what percent of people in the usa are addicted to opiods

Presented by Nora D. Volkow, Thou.D.

Presented to Senate Caucus on International Narcotics Control

Good Morning time, Madam Chair and members of the Caucus.  Thank you for inviting the National Institute on Drug Corruption (NIDA), a component of the National Institutes of Wellness (NIH), to participate in this important hearing and contribute what I believe volition be useful insights into the growing and intertwined problems of prescription pain relievers and heroin abuse in this country.

Background

The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies.  Information technology is estimated that between 26.iv one thousand thousand and 36 million people corruption opioids worldwide,^[1] with an estimated ii.1 1000000 people in the United states suffering from substance utilize disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 fond to heroin.^[2]   The consequences of this abuse have been devastating and are on the rising.  For instance, the number of unintentional overdose deaths from prescription pain relievers has soared in the The states, more than than quadrupling since 1999.  There is too growing prove to suggest a human relationship between increased non-medical utilize of opioid analgesics and heroin abuse in the Us.^[3]

To address the circuitous problem of prescription opioid and heroin corruption in this country, nosotros must recognize and consider the special character of this phenomenon, for we are asked not merely to face the negative and growing touch of opioid abuse on wellness and mortality, but also to preserve the fundamental role played by prescription opioid pain relievers in healing and reducing human suffering. That is, scientific insight must strike the right balance betwixt providing maximum relief from suffering while minimizing associated risks and adverse effects.

Abuse of Prescription Opioids: Scope and Impact

Prescription opioids are one of the three principal wide categories of medications that nowadays abuse liability, the other two beingness stimulants and cardinal nervous arrangement (CNS) depressants.

Several factors are likely to have contributed to the severity of the current prescription drug abuse problem.  They include drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and ambitious marketing by pharmaceutical companies.  These factors together take helped create the broad "environmental availability" of prescription medications in general and opioid analgesics in item.

Figure 1 - Opioid Prescriptions Dispensed by US Retail Pharmacies IMS Health, Vector Ane: National, years 1991-1996, Information Extracted 2011. IMS Health, National Prescription Audit, years 1997-2013, Data Extracted 2014.

To illustrate this betoken, the full number of opioid hurting relievers prescribed in the Us has skyrocketed in the past 25 years(Fig. one).^[4] The number of prescriptions for opioids (like hydrocodone and oxycodone products) have escalated from around 76 one thousand thousand in 1991 to well-nigh 207 million in 2013, with the United States their biggest consumer globally, bookkeeping for almost 100 percent of the world full for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (due east.g., Percocet).^[v]

This greater availability of opioid (and other) prescribed drugs has been accompanied by alarming increases in the negative consequences related to their corruption.^[6] For case, the estimated number of emergency section visits involving nonmedical utilise of opioid analgesics increased from 144,600 in 2004 to 305,900 in 2008;^[seven] treatment admissions for master corruption of opiates other than heroin increased from one per centum of all admissions in 1997 to five percent in 2007^[eight]; and overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years, escalating to xvi,651 deaths in the United States in 2010.^[9]

In terms of abuse and mortality, opioids account for the greatest proportion of the prescription drug abuse problem.  Deaths related to prescription opioids began rise in the early office of the 21^st century.  By 2002, death certificates listed opioid analgesic poisoning as a crusade of death more commonly than heroin or cocaine.^[10]

Figure ii - Chemical Similarity between Opioid Prescriptions and Heroin

Because prescription opioids are similar to, and human activity on the aforementioned brain systems affected past, heroin and morphine (Fig.ii), they present an intrinsic abuse and addiction liability, particularly if they are used for not-medical purposes.  They are nearly unsafe and addictive when taken via methods that increase their euphoric effects (the "high"), such as crushing pills and so snorting or injecting the powder, or combining the pills with booze or other drugs.  Besides, some people taking them for their intended purpose chance dangerous agin reactions past not taking them exactly as prescribed (e.thousand., taking more pills at once, or taking them more oft or combining them with medications for which they are non being properly controlled); and information technology is possible for a small number of people to become fond even when they take them as prescribed, but the extent to which this happens currently is not known.  It is estimated that more 100 million people endure from chronic hurting in this land,^[11] and for some of them, opioid therapy may be advisable. The majority of American patients who need relief from persistent, moderate-to-astringent non-cancer pain have back hurting conditions (approximately 38 meg) or osteoarthritis (approximately 17 million).^[12] Even if a small-scale percentage of this group develops substance use disorders (a subset of those already vulnerable to developing tolerance and/or clinically manageable concrete dependence^[13]), a big number of people could be affected.  Scientists debate the appropriateness of chronic opioid use for these weather condition in light of the fact that long-term studies demonstrating that the benefits outweigh the risks have not been conducted. In June 2012, NIH and FDA held a articulation meeting on this topic,^[14] and now FDA is requiring companies who industry long-acting and extended-release opioid formulations to conduct mail service-marketing inquiry on their condom.^[15]

The Furnishings of Opioid Abuse on the Brain and Torso

Opioids include drugs such as OxyContin and Vicodin that are mostly prescribed for the handling of moderate to severe pain.  They act by attaching to specific proteins chosen opioid receptors, which are institute on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the trunk.  When these drugs attach to their receptors, they reduce the perception of pain and tin produce a sense of well-being; nevertheless, they can also produce drowsiness, mental confusion, nausea, and constipation.^[xvi]  The effects of opioids are typically mediated by specific subtypes of opioid receptors (mu, delta, and kappa) that are activated by the body'south ain (endogenous) opioid chemicals (endorphins, encephalins).   With repeated assistants of opioid drugs (prescription or heroin), the production of endogenous opioids is inhibited, which accounts in office for the discomfort that ensues when the drugs are discontinued (i.eastward., withdrawal). Adaptations of the opioid receptors' signaling machinery have also been shown to contribute to withdrawal symptoms.

Opioid medications can produce a sense of well-being and pleasance because these drugs affect brain regions involved in advantage. People who corruption opioids may seek to intensify their experience by taking the drug in means other than those prescribed.  For case, extended-release oxycodone is designed to release slowly and steadily into the bloodstream afterward being taken orally in a pill; this minimizes the euphoric furnishings. People who abuse pills may trounce them to snort or inject which not only increases the euphoria just too increases the risk for serious medical complications, such as respiratory arrest, coma, and addiction. When people tamper with long-acting or extended-release medicines, which typically comprise college doses considering they are intended for release over long periods, the results can be particularly dangerous, as all of the medicine can be released at in one case. Tampering with extended release and using by nasal, smoked, or intravenous routes produces risk both from the higher dose and from the quicker onset.

Opioid pain relievers are sometimes diverted for nonmedical utilize by patients or their friends, or sold in the street.  In 2012, over five percent of the U.S. population anile 12 years or older used opioid pain relievers non-medically.^[17] The public health consequences of opioid pain reliever corruption are broad and disturbing.  For example, corruption of prescription hurting relievers by pregnant women tin result in a number of problems in newborns, referred to as neonatal forbearance syndrome (NAS), which increased past about 300 pct in the U.s.a. between 2000 and 2009.^[18] This increase is driven in role by the high rate of opioid prescriptions being given to meaning women. In the The states, an estimated 14.four per centum of pregnant women are prescribed an opioid during their pregnancy.^[nineteen]

Prescription opioid corruption is non but plush in economical terms (it has been estimated that the nonmedical employ of opioid pain relievers costs insurance companies up to $72.5 billion annually in health-intendance costs^[xx]) but may also be partly responsible for the steady upwards trend in poisoning mortality. In 2010, there were xiii,652 unintentional deaths from opioid pain reliever (82.eight percent of the sixteen,490 unintentional deaths from all prescription drugs),^[21] and there was a five-fold increase in treatment admissions for prescription pain relievers between 2001 and 2011 (from 35,648 to 180,708, respectively).^[22] In the same decade, there was a tripling of the prevalence of positive opioid tests among drivers who died inside one hour of a crash.^[23]

A property of opioid drugs is their tendency, when used repeatedly over time, to induce tolerance. Tolerance occurs when the person no longer responds to the drug equally strongly as he or she did at offset, thus necessitating a higher dose to achieve the same effect.  The establishment of tolerance hinges on the ability of abused opioids (east.yard., OxyContin, morphine) to desensitize the brain's own natural opioid organisation, making it less responsive over time.^[24]  This tolerance contributes to the loftier risk of overdose during a relapse to opioid apply afterwards a period in recovery; users who do not realize they may accept lost their tolerance during a flow of abstinence may initially accept the high dosage that they previously had used before quitting, a dosage that produces an overdose in the person who no longer has tolerance.^[25]  Some other contributing gene to the risk of opioid-related morbidity and mortality is the combined use of benzodiazepines (BZDs) and/or other CNS depressants, even if these agents are used appropriately. Thus, patients with chronic pain who utilise opioid analgesics along with BZDs (and/or alcohol) are at higher gamble for overdose. Unfortunately, there are few available practice guidelines for the combined use of CNS depressants and opioid analgesics; such cases warrant much closer scrutiny and monitoring.^[26] Finally, information technology must be noted in this context that, although more men die from drug overdoses than women, the percentage increase in deaths seen since 1999 is greater among women: Deaths from opioid pain relievers increased five-fold between 1999 and 2010 for women versus iii.6 times among men.^[27]

Relationship between Prescription Opioids and Heroin Abuse

The recent trend of a switch from prescription opioids to heroin seen in some communities in our state alerts u.s. to the complex problems surrounding opioid addiction and the intrinsic difficulties in addressing information technology through whatsoever single measure such every bit enhanced diversion control (Fig.3). Of particular concern has been the  rise in new populations of heroin users, particularly immature people.

Figure iii - Growing Testify suggests that abusers of prescription opioids are shifting to heroin as prescription drugs get less available or harder to abuse. For example, a recent increase in heroin apply accompanied a downwards tendency in OxyContin abuse following the introduction of an abuse-deterrent formulation of that medication (dashed vertical line)

The emergence of chemical tolerance toward prescribed opioids, perhaps combined in a smaller number of cases with an increasing difficulty in obtaining these medications illegally^[28], may in some instances explain the transition to abuse of heroin, which is cheaper and in some communities easier to obtain than prescription opioids.

Figure iv - Trend in Prevalence of Heroin Use and Heroin Related Overdose Death in the US (1999-2012)

The number of past-yr heroin users in the United states of america nearly doubled between 2005 and 2012, from 380,000 to 670,000 (Fig. 4).^[29] Heroin abuse, like prescription opioid abuse, is dangerous both because of the drug's addictiveness and because of the loftier risk for overdosing.  In the case of heroin, this danger is compounded by the lack of control over the purity of the drug injected and its possible contamination with other drugs (such every bit fentanyl, a very potent prescription opioid that is also driveling by itself).^[30]  All of these factors increment the risk for overdosing, since the user can never be sure of the corporeality of the active drug (or drugs) existence taken. In 2010, at that place were 2,789 fatal heroin overdoses, approximately a 50 percentage increase over the relatively constant level seen during the early 2000s.^[31] What was once almost exclusively an urban problem is spreading to small towns and suburbs.  In add-on, the abuse of an opioid like heroin, which is typically injected intravenously, is as well linked to the transmission of human being immunodeficiency virus (HIV), hepatitis (especially Hepatitis C), sexually-transmitted infections, and other blood-borne diseases, mostly through the sharing of contaminated drug paraphernalia just also through the risky sexual behavior that drug abuse may engender.

NIDA Activities to Stem the Tide of Prescription Opioid and Heroin Abuse

NIDA first launched its prescription drug abuse public wellness initiative in 2001.  Our bear witness-based strategy calls for a comprehensive three-pronged approach consisting of (ane) enhancing our understanding of pain and its management; (ii) preventing overdose deaths; and (3) effectively treating opioid addiction.

Research on Pain and Next Generation Analgesics.

Although opioid medications finer treat acute pain and help relieve chronic pain for some patients,^[32] their addiction adventure presents a dilemma for healthcare providers who seek to relieve suffering while preventing drug abuse and habit.  Fiddling is yet known about the risk for addiction amongst those being treated for chronic pain or about how basic pain mechanisms interact with prescription opioids to influence addiction potential.  To ameliorate sympathize this, NIDA launched a research initiative on "Prescription Opioid Utilize and Corruption in the Treatment of Hurting."  This initiative encourages a multidisciplinary approach using both human and animal studies to examine factors (including pain itself) that predispose or protect against opioid abuse and addiction.  Funded grants cover clinical neurobiology, genetics, molecular biology, prevention, treatment, and services enquiry.  This type of data will help develop screening and diagnostic tools that physicians can use to assess the potential for prescription drug abuse in their patients.  Because opioid medications are prescribed for all ages and populations, NIDA is likewise encouraging enquiry that assesses the effects of prescription opioid abuse by pregnant women, children, and adolescents, and how such abuse in these vulnerable populations might increase the lifetime risk of substance abuse and habit.

Another important initiative pertains to the evolution of new approaches to treat hurting.  This includes research to identify new hurting relievers with reduced abuse, tolerance, and dependence risk, as well as devising alternative delivery systems and formulations for existing drugs that minimize diversion and abuse (e.chiliad., by preventing tampering and/or releasing the drug over a longer period of time) and reduce the hazard of overdose deaths. New compounds are being developed that exhibit novel backdrop every bit a effect of their combined activity on two different opioid receptors (i.e., mu and delta).  Preclinical studies show that these compounds can induce strong analgesia but fail to produce tolerance or dependence.  Researchers are also getting closer to developing a new generation of non–opioid-based medications for severe pain that would circumvent the brain reward pathways, thereby greatly reducing corruption potential.  This includes compounds that work through a blazon of cannabinoid receptor found primarily in the peripheral nervous organization.  NIDA is too exploring the utilise of non-medication strategies for managing hurting.  An example is the employ of "neurofeedback," a novel modality of the general biofeedback approach, in which patients learn to regulate specific regions in their brains by getting feedback from real-time brain images.  This technique has shown promising results for altering the perception of pain in healthy adults and chronic pain patients and could even evolve into a powerful psychotherapeutic intervention capable of rescuing the circuits and behaviors impaired past addiction.

Developing More Effective Means for Preventing Overdose Deaths

The opioid overdose antidote naloxone has reversed more ten,000 overdose cases between 1996 and 2010, according to CDC. ^[33]  For many years, naloxone was available only in an injectable formulation and was mostly only carried past medical emergency personnel.  Notwithstanding, FDA has recently canonical a new hand-held auto-injector of naloxone to reverse opioid overdose that is specifically designed to be given by family unit members or caregivers.  In order to expand the options for effectively and quickly counteracting the furnishings of an overdose, NIDA is also supporting the development of a naloxone nasal spray—a needle-free, unit-dose, prepare-to-use opioid overdose antitoxin that can easily be used by an overdose victim, a companion, or a wider range of first responders (due east.g., police) in the issue of an emergency.^[34]

Inquiry on the Treatment of Opioid Addiction

Drug abuse treatment must address the brain changes mentioned earlier, both in the brusk and long term.  When people addicted to opioids first quit, they undergo withdrawal symptoms, which may be severe (pain, diarrhea, nausea, airsickness, hypertension, tachycardia, seizures). Medications can be helpful in this detoxification stage, easing craving and other physical symptoms that can often trigger a relapse episode.  All the same, this is just the start footstep in treatment. Medications take also become an essential component of an ongoing treatment program, enabling opioid-addicted persons to regain control of their health and their lives.

Agonist medications developed to treat opioid addiction work through the same receptors as the addictive drug but are safer and less likely to produce the harmful behaviors that characterize habit, because the rate at which they enter and exit the brain is slower. The three classes that have been developed to engagement include (one) agonists, e.g., methadone (Dolophine or Methadose), which actuate opioid receptors; (2) fractional agonists, e.m., buprenorphine (Subutex, Suboxone), which besides activate opioid receptors but produce a macerated response; and (three) antagonists, e.g.,naltrexone (Depade, Revia, Vivitrol), which block the receptor and interfere with the rewarding effects of opioids.  Physicians can select from these options on the basis of a patient'due south specific medical needs and other factors.  Enquiry has shown methadone- and buprenorphine-containing medicines, when administered in the context of an habit treatment program, tin effectively maintain abstinence from other opioids and reduce harmful behaviors; we believe their gradual onset and long duration contribute to this ability to "stabilize" patient behavior.

Figure 5 - Methadone Handling Pre- and Mail Release Increases Treatment Retention and Reduces Drug Use (Findings at 12 calendar month post-release)

Scientific inquiry has established that medication-assisted treatment of opioid addiction is associated with decreases in the number of overdoses from heroin abuse,^[35] increases memory of patients in treatment and decreases drug utilise, infectious affliction transmission, and criminal activity. For example, studies among criminal offenders, many of whom enter the prison house system with drug abuse bug, showed that methadone treatment begun in prison and connected in the community upon release extended the fourth dimension parolees remained in handling, reduced farther drug use, and produced a three-fold reduction in criminal activeness (Fig. 5).  Investment in medication-assisted treatment of opioid habit also makes good economic sense.  According to a 2005 published analysis that tracked methadone patients from historic period 18 to threescore and included such variables equally heroin utilise, treatment for heroin use, criminal behavior, employment, and healthcare utilization, every dollar spent on methadone treatment yields $38 in related economic benefits—seven times more than than previously idea.^[36]

Buprenorphine is worth highlighting in this context for its pioneering contributions to addiction treatment.  NIDA-supported basic and clinical research led to the evolution of this compound, which rigorous studies have shown to be effective, either lone or in combination with naloxone, in significantly reducing opiate drug abuse and cravings.

The arrival of buprenorphine represented a pregnant health services delivery innovation. FDA approved Subutex® (buprenorphine) and Suboxone® tablets (buprenorphine/naloxone formulation) in October 2002, making them the beginning medications to exist eligible for prescribing under the Drug Addiction Treatment Act  of  2000. Subutex contains only buprenorphine hydrochloride. This formulation was developed equally the initial production. The second medication, Suboxone, contains naloxone to baby-sit confronting misuse (by initiating withdrawal if the formulation is injected).  Subutex and Suboxone are less tightly controlled than methadone because they have a lower potential for abuse and are less unsafe in an overdose.  Every bit patients progress in their therapy, their doctor may write a prescription for a take-abode supply of the medication.  To appointment, of the near 872,615 potential providers registered with the Drug Enforcement Assistants (DEA), 25,021 registered physicians are authorized to prescribe these 2 medications. The development of buprenorphine and its authorized use in physicians' offices gives opioid-addicted patients more than medical options and extends the reach of habit medication to remote populations.

Medication-assisted treatments remain grossly underutilized in many addiction treatment settings, where stigma and negative attitudes (based on the misconception that buprenorphine or methadone "substitute a new addiction for an erstwhile one") persist amidst dispensary staff and administrators.  This leads to bereft dosing or limitations on the duration of utilise of these medications (when they are used at all), which often leads to treatment failure and the perception that the drugs are ineffective, further reinforcing the negative attitudes toward their use.^[37]  Policy and regulatory barriers also tin present obstacles.

Integrating Drug Treatment into Healthcare Settings

Medication-assisted treatment will exist most effective when offered within the larger context of a high-quality commitment system that addresses opioid habit not simply with medication but also with behavioral interventions to support treatment participation and progress, communicable diseases identification and treatment (especially HIV and HCV), screening and handling of co-morbid psychiatric diseases, and overdose protection (naloxone).  NIDA's research over the concluding ii decades has provided usa with testify that a high quality treatment organization to accost opioid addiction must include all these components, yet in that location are currently very few systems in the United States that provide this packet of effective services.^[38] Health care reform—with a focus on both expanding admission to treatment and improving the quality of care—offers hope that we may exist better able to integrate drug treatment into healthcare settings and offer comprehensive handling services for opioid addiction.  Nosotros also are examining ways to utilise health intendance reform and the focus on health promotion and wellness to pay for and deliver prevention interventions targeted at children, adolescents, young adults, and loftier-hazard adult populations similar those with chronic hurting or returning veterans.

Figure 6 - Medscape's Exam-and-Teach is one instance of NIDA's multi-platform approach to enhance a md'south ability to properly manage pain while preventing the corruption of prescription opiods

Prevention, Education, and Outreach

Because prescription drugs are safety and effective when used properly and are broadly marketed to the public, the notion that they are likewise harmful and addictive when abused tin be a difficult one to convey.  Thus, we demand focused research to discover targeted communication strategies that effectively address this problem.  Reaching this goal may exist significantly more circuitous and nuanced than developing and deploying constructive programs for the prevention of abuse of illegal drugs, but good prevention messages based on scientific evidence will be difficult to ignore.^[39]

Pedagogy is a critical component of whatsoever effort to curb the abuse of prescription medications and must target every segment of society, including doctors (Fig.6).  NIDA is advancing habit sensation, prevention, and treatment in primary intendance practices, including the diagnosis of prescription drug abuse, having established four Centers of Excellence for Dr. Information.  Intended to serve every bit national models, these Centers target physicians-in-grooming, including medical students and resident physicians in primary intendance specialties (e.g., internal medicine, family practice, and pediatrics).  NIDA has also developed, in partnership with the Office of National Drug Control Policy (ONDCP), 2 online continuing medical teaching courses on rubber prescribing for pain and managing patients who abuse prescription opioids.  To date, combined, these courses have been completed over fourscore,000 times. Additionally, NIDA is directly reaching out to teens with its PEERx initiative, an online educational activity program that aims to discourage prescription drug corruption among teens,^[forty] by providing factual information about the harmful furnishings of prescription drug abuse on the brain and trunk.

NIDA will also continue its shut collaborations with ONDCP, the Substance Abuse and Mental Health Services Assistants (SAMHSA), and other Federal Agencies. It will besides continue to work with professional associations with a potent interest in preserving public health. For example, NIDA recently sponsored a two-twenty-four hours meeting in conjunction with the American Medical Association and NIH Hurting Consortium, where more than 500 medical professionals, scientific researchers, and interested members of the public had a risk to dialogue nearly the issues of prescription opioid abuse and to acquire well-nigh new areas of inquiry.   In another important collaborative effort, NIDA, CDC, SAMHSA, and the Office of the National Coordinator for Health Information Applied science reviewed viii clinical exercise guidelines on the apply of opioids to treat pain and developed a common set of  provider actions and associated recommendations.^[41]

Conclusion

We are seeing an increase in the number of people who are dying from overdoses, predominantly after abuse of prescribed opioid analgesics. This disturbing trend appears to exist associated with a growing number of prescriptions in and diversion from the legal marketplace.

We commend the Caucus for recognizing the serious and growing claiming posed by the abuse of prescription and non-prescription opioids in this land, a problem that is exceedingly complex.  Indeed, prescription opioids, like other prescribed medications, exercise present health risks but they are too powerful clinical allies.  Therefore, it is imperative that we strive to achieve a balanced approach to ensure that people suffering from chronic hurting tin get the relief they need while minimizing the potential for negative consequences.  We support the evolution and implementation of multipronged, testify-based strategies that minimize the intrinsic risks of opioid medications and make constructive, long term treatments available.

References

[2] Substance Corruption and Mental Wellness Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, Medico: Substance Abuse and Mental Wellness Services Administration, 2013.

[3] Pradip et al. Associations of Nonmedical Hurting Reliever Use and Initiation of Heroin Use in the The states. Centre for behavioral Wellness Statistics and QualityData Review. SAMHSA (2013).

[4] IMS's National Prescription Audit (NPA) & Vector One ®: National (VONA).

[6] To clarify our terminology hither, when we say "prescription drug corruption" or "nonmedical use," this includes utilize of medications without a prescription, use for purposes other than for what they were prescribed, or use merely for the feel or feeling the drug can cause.

[7] Substance Abuse and Mental Health Services Administration. Drug Abuse Alarm Network, 2007: national estimates of drug-related emergency department visits.

[8] Treatment Episode Information Set (TEDS) Highlights – 2007. National Admissions to Substance Corruption Treatment Services. SAMHSA

[9] Mack, Yard.A. Drug-induced deaths - United States, 1999-2010. MMWR Surveill Summ. 2013 Nov 22;62 Suppl 3:161-iii. CDC

[x] Paulozzi et al. Increasing deaths from opioid analgesics in the U.s. Pharmacoepidemiol. Drug Saf., 15 (2006), pp. 618–627

[11] Relieving Hurting in America: A Blueprint for Transforming Prevention, Care, Didactics, and Research. REPORT Cursory JUNE 2011; Johannes et al. The prevalence of chronic pain in United States adults: results of an Net-based survey. J Hurting. 11(11):1230-nine. (2010); Gallup-Healthways Well-Being Index.

[12] De Leon Casada. Opioids for Chronic Pain: New Evidence, New Strategies, Safe Prescribing The American Periodical of Medicine, 126(3s1):S3–S11. (2013)..

[xiii]American University of Hurting Medicine; American Pain Society; American Gild of Addiction Medicine. Definitions Related to the Employ of Opioids for the Treatment of Pain. Glenview, IL, and Chevy Chase, MD: American Academy of Hurting Medicine, American Pain Society, American Society of Addiction Medicine; 2001

[16] Mattoo, South. Prevalence and correlates of epileptic seizure in substance-abusing subjects. Psychiatry Clin Neurosci. 63(4):580-two. (2009).

[xix] Bateman, B.T. et al. Patterns of Opioid Utilization in Pregnancy in a Large Cohort of Commercial Insurance Beneficiaries in the United States. Anesthesiology.  in printing (2014)

[twenty] Coalition Against Insurance Fraud. Prescription for peril: how insurance fraud finances theft and corruption of addictive prescription drugs. Washington, DC: Coalition Against Insurance Fraud; 2007. Bachelor at http://www.insurancefraud.org/downloads/drugDiversion.pdf

[21] Centers for Affliction Control and Prevention , National Heart for Health Statistics. Multiple Cause of Expiry 1999-2010 on CDC WONDER Online Database, released 2012. Information are from the Multiple Cause of Death Files, 1999-2010, equally compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Plan.

[22] Substance Corruption and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Gear up (TEDS): 2001-2011. National Admissions to Substance Abuse Treatment Services. BHSIS Series Southward-65, HHS Publication No. (SMA) xiii-4772. Rockville, Doc: Substance Corruption and Mental Health Services Administration, 2013.

[23] Brody and Li. Am. J. Epidemiology. 2014

[24] Williams, J. Regulation of μ-opioid receptors: desensitization, phosphorylation, internalization, and tolerance. Pharmacol Rev. 65(1):223-54. (2013).

[25] Møller et al. Acute drug-related mortality of people recently released from prisons. Public Health.  124(11):637-9. (2010); Buster et al. An increment in overdose mortality during the offset ii weeks after entering or re-entering methadone treatment in Amsterdam. Addiction. 97(8):993-1001. (2002).

[26] Paulozzi, L. Prescription drug overdoses: a review. J Safety Res. 43(iv):283-9 (2012)

[27] CDC.Vital signs: overdoses of prescription opioid pain relievers and other drugs amongst women--United States, 1999-2010. MMWR 62(26):537-42. (2013).

[28] Slevin and Ashburn. Primary care dr. stance survey on FDA opioid risk evaluation and mitigation strategies. J Opioid Manag. 2011 Mar-Apr;7(2):109-15.

Hooten and Bruce. Beliefs and attitudes about prescribing opioids among healthcare providers seeking standing medical education. J Opioid Manag. seven(6):417-24.(2011).

[29] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Corruption and Mental Wellness Services Administration, 2013.

[30] SAMHSA informational Bulletin 2/7/14  http://world wide web.samhsa.gov/newsroom/advisories/1402075426.aspx).

[31] Centers for Affliction Command and Prevention , National Eye for Health Statistics. Multiple Cause of Expiry 1999-2010 on CDC WONDER Online Database, released 2012. Data are from the Multiple Cause of Death Files, 1999-2010, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.

[32] Moore, A. et al. Wait analgesic failure; pursue analgesic success BMJ. 3;346 (2013).

[33]Community-Based Opioid Overdose Prevention Programs Providing Naloxone. United States, 2010. U.South. Department of Health and Human Services. Centers for Illness Control and Prevention. MMWR. Vol 61/No.6 February 17, 2012.

[34]NIDA STTR Grantee: AntiOp, Inc., Daniel Wermerling, CEO.

[35] Schwartz, R.P. et al. Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009. Am J Public Health. 103(five):917-22 (2013).

[36] Zarkin, Chiliad. Benefits and costs of methadone treatment: results from a lifetime simulation model.  Health Econ. 14(11):1133-50 (2005).

[37] Knudsen, H.Thou.; Abraham, A.J.; and Roman, P.M. Adoption and implementation of medications in habit treatment programs. J Addict Med 2011; 5:21-27.

[38] National Institute on Drug Corruption. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition), NIH Publication No. 12-4180. Rockville, Doctor: National Institute on Drug Abuse, 2012. www.drugabuse.gov/publications/principles-drug-addiction-treatment

[39] Spoth et al. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors xvi(2):129–134, 2002.

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Source: https://archives.drugabuse.gov/testimonies/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse

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