularly when they are taken at a higher-than-prescribed dose, or administered in other ways than intended.
What is fentanyl?
A synthetic opioid, it comes in two categories: pharmaceutical and non-pharmaceutical.
Pharmaceutical fentanyl is mainly used to relieve advanced cancer pain. It is 50 to 100 times more potent than morphine, and is typical prescribed in the form of patches or lozenges to ensure controlled release.
Non-pharmaceutical fentanyl is most closely linked to fentanyl-related harm, overdose and death. It’s cheaper than heroin, and up to 50 times more potent. It’s also often mixed with heroin and/or cocaine – with or without the user’s, and often the dealer’s, knowledge.
To give an idea of how lethal fentanyl is, the Drug Enforcement Administration said that a recent seizure of 141 lbs. of fentanyl in New York City was enough to kill 32 million people.
What started the epidemic?
In the 1990s, opioids gained popularity among doctors for managing patients’ pain following surgery or during cancer treatment. An aggressive marketing campaign by big pharma in the 2000s of opiates as safe treatment for chronic pain helped fuel over-prescription of opiates.
By the time doctors, patients and the government began understanding the dangers of these prescriptions, misuse was already widespread. When it became hard to get opioids legally, people began turning to the cheaper and easier option: heroin. Heroin overdose death rates began to climb in 2011, and have been rising since.
How is this affecting New York City?
In 2016, 1,374 New Yorkers died from drug overdoses – up from 937 in 2015. Of the 1,374 deaths, about 1,075 involved an opioid. More New Yorkers died from opioid overdoses last year than from car accidents and homicides combined.
While the Bronx and Brooklyn had the highest number of drug overdose deaths, at 308 and 297 respectively, Staten Island and the Bronx had the highest per capita rate of drug overdose death, at 31.8 per 100,000 and 28.1 per 100,000, respectively.
Almost 90% of opioid overdose deaths in 2016 involved heroin or fentanyl, and 18% involved prescription opioid painkillers. Before 2015, fentanyl was involved in less than 5% of all overdose deaths in the city. During the second half of 2016, fentanyl was involved in around half of the city’s overdose deaths.
Figure 2: Rate (per 100,000) of overdose deaths by borough of residence, 2016
Source: HealingNYC: Preventing Overdoses, Saving Lives
Figure 3: Rate of opioid-involved overdose deaths by neighborhood of residence (2015-2016)
Source: HealingNYC: Preventing Overdoses, Saving Lives