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Get the Upshot in your Inbox. On Thursday, President Trump said he intended to declare the opioid crisis a national emergency , as previously recommended by his opioid commission. With the death toll from drugs rising faster than ever , you might feel that you could use a little catching up. For a quick refresher, and more on the practical effects of a formal declaration of an emergency, here are answers to 12 critical questions. Drug overdoses are the leading cause of death for Americans under 50, and deaths are rising faster than ever, primarily because of opioids. Overdoses killed more people last year than guns or car accidents, and are doing so at a pace faster than the H. In , roughly 2 percent of deaths — one in 50 — in the United States were drug-related. Overdoses are merely the most visible and easily counted symptom of the problem. Over two million Americans are estimated to have a problem with opioids. According to the latest survey data , over 97 million people took prescription painkillers in ; of these, 12 million did so without being directed by a doctor. The first such drug, and the one from which the opioid receptors get their name, was opium. Opium, a narcotic obtained from a kind of poppy, has been used in human societies for thousands of years. From opium people derived a whole host of other drugs with similar properties: first morphine, then heroin, then prescription painkillers like Vicodin, Percocet and OxyContin. Opium along with all of these derivatives are collectively known as opiates. Opiates along with these synthetic drugs — chiefly methadone and fentanyl — are grouped together into the category of substances called opioids. Opioid receptors regulate pain and the reward system in the human body. That makes opioids powerful painkillers, but also debilitatingly addictive. The crisis has its roots in the overprescription of opioid painkillers, but since overdose deaths from prescription opioids have leveled off. Deaths from heroin and fentanyl, on the other hand, are rising fast. In several states where the drug crisis is particularly severe, including Rhode Island , Pennsylvania and Massachusetts , fentanyl is now involved in over half of all overdose fatalities. While heroin and fentanyl are the primary killers now, experts agree that the epidemic will not stop without halting the flow of prescription opioids that got people hooked in the first place. The latest iteration of the opioid epidemic has been especially deadly among adults in their 20s and early 30s. In , the most common age for drug deaths, including those not involving opioids, was around This was the generation that first grew addicted to prescription opioids in large numbers — white people especially so. Teasing out the reasons for the geographical differences is not easy. Fentanyl, a highly potent opioid, affects heroin users and pill users both, the latter often falling victim to counterfeit pills that look like prescription painkillers. So far, the white population has been hardest hit, but this is beginning to change. Addiction to opioids goes back centuries, but the current crisis really starts in the s. A handful of highly influential journal articles relaxed long-standing fears among doctors about prescribing opioids for chronic pain. The pharmaceutical industry took note, and in the mids began aggressively marketing drugs like OxyContin. This aggressive and at times fraudulent marketing, combined with a new focus on patient satisfaction and the elimination of pain, sharply increased the availability of pharmaceutical narcotics. Pill mills began popping up around the country as communities were flooded with prescription opioids. Over the next decade, a growing number of people grew addicted to the drugs, whether from prescriptions or from taking them recreationally. For many, what started with pills evolved into a heroin addiction. At the same time, the heroin market was changing. The price plummeted. Newly decentralized drug distribution networks pushed heroin and counterfeit pharmaceuticals into suburban and rural areas where they had never been. Everywhere the suppliers went, they found a ready and willing customer base, primed for addiction by decades of prescription opiate use. Heroin is derived from opium, a plant. That means its growers need fields and labor to harvest the crop. They are tied to land, weather and time. Fentanyl is purely synthetic. Think chemistry, not agriculture. According to the Drug Enforcement Administration, the majority of illicit fentanyl in the United States is manufactured either in China or in Mexico using precursors bought from China. And at least some portion of it comes to the United States in the mail, ordered from dark web sources like the recently shuttered AlphaBay. This is how most people are exposed to illicit fentanyl: It will be mixed into, or made to look like, powdered heroin or it will be used to produce counterfeit prescription pills. That makes it almost impossible to control supply. With heroin, investigators could rely on regionally specific chemical markers to indicate where the drugs had been produced. While that is certainly true for some number of drug users , research suggests that they are a minority. For long-time drug users, their continued use underlines the grip of addiction and the agony of withdrawal: They know it could kill them but do it anyway. Casual drug users are also at risk of fentanyl poisoning, particularly with increased reports of fentanyl-adulterated cocaine. Opioids are a vital component of modern medicine that have measurably improved the quality of life for millions of people, particularly cancer patients and those with acute pain. But their efficacy in treating chronic pain is less clear , especially when weighed against the risks of overdose and addiction. Though prescription opioid consumption has been decreasing in the United States since or , it remains high. According to the International Narcotics Control Board , if the amount of opioids prescribed per year were averaged out over each person living in America, everyone would get about a two-week supply. Or a three-week supply, according to the C. Different ways of measuring what counts as a daily opioid dose give different values. At the same time, some chronic pain patients now struggle to fill their prescriptions. Solving the opioid problem requires controlling prescription opioid distribution while maintaining access for patients with legitimate medical needs. Suddenly removing access to opioids from those who are dependent on them to function could easily push people to illicit opioid sources, like heroin or counterfeit pills. Experts agree fixing the opioid epidemic will take a combination of solutions. What is the best use of resources? Officials want to use state prescription drug monitoring programs to reduce the supply of prescription opioids that end up being used recreationally while maintaining adequate access for current chronic pain patients. More broadly, experts say we need to improve the way our medical system manages pain. Remember the 12 million people we said took prescription painkillers outside of medical use? Roughly two-thirds of those did so to relieve physical pain. A more holistic approach to pain treatment would lessen the need for opioids. On the treatment side, experts stress the importance of having treatment readily available for those who are already addicted. Often that means going to where the people are, not waiting for them to seek out treatment themselves. Studies show the most effective treatment for opioid addiction often requires opioid medications like methadone or buprenorphine. In the meantime, widespread distribution of naloxone — an overdose antidote — will save lives in acute cases. Public health experts advocate things like safe injection sites , where people could use drugs under medical supervision, and drug checking services that people could use to test drugs for fentanyl , but many in law enforcement remain reluctant to adopt such measures. The commission laid out a series of recommendations in its interim report, with a final report expected in October. Some of the recommendations — like enhancing prescription drug monitoring programs and mandatory physician education on the dangers of opioids — are aimed at prevention. Some — expanding access to and funding development of medication-assisted treatment, eliminating Medicaid barriers to in-patient addiction treatment and enforcing laws that prevent health insurance companies from limiting mental health coverage — are aimed at treatment. Of course, these are only recommendations. Experts know how to attack the problem. Trump to declare a national emergency. During a public health emergency, this law gives the secretary of health and human service broad authority to make grants, conduct investigations and waive or amend a variety of health regulations. For example, the opioid commission argued that the H. Since Medicaid pays for a significant portion of inpatient drug addiction treatment, the exclusion is a major obstacle. Many states have been granted waivers from this regulation, but the onus is on each state to prove that it qualifies for one. The commission asserted that an emergency declaration would give the H. Please let us know. Please upgrade your browser. See next articles. George Bates. Percentage of deaths classified as drug-related. The chart includes both deaths from drug poisoning and those caused by drug-related mental disorders. Sources: W. Something that acts on opioid receptors in the nervous system. Drug overdose deaths involving Distribution of drug deaths by age. In counties with fewer than 20 drug overdose deaths, the map combines observed totals with modeled estimates. Decades of opioid overprescription, an influx of cheap heroin and the emergence of fentanyl. Then in , fentanyl began entering the drug supply in large amounts. Drug seizures containing fentanyl. Source: D. National Forensic Laboratory Information System. Average days of opioid use per resident per year. Values are three-year rolling averages for to Source: International Narcotics Control Board. It unlocks money and gives the H.

Short Answers to Hard Questions About the Opioid Crisis

Cameron Highlands buying Heroin

The victims' families and loved ones; Midwest Medical Examiner's Office; law enforcement officials obituaries ; Centers for Disease Control and Prevention data. Sources: The victims' families and loved ones; Midwest Medical Examiner's Office; law enforcement officials obituaries ; Centers for Disease Control and Prevention data. More from WSJ Graphics. How to Help Limit the Spread of Coronavirus. Election Primary Live Results.

Cameron Highlands buying Heroin