Epidemiology is the branch of medical science that studies all the elements, including the patterns, causes, and effects of health and disease conditions that determine the presence or absence of diseases and disorders in defined populations.  It provides information to help us to understand how many people have a particular disease or disorder, if those numbers are changing, and how the disease or disorder affects our society and our economy.  In other words, it is invaluable for purposes of public health.  Its information and conclusions influence policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare.  Epidemiology answers the questions who, what, where, when, why, and how of a disease or disorder.  In this case, these questions are about opioid use in teens.

What Is The Epidemiology of Opioid Use in Teens?

For whatever disease or disorder is being studied, its epidemiology measures the number of new cases of in a population over a period of time; the number of existing cases in a population at a given time; the expenditures on medical care for the disease,  as well as any identifiable work-related costs, educational costs, costs of support services required by the condition, and the amount individuals would pay to avoid the health risks attendant to the condition; and the total significance of the disease for society, apart from the immediate cost of treatment of the disease, including the years of life lost due to the disease.  The World Health Organization has adopted a Disability-Adjusted Life Year (“DALY”) as a measure of the burden of a disease or disorder.  One DALY can be thought of as one lost year of “healthy” life.  The sum of DALYs across a population is regarded as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.

What are Opioids?

According to the National Institute on Drug Abuse, opioids are opium-like substances that bind to one or more of the three opioid receptors of the body.  They are medications that relieve pain.  They act to reduce the intensity of pain signals that reach the brain and affect those areas of the brain that control emotion, thereby lessening the effects of a painful stimulus.  Medications that fall within the classification of opioids class include hydrocodone (“Vicodin”), oxycodone (“OxyContin,” “Percodan” or “Percocet”), morphine (“Kadian” or “Avinza”), hydromorphone (“Dilaudid”), fentanyl (“Duragesic”), propoxyphene (“Darvon”), meperidine (“Demerol”), codeine, and related drugs.

Hydrocodone is most commonly prescribed for a variety of painful conditions, including dental and injury-related pain.  Morphine is generally used before and after surgical procedures to ease severe pain.  Codeine is generally prescribed for mild pain.

People abuse opioids by taking them in a way that is not intended, such as taking someone else’s prescription opioid medication, taking a prescription opioid medication in a way other than prescribed, taking more of the medication than prescribed or combining it with alcohol or other drugs, or taking the opioid prescription to get high.

Incidence

Incidence is the number of new cases of a disease or disorder in a population over a specified period of time.

The Monitoring the Future (MTF) survey, which is funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), has been conducted by researchers at the University of Michigan since 1975.  It has included 12th graders since its inception in 1975, and added 8th and 10th graders were added to the survey in 1991.  Survey participants generally report their drug use behaviors for three time periods: lifetime, past year, and past month.  The MTF survey measures drug use and attitudes among eighth, 10th, and 12th graders.  Overall, 44,892 students from 382 public and private schools participated in the self-reporting 2015 survey.  The data collected show, for the year relevant to the survey, that 0.9% of 8th graders, 2.5% of 10th graders, and 4.4% of 12th graders reported non-medical use of Vicodin.  They also show that 0.8% of 8th graders, 2.6% of 10th graders, and 3.7% of 12th graders abused OxyContin.  Most teens abusing prescription opioids reported getting them from friends or family members.  However, a third of those reporting stated that they get the drugs from their own prescriptions.  Since the survey is self-reporting, they take the respondents’ answers as true.  They cannot account for survey responses that are untruthful.  Nevertheless, these numbers alone, assuming they are true, re-emphasize the need to monitor teens taking opioids and evaluate prescribing practices.

Prevalence

Prevalence is the number of existing cases of a disease in a population at a given time.  NIH studies show that from 2001 to 2014 there was a 3.4-fold increase in the total number of deaths in the United States due to prescription opioid pain relievers.  In 2001, there were approximately 6,000 deaths, and in 2014 there were just fewer than 20,000 deaths.

In 2014, for example, the National Survey on Drug Use and Health (NSDUH), sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), also provided data graphically illustrating the increase in prescription opioid abuse.  In 2014, 10,337 persons aged 12 or older had used pain relievers illicitly in the last year; 4,325 persons aged 12 or older used pain relievers illicitly in the last month.  An analysis from the U.S. Centers for Disease Control and Prevention (CDC) of 2012 prescribing data collected from U.S. retail pharmacies showed that healthcare providers wrote 259 million prescriptions for opioid painkillers that year and that 46 individuals died each day in the United States from an overdose of prescription painkillers.

Cost of Illness

The cost of opioid use by teens is a tricky number to calculate.  The actual money spent on medical care would be the obvious number.  But one must add to that number factors that are more difficult to measure, such as work-related costs, educational costs, the cost of support services required by the medical condition, and the amount individuals would pay to avoid health risks.

A study was undertaken of the societal costs, in 2007, of prescription opioid abuse, dependence, and misuse in the United States.  The results of the study, adjusted to 2009 dollars, estimate health care costs of $25.0 billion (45%), workplace costs accounted for $25.6 billion (46%), and criminal justice costs of $5.1 billion (9%), for a total of $55.7 billion.

Burden of Disease

The burden to society of opioid use goes beyond the immediate cost of treatment.  It is goes beyond economic measures, and extends to the quality and quantity of human life.  It is measured in years of life lost to ill health, or the difference between total life expectancy and disability-adjusted life expectancy (DALY).  DALYs are a calculation of the average number of years that a person with an opioid dependence or addiction spends in a disabled state, as well as the average number of years that such a person loses to premature death as a measure

A 2014 worldwide investigation was conducted of the level of harm associated with opioid dependence or addiction.  The study showed that residents of the U.S. and Canada consume more opioid substances than the residents of any other countries in the world.  According to figures compiled SAMHSA, almost 5 million people abuse a prescription opioid medication in America every year.  In 2012, about 1,880,000 people misused an opioid medication for the first time.  When opioid-related harm is calculated through DALYs, North America has the highest rate of such harm in the world.  The study demonstrated that opioid dependence and addiction places a substantial burden on the health of human society.  In terms of opioid-related disability and mortality, for every 100,000 individuals in the total population, North American residents lose about 292 years to disability or premature death as a result of a dependence on or addiction to an opioid substance.

Abuse, addiction to and misuse of opioids is a dangerous global problem that affects the health, social, and economic welfare of all societies.