Marc LaRochelle, MD, assistant professor of medicine, Boston University School of Medicine, sees first-hand in his work with patients why the opioids abuse and addiction problem is different than other addictions that have plagued people throughout time.

“Opioids are particularly sticky. People who use opioids can very quickly become dependent on them, and this makes stopping their use challenging,” he says. “And, so that level of physical dependence is more than we see with other drugs and hard to stop.”
A second reason that make opioids unique is the various drugs that fall under the classification have a direct effect on suppressing the central nervous system, which can lead to aspiration and overdose and death at a much higher frequency than for other drugs, LaRochelle says.
In assessing the current state of all things opioids, he makes certain to note that the opioids crisis did not appear out of the blue. “Look at the data, the problem has been evolving for two to three decades now. So if you look at trends, the trend has been for a steady rise in this problem over the last 20 to 25 years,” he says.
LaRochelle says most experts feel that through 2010 much of the increase in deaths centered around prescription opioids tied to the increasing subscribing of those medications linked to what the medical community thought was the under treatment of pain in the past. 
“Since 2010, if you really look at trends, between 2010 and 2013, both opioid prescribing and prescription-related deaths had leveled off. But, then heroin deaths increased,” he says. “And, since 2013 the same trends have been going on for prescription drugs and heroin but really the synthetic fentanyl has come in. So, there are a couple of different periods when different things occurred.”
This sort of Whack-A-Mole type of activity by people abusing opioids is a frustration for those searching for ways to stem the crisis. If action is taken on prescription meds, then heroin explodes; start making progress in those two areas and a synthetics problem arises.
And, it is this latest trend favoring fentanyl that is the deadliest version, yet. “Fentanyl is 50 to 100 times stronger than heroin on a gram-to-gram basis and it has infiltrated the heroin supply and been driving recent increases in deaths. It was seen in the Northeast in early days and now has spread across the country,” LaRochelle says.
All told, the role for clinicians and providers when it comes to opioids is to be judicious and smart and do their part in helping to control what has become a seemingly uncontrollable problem for many pain sufferers.
“Even if opioids are given for a good reason people can get dependent,” he says.
It is also important to provide care in a compassionate manner for those already addicted and help to bring people into the health care system for help. “There remains a stigma at every level and many people are very reluctant to get care,” LaRochelle says.

Read the July 2018 cover story.