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6.1.D. - Page 9 <br />Opioids <br />Opioids are powerful pain relievers prescribed to alleviate moderate to severe pain. 17 Prescription <br />opioids, including codeine, hydrocodone, morphine, and oxycodone, are among the most <br />prescribed drugs in the country. They are ordinarily safe and reliable when prescribed as part of a <br />strictly supervised, short-term treatment plan to relieve suffering caused by acute pain. 18 But, <br />patients using opioids to treat chronic pain are at risk of abuse and addiction. 19 Among patients <br />who take opioids for more than 30 days in the first year, 47 percent continued to do so for three <br />years or longer .20 The Centers for Disease Control and Prevention (CDC) reports that up to 25 <br />percent of patients who are prescribed opioids for long-term pain management struggle with <br />addiction. 21 Of the more than 42,000 opioid overdose deaths in 2016, an estimated 14,400 were <br />the result of prescription opioid overdose.22 <br />In response to the opioid epidemic, the medical community is restricting access to prescription <br />opioids.23 When opioid abusers lose access to their prescriptions, they often turn to illegal means <br />of obtaining opioids. 24 Among the most dangerous opioids they can obtain are certain synthetic <br />opioids, such as fentanyl, carfentanil, and their derivatives (fentanyl derivatives). Fentanyl <br />derivatives are chemically related to, and utilize the same neurological pathways as other opioids <br />such as morphine and codeine. However, fentanyl derivatives can be extraordinarily potent, <br />delivering more than 50 times the dose of opioids as morphine.25 <br />Opioid abusers who have lost their prescriptions are increasingly turning to these fentanyl <br />derivatives due to their relatively low cost, accessibility, and potency. As a result, synthetic <br />opioid -related deaths nationwide have increased from 3,000 in 2013, to 20,100 in 2016 — an <br />increase of over 500 percent.26 <br />17 National Institute on Drug Abuse, "Opioids" National Institutes of Health. Accessed February 26, 2018. <br /><htti)s://www.dru2abuse.2ov/dru2s-abuse/oi)ioids> <br />18 Ibid. - <br />"Brady Dennis, "Opioids are among the most prescribed drugs. Here are the most common versions" Washington <br />Post, April 14, 2014. <www.washin2ton_)ost.com/news/to-vour-health/vm/2014/04/14/ban-some-_rain-killers-here- <br />are-6-common-onioids/> <br />20National Institute of Drug Abuse, "Opioid Prescribers Play a Key Role in Stopping the Opioid Overdose <br />Epidemic' National Institutes of Health. Last modified March 2017. <br /><https://www.drueabuse. eov/publications/improving-opioid-prescribing/improving-opioid-Drescribing> <br />21Centers for Disease Control and Prevention, "Prescription Opioid Overdose Data" Last Modified August 1, 2017. <br /><htti)s://www.cdc.2ov/dru2overdose/data/overdose.html>. <br />22Ibid. <br />21 Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, "The Opioid <br />Epidemic from Evidence to Impact" Johns Hopkins, October 2017. Pg. 13. <br /><httns://www. i hsph. edu/events/2017/americas-opioid-epidemic/report/2017-JohnsHonkins-Opioid-di gital.pdf> <br />2'German Lopez, "The opioid epidemic, explained" Vox, December 21, 2017. <httns://www.vox.com/science-and- <br />health/2017/8/3 / 16079772/opioid-epidemic-drug-overdoses> <br />""Synthetic Opiates List --Drugs that Derive from Opium," Opium.com, Accessed on February 26, 2018. <br /><httn://www. onium. ore/svnthetic-opiates-list-drugs-derive-onium.html> <br />26Josh Katz, "The First County of Fentanyl Deaths in 2016: Up 540% in Three Years" New York Times, September <br />2, 2017. <httas://www.nvtimes.com/interactive/2017/09/02/unshot/fentanvl-drug-overdose-deaths.html> <br />2017-2018 San Mateo County Civil Grand Jury 4 <br />