PMC:7463108 / 1940-5718
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7463108","sourcedb":"PMC","sourceid":"7463108","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7463108","text":"The Opioid Crisis\nOpioid abuse in the United States (U.S.) has reached catastrophic levels. According to the latest World Drug Report, 53.4 million people worldwide used opioids in 2017, which is 56% higher than in the previous year (UNODC 2019a). North America remains the region with the highest non-medical use of opioids with a staggering 4% of the population aged 15–64 using opioids (UNODC 2019a, c). In 2017, the burden of opioid use in the U.S. had accounted for 42 million healthy years of life lost due to premature death and disability (Institute for Health Metrics and Evaluation 2017; UNODC 2019a). During 2017, there were 70,237 overdose related deaths, out of which 47,600 (67.8%) were caused by opioids, which was a 12% increase from 2016 (Scholl et al. 2018; UNODC 2019c). The Centers of Disease Control and Prevention (CDC) reports that on average 130 Americans die from an opioid overdose each day (CDC 2017). Due to the constant rise in deaths involving opioids, the U.S. Government declared the opioid crisis/epidemic a public health emergency in 2017 (U.S. Department of Health and Human Services 2017). Injection drug use increases the likelihood of contracting human immunodeficiency virus (HIV) and drug abuse and HIV have long been described as interrelated epidemics (Swan 1997; Leshner 1998; Nath et al. 1999, 2002). Despite this understanding, opioid use disorder (OUD) and HIV remain a huge public health concern (Strathdee and Beyrer 2015; Peters et al. 2016). In fact, the opioid crisis is seen as a major roadblock in several aspects of public health, including thwarting the goal of eliminating HIV within the next decade (Fauci et al. 2019; Lerner and Fauci 2019).\nOUD is also likely to exacerbate many negative aspects of the COVID-19 pandemic (Alexander et al. 2020; Becker and Fiellin 2020; NIDA 2020; Wakeman et al. 2020). Not only are individuals with OUD more vulnerable to SARS-CoV-2 and liable to spread the infection, social-distancing practices create isolation, despair, and economic hardships, heightening opioid abuse (with inherent respiratory depression depending on the amount of tolerance developed) and the probability of overdose (Becker and Fiellin 2020; Wakeman et al. 2020). By virtue of its greater safety profile and decreased likelihood for abuse (Bell and Strang 2020), the use of buprenorphine via telemedicine has become advantageous for managing OUD during the COVID-19 pandemic (Leppla and Gross 2020; Samuels et al. 2020) but presents new challenges (Khatri and Perrone 2020).\nThe current opioid crisis did not happen quickly; in fact, it has been described as occurring in three phases. The first phase began in the late 1990s with an increase in the number of prescription opioids. This led to overdose deaths that were attributable to natural and semi-synthetic opioids, such as methadone (Kolodyny et al. 2015; CDC 2017). The second phase began in 2010 in which heroin took the lead as the principal cause of overdose deaths. The most recent, third wave, began in 2013 in which highly potent synthetic opioids, such as fentanyl and its analogs became the main cause of mortality (Kolodyny et al. 2015; CDC 2017). The entry of fentanyl and its analogs into the clandestine market has changed the dynamics of the opioid market in the U.S. The synthetic opioids, such as fentanyl, are several orders of magnitude more potent than morphine, easily smuggled, and frequently and inconsistently mixed with lower quality drugs increasing the probability of overdosing. According to the National Forensic Laboratory Information System of the U.S. Drug Enforcement Administration (DEA), fentanyl accounted for one-third of the illicit opioids seized in 2017 (UNODC 2019c) and has become a global problem (UNODC 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