Millions of people around the world struggle every day with addiction to opioids, and about half a million people have died in the US alone since 1999 due to an opioid addiction. Getting evidence-based treatment improves outcomes, but only about 10 percent of the global population has access to, and receives, this treatment. Unfortunately, many people do not remain in treatment for numerous reasons.
Relapse is a symptom of all chronic illnesses, including addiction. Returning to treatment helps the ongoing recovery process. With continued help, recovery is possible for opioid addicts.
How Many People Around the World Struggle With Opioid Addiction?
Opioid use disorder (OUD), or opioid addiction and abuse, is one of the most serious health crises not only in the United States, but around the world.
In 2019, there were 70,630 deaths from drug overdoses in the US, and about 70 percent of these deaths involved an opioid narcotic like a prescription painkiller, heroin, or fentanyl. In the prior year, 1.6 million people in the US had an opioid use disorder; 1.6 million people misused a prescription painkiller like hydrocodone or oxycodone for the first time; 10.1 million people misused prescription painkillers; 745,000 people began abusing heroin; and 50,000 people abused heroin for the first time.
Globally, half a million deaths are attributable to drug overdose, according to the World Health Organization (WHO). As many as 26 to 36 million people globally abuse opioids, with high rates of relapse. More than 70 percent of these involve an opioid, and 30 percent involve an opioid overdose.
There are well-understood, evidence-based, effective treatments like medication-assisted treatment (MAT) and behavioral therapies that help people overcome opioid addiction, but less than 10 percent of people worldwide who need these treatments receive them.
The Opioid Abuse Problem in the United States
The opioid abuse and overdose epidemic is considered to have begun in 1999, when prescribing practices around opioid painkillers changed, leading to higher levels of misuse and addiction. In the 20 years between 1999 and 2019, half a million people died from drug overdoses associated with prescription narcotics.
The National Institute on Drug Abuse (NIDA) notes that between 21 and 29 percent of people who are given prescription painkillers for chronic pain or a severe injury begin misusing these substances, and between 8 and 12 percent of those individuals develop an addiction to narcotics. Between 4 and 6 percent of people who abuse prescription opioids transition to heroin abuse. About 80 percent of people who currently struggle with heroin addiction abused prescription painkillers first.
Although 2017 to 2018 saw a decline of death associated with prescription opioids, and no states experienced a significant increase, this trend has not continued. Between 2018 and 2019, drug overdose deaths overall increased 5 percent; opioid-specific overdose deaths increased 6 percent; prescription opioid deaths increased 7 percent; and synthetic-involved opioid overdose deaths, not including methadone, increased 15 percent (likely associated with illicitly made fentanyl). Heroin deaths did go down, about 7 percent.
Treatment: The Struggle for Access & Better Data
Globally, health organizations like the CDC, WHO, NIDA, and others are working to adjust opioid prescribing practices and make addiction treatment more accessible. Although many people need this treatment, finding treatment providers, affording access to medications and therapy, spending time away from work or family, distance between treatment providers, and other obstacles greatly limit most people’s ability to enter these programs.
Without MAT, ending the body’s opioid dependence can take about 10 days, with the most intense withdrawal symptoms occurring between the third and fifth day. Cravings and psychological withdrawal symptoms may last longer, which increases the risk of relapse.
Unfortunately, many people who enter addiction treatment do not receive the full course of care they need, either because they cannot afford it or because they drop out for other reasons.
It is difficult to know how many people have gone through addiction treatment and recovered from opioid abuse. One article published in 2018 stated that an estimated 22 million Americans, at the time, were in a recovery program to overcome opioid abuse. The reason this is an estimate, and not a known fact, is that state and federal governments do not track opioid recovery like they track rates of addiction, overdose, and death. Without this information, it can be difficult to know which recovery programs are the most effective and which states are providing the right types of medical, financial, and behavioral support to improve the evidence-based recovery process.
Evidence-based programs have state health licenses and organizational certifications, which you can ask about or find on their website. Many are transparent about their services, their recovery statistics, and what type of support they offer in the event of a relapse.
Relapse Does Not Mean Treatment Has Failed
One study reports that the majority of people who undergo treatment for opioid addiction relapse within one year after completing rehabilitation. The study found that the most reported reason for relapsing back into substance abuse patterns was the desire to feel good.
Many people who struggle to maintain abstinence report lower rates of self-efficacy, so they have a hard time taking care of themselves; higher perceived criticism, which can indicate underlying mental or emotional health conditions; and higher cravings, suggesting that brain chemistry has not adjusted to self-regulate without opiates. Addressing individual needs, like mental health treatment, job retraining, physical therapy, and nutritional therapy, and offering other types of support for the entire person, not just the addiction, can improve these outcomes.
It is important to know that all types of addiction, including opioid use disorder, are chronic illnesses. This means that a return of some symptoms is normal during the course of recovery. People with other chronic illnesses, including diabetes, heart disease, and asthma, report a relapse in symptoms.
For example, between 30 and 50 percent of people with type 1 diabetes experience relapses; between 50 and 70 percent of people with hypertension or asthma also experience a relapse of symptoms. Reportedly, between 40 and 60 percent of people with any addiction, including to opioids, experience relapses. It is important not to think of this as a moral or personal failure, but a normal experience associated with chronic illness.
People who have a chronic illness like diabetes return to their doctor for an adjusted treatment plan when they experience a relapse in symptoms. Similarly, people who have gone through addiction treatment should be encouraged to return for additional support when they experience a relapse.
- What Is the US Opioid Epidemic? (February 2021). US Department of Health and Human Services (HHS).
- Understanding the Epidemic. (March 2021). Centers for Disease Control and Prevention (CDC).
- Opioid Overdose. (August 2020). World Health Organization (WHO).
- A Comparative Study of Factors Associated With Relapse in Alcohol Dependence and Opioid Dependence. (September-October 2017). Indian Journal of Psychological Medicine.
- Opioid Overdose Crisis. (March 2021). National Institute on Drug Abuse (NIDA).
- Opioid Abuse. American Society of Anesthesiologists.
- It’s Time to Measure Addiction Recovery Rates, Not Just Addiction Rates. (August 2018). Stat News.