(l. to r.) Cindy Hall, President, Women’s Congressional Policy Institute, Dr. Nora Volkow, Director, National Institute on Drug Abuse (NIDA), National Institutes of Health, and Dr. Jerome Adams, Indiana State Health Commissioner; photo by Sylvia Johnson

On July 12, 2017, the Women’s Congressional Policy Institute (WCPI) sponsored a briefing, "Chronic Pain in Women and its Relationship to Opioid Addiction," in cooperation with Reps. Susan Brooks (R-IN) and Lois Frankel (D-FL), Co-Chairs of the Congressional Caucus for Women’s Issues (Women’s Caucus), and Reps. Mimi Walters (R-CA) and Brenda Lawrence (D-MI), Vice-Chairs of the Women’s Caucus.  The briefing was the twelfth event in a women’s health series sponsored by WCPI over several years, with support from the Robert Wood Johnson Foundation. Cindy Hall, President of WCPI, thanked the Foundation for its support and its work to improve the health and health care of all Americans through its support for research and programs working to help build a national Culture of Health.

Members of the Women's Caucus

Serving her third term representing the 21st District of Florida, Rep. Lois Frankel serves on the Foreign Affairs and Transportation and Infrastructure Committees. Rep. Frankel stated that the issue of drug addiction is incredibly timely, is a huge problem in her district, and that she would be staying to listen to the briefing in its entirety because of its importance.

Serving her third term representing the 5th district of Indiana, Rep. Susan Brooks chairs the Ethics Committee, serves on the Energy and Commerce Committee where she is a member of the Health Subcommittee and has authored several bills on the topic of drug addiction. Rep. Brooks mentioned Indiana’s HIV outbreak as one of the many consequences of the opioid epidemic.

Speakers

Nora D. Volkow, MD
The first speaker was Nora D. Volkow, MD, Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH). NIDA supports most of the world’s research on health aspects of drug use and addiction.

Dr. Volkow’s work has been instrumental in demonstrating that drug addiction is a disease of the human brain. As a research psychiatrist and scientist, Dr. Volkow pioneered the use of brain imaging to investigate the toxic effects and addictive properties of abusable drugs. Her studies have documented changes in the dopamine system affecting, among others, the functions of frontal brain regions involved with motivation, drive, and pleasure in addiction. She also has made important contributions to the neurobiology of obesity, ADHD, and aging.

Dr. Volkow stated that she would be discussing the topic of opioids on two levels: the opioid crisis in general terms and how the opioid crisis is unique as it relates to women. Three notable concerns about the opioid crisis were cited by Dr. Volkow:

 The number of people dying.  In 2015, 33,000 people died from an opioid overdose. The impact on the health care system as it relates to maternal mortality and economics is substantial.

 This is a crisis born out of the health care system.  We need to change the practice and structure by which we provide care as it relates to the treatment of pain and the treatment of substance use disorders, including opioid addiction.

 This epidemic has affected a vast set of individuals who normally and traditionally are not associated with drug taking.  In the epidemiological data for all patterns of drug taking, women have much lower prevalence ratings than males. However, in the opioid crisis, equivalent numbers of females and males are impacted.

Opioid prescriptions are predominately utilized to address very severe pain. Opioids can be lifesaving when prescribed properly and used for the indications for which they are prescribed. As a consequence of overuse, opioids are particularly prevalent in the misuse data. There are three classes of prescription medications that are generally misused: opioid analgesics, stimulants, and sedative hypnotics. Dr. Volkow stated that whether you are taking heroin or an opioid for pain, the drug activates and binds to the mu receptors of the brain and inhibit sensations of pain. The brain consists of a network that allows an individual to perceive pain, but also the emotional reactions to it. The problem lies in other areas of the brain (accumbens) where the opioid targets and the individual receives pleasure. The pharmacological effect is so powerful that it can activate a chain of events that can result in addiction. The main cause of opioid death is when the drug binds to the receptors in the brain stem that control breathing. When the drug manipulates that area it triggers respiratory depression, and an individual can stop breathing.

In the 1990s, a campaign was launched to treat pain very aggressively because the outcomes of pain left untreated were incredibly poor. The number of prescriptions skyrocketed during this time, but we did not yet have a clear understanding of the effects opioids had on chronic pain as doctors typically prescribed opioids for patients with acute pain. Today, Americans consume 80-85 percent of the opioids in the world. The over-prescribing has led to diversion, abuse, and addiction/overdose for individuals who have never before had a history of dependency.

Dr. Volkow presented a comparison map of overdose death rates in the United States. In 1999, only small pockets in West Virginia and New Mexico had high incidences of overdosing. In 2015, the whole country was affected by this crisis with overdose death rates scattered in high levels across the US. Opioid abuse is unusual in that women and men are about equivalent in their use, which typically is not seen for other substance use disorders.

Since 2011, aggressive campaigns to reduce the number of opioid prescriptions have been introduced with some success. Dr. Volkow stated that between 2010-2015 opioid prescriptions decreased by 15 3 percent, but there needs to be a further reduction. Researchers and health care providers were expecting death rates to decrease equally over this time period, but the overdose rate continues to increase. Dr. Volkow noted that 4-6 percent of individuals prescribed opioids become addicted and turn to heroin because it is cheaper and more accessible than prescription drugs. Eighty percent of the new heroin users in the US started with prescription opioids, which explains the continual increase in deaths despite the decrease in opioid prescriptions.

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