FBB Primer: The American Opioid Epidemic

Tom Warwick

“The opioid crisis is an emergency, and I’m saying officially right now it is an emergency. It’s a national emergency. We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” – President Donald Trump

Last week, in between statements about North Korea and the Confederacy, President Trump declared a different type of battle – one on the growing national opioid epidemic. While the details of the President’s proclamation are yet to be seen, the declaration marks a new front in the on going crisis. However, the question remains, how exactly did we get here? To answer this question, the staff of the Finest Bagels Blog has put together a comprehensive guide, that will hopefully provide our readers with a better understanding of this epidemic.   

So what exactly are opioids?

Opioids is an overarching term to describe the narcotics that bind specific receptors in the central nervous system.  In other words, a chemical pain killer.  Prescription opioids include legal  painkillers such as morphine, oxycodone, and hydrocodone, as well as synthetic pain relievers such as fentanyl. Opioids also includes illegal drugs such as heroin, which is derived from the same poppy pant (think Wizard of Oz) as Food and Drug Administration-approved opioid pills. While opioids are effective in alleviating chronic pain, they also can trigger an intense craving when the drug is absent.  In some, a tolerance for the drug can be developed requiring the need for higher doses to have the same effect. It is in this effect that the problem lies. As the craving for opioids increase, and a larger dose becomes necessary to reach its effects, addition begins and the chances of an overdose skyrocket.  

How did this all start?

Opioids have been used for medical purposes as far back as 3400 BCE, when the Mesopotamians cultivated poppy flowers along the banks of the Euphrates river.  It was later used by the Assyrians, Egyptians, and in 460 BCE Hippocrates – the father of medicine – acknowledged opium’s usefulness a narcotic and styptic in treating internal diseases. More modern usage of Opioids began in the 19th century when chemist Friedrich Wilhelm Adam Sertrner isolated morphine from opium.  The name morphine came from the greek god of dreams, Morpheus.  Morphine soon became the mainstay of medical treatment in Western nations and was used to treat pain, anxiety, respiratory problems, as well as “consumption” and “women’s ailments.”  It was around this time that the first cases of Opioid addiction was recorded.  In the American Civil War, due to the fact that it was slightly more effective than biting down on a led bullet, morphine was commonly used as a pain killer. However, victorian medical practices being what they are, many soldiers were given too much and developed addictions.  In the years after the war, a such a large number of veterans were addicted to the opioids that the addiction became known as “Soldier’s Disease.”  Even Sir Arthur Doyle’s famous detective was a victim to the “disease.”

In 1900, the prominence of morphine addiction was so great that a US community group known as the St. James Society undertook a campaign to supply free samples of a new derivative of the drug marketed as a “non-addictive” substitute to addicts trying to kick the habit.  This wonder drug was known as Heroin. Considering you know exactly what Heroin is, I’m going to gloss over the details and get to the part about Congress passing an Act to make it illegal, the OG war on drugs if you will.  In response to this ban, the mass production of heroin was halted and the new drug Oxycodone was invented with the hope that it would retain the pain killing effects of morphine and heroin without the crippling dependence.  

Fast forward another few decades and not only is Oxycodone still in use, but it is being mass marketed by Purdue Pharmas “OxyContin.”  Purdue created a video promotion called “I Got My Life Back,” which followed people who suffered from chronic pain and used OxyContin. The video was distributed to doctor’s officers as a “check out” item for the office’s “patient education library.”  In the video a doctor was featured telling patients that “these drugs…are our best, strongest pain medication, should be used much more than they are for patients in pain.” A year after the video came out, prescriptions of OxyContin filled jumped by eleven million.  Unsurprisingly, the abuse and misuse of drugs like OxyContin – and later Vicodin, Percocet, and Lortab, increased significantly.  As a result, pharmaceutical companies began developing  new formulates versions of the drug with “abuse deterrents.”  Additionally, law enforcement agencies began campaigns to limit abuse through the collection and destruction of leftover prescription pills. While these changes have been effective at reducing prescription pill abuse, it has had some unintended consequences. Of those who had already become addicted to opioids, one study showed that over two-thirds of them had switched from a prescription drug to a different opioid the most popular of which being heroin.  

If it’s been around for so long, why are we just hearing about it?

Mostly due to the unprecedented levels the epidemic has reached.  Today, millions of Americans are addicted to prescription opioids, with the death rate due to overdose quadrupling between 1999 and 2015.  The epidemic is affecting communities that are mostly while and lower income with higher unemployment and higher rates of chronic diseases like diabetes and arthritis.  Ohio, West Virginia, and New Hampshire have been hit especially hard. To make matters worse, theses and other states are having a hard time covering the cost associated with the epidemic, with some even going as far as threatening to stop medical service to repeat overdosers.  Other states have started sharing pictures and videos of people who have overdosed to raise awareness of the dangers.

So what else is being done about this?

Pharma companies are continuing to rework their drugs to make them harder to abuse, including making them harder to crush and snort. Since their efforts in the past to make drugs less addictive have been so effective, we have high hopes for this renewed effort. The federal government has also been “encouraging” doctors to use other forms of pain relief, such as ibuprofen and exercise, instead of prescribing opioids.

Final Thoughts

This is a problem with out an easy fix.  Despite current efforts, nearly one hundred Americans are dying every day from an opioid overdose. While the crisis is more concentrated in certain areas of the country, this epidemic is affecting Americans of every gender, age, and race.  We hope this primer has helped to give you an overview of the crisis. The FBB team will continue to cover this epidemic as new policies and efforts are launched.  

 

Photo Credit: Fox News

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