Innovations-Magazine-October-2022 - 9

Twenty-five years since the onset of the opioid misuse crisis, the
overdose epidemic related to these powerful drugs continues to be
one of the foremost areas of concern among health policy experts
and regulators throughout the United States.
Alarmingly, overdose deaths in the country, including those
related to opioids, have set new records in recent years. For
example, from 1999-2021, overall drug overdoses claimed
at least 1 million lives in the US. Annual drug overdoses
surpassed 100,000 for the first time in 2021, with nearly
75% involving an opioid. These bleak statistics underline
the need for this issue to remain a priority at all levels.
Sadly, as opioid-related overdoses continue to increase,
many researchers believe the country has entered a new,
deadly wave of the epidemic involving stimulants, including
medications. At the same time, policymakers, government
agencies, regulators, health care providers, and many other
stakeholders continue working tirelessly to renew and
enhance efforts to save lives, including focusing on
harm reduction strategies.
The State of the Crisis
As reported in previous issues of Innovations, the rate
of opioid overdoses has seen a dramatic increase since
2020. After a short period when the opioid crisis finally
seemed to be cooling down, the social and economic
pressures of the coronavirus disease 2019 (COVID-19)
pandemic - in addition to the growing prevalence of
synthetic opioids (mainly fentanyl and its analogues) -
seem to have combined to create a perfect storm that has
led to more Americans misuing opioids and other drugs
than ever. Worse, because fentanyl can be dangerous
in even small quantities, and is being used in place of
other, less potent opioids, it is increasingly common
for people to overdose without even knowing that they
are taking fentanyl. More than 82% of opioid deaths
reported in 2020 involved the use of synthetic opioids.
According to Centers for Disease Control and Prevention
(CDC), the national rate of opioid overdoses climbed by
15% in 2021, from 70,029 to 80,816. This growth, while
disturbing, is half of what CDC reported for 2020, when
opioid overdose rates climbed 30%. In addition, 2021 saw
prescription opioid overdoses increase by 17% and synthetic
opioid overdose rates increase by 56%.
Combined with surging overdose rates, there have been
several other trends and developments over the last few years
that regulators and other stakeholders are watching. First, there
was the emergence of isotonitazene (also known as nitazene
or " ISO " ), another class of synthetic opioids, on the black
market. Drug Enforcement Administration says the drug is
" as dangerous and deadly as fentanyl, " and has been found in
counterfeit pills falsely marketed as prescription opioids, such as
hydromorphone and oxycodone. Illicit versions of this opioid
were first identified in the Midwest in 2019 and have since been
found along the Eastern Seaboard and in the South.
Previously, researchers at CDC and other stakeholders
have characterized different eras of the opioid epidemic
as three " waves. "
* First Wave (1999-2009): The rapid growth in prescription
opioid use and abuse beginning in the 1990s.
* Second Wave (2010-2012): Steep increases in overdose
deaths involving heroin, largely attributed to people
switching from prescription opioids when they were no
longer able to obtain them, beginning in about 2010.
* Third Wave (2013-Present): The surge in availability
of illegally manufactured synthetic opioids, particularly
fentanyl, and corresponding increase of related overdoses.
The emergence of isotonitazene as another synthetic
opioid adds to the already growing prevalence of fentanyl.
Now, some researchers are making the case that the
opioid epidemic has produced a " fourth wave. " In the
journal Preventive Medicine, Richard A. Jenkins with the
National Institute on Drug Abuse describes this change
in the epidemic as " a stimulant/opioid epidemic, with
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Innovations-Magazine-October-2022

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