Why we must consider general mental health care in the fight against the opioid crisis
In the United States, opioid overdoses are the leading cause of death among Americans under 50 – amounting to as much as 70,000 cases annually. When a member of my class at Columbia College tragically passed away last year due to an opioid overdose, I personally experienced how prevalent opiate use is among my peers. After marijuana, nonmedical use of prescription opiates is the second most common form of drug useamong American college students.According to the Penn State study, approximately one-in-five college students knows someone who was addicted to opioids, and one-third of college students know someone who had overdosed on pain medication. The scale of suffering of drug users in the American society and the burden experienced by the members of their communities is terrifying. It is urging us to develop solutions that would finally tackle this public health crisis with efficiency it calls for.
About a month ago I attended the Empire State Opioid Epidemic Innovation Challenge Summit followed by Solutions Sprint, which was organized by the CamTECH Company. At the event, public health specialists, engineers and computer scientists teamed up with recovery activists, clinical psychologists and community members in an attempt to develop sustainable solutions to the opioid epidemic. The speakers at the summit were clear that the opioid crisis goes far beyond the obvious clinical reality: it affects the economy and society as a whole in the form of lost productivity, increased incarceration or parental neglect. I was happy to witness the holistic approach and to hear the participants acknowledging that addiction is a chronic illness that should be treated as such. However, to my surprise, it went largely unrecognized that other mental disorders increase vulnerability to opioid addiction. Discussion of psychiatric comorbidities was definitely missing in the conversations we had on the opioid crisis.
Meanwhile, over half of all opioid prescriptions in the United States is given to individuals with a mental health disorder, even though such patients amount to only 16 percent of the general population. Such statistic is very concerning given that mental illness increases the likelihood of developing substance use disorder, while substance use disorder can in turn exacerbate other forms of mental illness. Patients with opioid use disorder demonstrate an above- average prevalence of mood and anxiety disorders; and between 20 and 50 percent of individualsreceiving treatment for opioid use disorder simultaneously suffer from post-traumatic stress disorder. As emphasized by the National Institute on Drug Abuse, a comprehensive approach to intervention is crucial. Proper diagnosis and treatment of the mood disorders for instance may allow to reduce the risk of future opioid abuse.
The clinical problem is addiction, the psychological and physical dependence triggered by drug abuse. The preventive measures, however, need also address the fact that drug abuse often times starts as a coping mechanism to alleviate some sort of emotional pain or trauma. “It took me outside of myself and I kept chasing it” – explained one of the speakers, talking about how her addiction started. Other people in recovery who attended the event also admitted that they started abusing opioids in an attempt to escape from reality and to “self-medicate.” It is clear that psychological risk factors should be taken into account while prescribing opioid painkillers to the patients, and that drug use recovery should focus more on holistic mental health care, rather than on addiction treatment exclusively.
In a sense, the scale of the opioid crisis indicates an even broader trend of deteriorating mental health in our population. By approaching this crisis as a phenomenon strictly limited to a specific class of drugs, we might cure the symptoms of the current epidemic and hopefully lower the number of overdose deaths in the near future, but we will fail to address the long-term underlying roots of the problem and the risk factors that may well lead to similar epidemics in the future.