Opioid crisis in USA

Why a name for a crisis, what crisis, and what does it have to do with San Francisco

Why a crisis has a name

There has been different crisis throughout the history of USA, and it seems like every time a crisis happens, humans tend to name the crisis. The reason behind naming a crisis is twofold; For one, everyone knows that if the government is naming a crisis, then it’s the real deal and a crisis approaches. The second goal for it, is that everyone knows what is being talked about when it has a name, and thereby the person talking about the crisis, doesn’t need to explain everything repeatedly, by naming it the explanation can be skipped for the most part.

Drug related crisis in the USA

From the 1990’s and till now drug related crisis is not unheard of in USA, in fact there have been so many, that there is talk about a fourth wave of a fentanyl crisis in the USA as this article in BBC News shows.

Therefor, instead of naming the crisis with the drug-related name, a common name which covers most drugs is used in it's place - the name is the Opioid crisis.
The word ‘opioid’ covers a broader range of drugs like Morphine, heroin, codeine, fentanyl, hydrocodone and oxycodone, synthetic opioids, and since the focus is on the drug related incidence in San Francisco from 2003-2018, let’s see what the crisis might have been going on in that timeline. In USA there have been different wave each with their own drug related to it Opioid epidemic in the United States.

First wave (1990-1999)

This is the start of the crisis and was characterized by advocating the use of opioid medications for chronic pain management, pushed by pharmaceutical companies promoting their own opioid for the use of this. At this point in time, around 100 million people in the USA suffered from chronic pain. But due to restrictions, opioid was initially reserved for acute pain related to cancer or terminal illness. Another factor that played a role in the use of opioids not being used for other medical conditions was:
- There was insufficient evidence supporting their use beyond acute pain.
- Concerns about opioids’ addictive nature led to caution.
- Doctors worried about potential scrutiny for liberal opioid practices.

coupled with the pharmaceutical companies insisting that opioids weren’t addictive lead to opioids becoming an accepted treatment for other medical conditions

This changed in 1980, where a letter was published in the New England Journal of Medicine challenged the above statements. It advocated for a more liberal use of opioids in pain management, which the World Health Organization eventually supported. Beside that, medical organizations emphasized the importance of pain as the ‘fifth vital sign’. This, coupled with the pharmaceutical companies insisting that opioids weren’t addictive lead to opioids becoming an accepted treatment for other medical conditions. This led to an increase of opioid prescriptions with 76 million in 1990 to 116 million in 1999, which makes the opioids the most prescribed class of medication in USA. More can be read here The Opioid Crisis in the United States: A Brief History.

Second wave(2005-2012)

The second wave evolved around the increase use of heroin and the related overdose death following it. During a period from 2005-2012 the number of people using heroin nearly doubled rising from 380,000 to 670,000, this also lead to an increase of overdose with 2789 deadly overdoses. The high use of heroin was due to the availability of heroin and it’s decreasing prices, thanks to a shift from South America to Mexico as the main provider of heroin, this ensured a reliable supply of low-cost heroin. This lead heroin to be an attractive option for those who were already addicted to opioids, and wanting to switch to a more potent and cost-effective alternative.

Third wave(2013-2016)

This wave was more impacted by overdose death with the primary reason being synthetic opioids, and more precisely illegally produced fentanyl, which can range between 50 to 100 times more potent than morphine. Moreover, it was also mixed into heroin or cocaine to enhance the potency.

Fourth wave (2016-present)

Began in 2016 and is characterized by polysubstance, which refer to the practice of using multiple drugs simultaneously or in succession.

U.S. overdose deaths involving opioids. Deaths per 100,000 population by year.[1]

How do the crisis affect the Drug/Narcotic in San Francisco

Even though the the Opioid crisis raged in the USA, San Francisco have managed to reduce the incident of drug related crimes. This feat is due to San Francisco commitment in being innovative and addressing the opioid crisis from the starts.

Graph shows the developement of drug/narcotic incidense from 2003-2018

One of the strategies is know as harm reduction which include needle exchange programs. This program task is to provide clean needles to reduce infections among those who inject drugs. As a benefit for providing clean needle, it also helps reducing the workload on the public healthcare. This program have been such a success, that California have allowed it to open once more as stated in this article SF Chronicle.

The communities are also a vital role in this regard, in that they help to inform and advocate for access to treatment among other things. For those addictive to drugs and don’t have the strength to fight for themselves, the communities are a welcome hand, it that they provide engagement and support for those who in need.
To read more about this, see this article from San Francisco Public Press.

Another project involves the project MAT which stands for Medication-Assisted Treatment, and is a project that involve getting drugs addicted getting evidence-based care.
Furthermore, they have also expanded the naloxone distribution, which is a life-saving opioid reversal medication.

As mention in a previous post, they also work with Law Enforcement and Heath Agencies.

Lastly, as something new they have begun to use a data-driven approach, where drug overdosed and treatment is being tracked, which in the future will help them adapt the stragies.

This initiative might be the reason why that even with the Opioid crisis raging, San Francisco have managed to reduce the incident throughout the years.

Figure by Center for Dieease Control and Prevention.

Image by Nick Otto / The Washington Post via Getty Images.

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