Krystal Thomas

Health 1050
Paul Roberts

Opioid abuse is at an all-time high. Drug overdoses are the leading cause of injury death

in the United States. Deaths from synthetic opioids increased by 72% between 2014 and 2015.

In 2016, more than 2 million Americans had an addiction to prescription or illicit opioids (The

Opioid Crisis). On October 26, 2017, President Trump declared the opioid crisis a national Public

Health Emergency. Every day, more than 175 people in the United States die after overdosing

on opioids. This includes prescription pain relievers, heroin, and synthetic opioids such as

fentanyl (Opioid Overdose Crisis). Addiction to prescription opioids can happen in as little as 7

days. 80% of heroin users reported misusing prescription opioids prior to heroin (U.S.

Department of Health and Human Services). How did the epidemic begin?

The use of opioids goes back to the early 1900s, when morphine was used to treat

injured soldiers in the Civil War. This led to soldiers becoming dependent on opiates, it became

known as the “soldier’s disease” (Levinthal 124). Increasing concern about opiate dependence

brought a new painkilling morphine derivative, heroin. The Bayer Co. started production on a

commercial scale in 1898. It was considered the “wonder drug” (Moghe). It was believed to be

free of dependence-producing properties. It was 3 times as strong as morphine. It was said to

be safe as a cough suppressant. Addicts soon found that its effects could be amplified by

injecting it. The abuse potential was not recognized until 1910, which exceeds morphine.

According to Levinthal, “By 1900, there were, by one conservative estimate, 250,000 opioid-
dependent people in the United States, and the actual number could have been closer to

750,000 or more (124).”

In 1914, The Harrison Act changed opioid use and abuse in America. The Harrison Act

imposed a tax on those making, importing and selling any derivative of opium or coca leaves

(Moghe). In the early 1920s, no medical professional was allowed to prescribe opioids for

“nonmedical use.” Addicts turned to the black market for their fix. Heroin was the easiest to

obtain. Drug use escalated in the 1970s, President Gerald Ford set up a task force to study the

program. It turned the focus from marijuana and cocaine to heroin. Percocet and Vicodin came

on the scene in the late 1970s. At first doctors were weary about prescribing it to their patients,

they had been taught about the highly addictive opioids.

According to Moghe,

“An 11-line letter printed in the New England Journal of Medicine in January

1980 pushed back on the popular thought that using opioids to treat chronic

pain was risky. In it, Jane Porter and Dr. Hershel Jick mentioned their analysis of

11,882 patients who were treated with narcotics. They wrote that, “the

development of addiction is rare in medical patients with no history of

addiction.””

Jick told the Washington Post that less than 1% of patients died from reactions to the drugs. He

said, “I think very serious adverse reactions are about as infrequent as one could possibly

expect given the enormous amount of exposure to drugs (Moghe).”

 In 1996, Purdue Pharma put OxyContin on the market. In the early 1990s, the number of

painkiller prescriptions filled at U.S. pharmacies increased from 2 million to 3 million each year,

according to a National Institute on Drug Abuse. It again jumped to 8 million from 1995 to 1996

(Moghe). Purdue Pharma created a video called “I Got My Life Back,” it distributed 15,000

copies to be displayed in doctors waiting rooms. It followed 6 people who suffered from chronic

pain and were treated with OxyContin. According to a doctor in the video, “They don’t wear

out; they go on working; they don’t have serious medical side effects. So, these drugs, which I

repeat, are our best, strongest pain medications, should be much more than they are for

patients in pain (Moghe).” After the video came out the number of prescription opioid

painkillers filled by the pharmacies increased by 11 million.

By 2001, The Joint Commission made pain treatment a priority. They made a standard

“Pain is assessed in all patients,” which meant doctors were required to examine their patients

pain levels. The Joint Commission would check on the doctor’s assessments and give the

hospital a “needs improvement” if they failed to meet this standard. This is a big deal to any

hospital. However, The Joint Commission removed this standard in 2009.

By August 2010, OxyContin created a new formula with an abuse deterrent, this had the

hope of making it more difficult to crush and abuse by snorting or injecting it. According to

Moghe,

“A study published in the New England Journal of Medicine surveyed more than 2,500

people who used OxyContin before and after safety measures were added. It found that

before the anti-abuse measures were put in place, 35.6% of people questioned
 admitted abusing the drug. Nearly two years after the deterrent was added, that

number dropped 12.8%. But 24% of those surveyed still found a way to defeat the

tamper-resistant properties of the medicine.”

One of the opioid user in the study said that most people they know don’t use Oxycontin to get

high anymore, they have moved on to heroin; it’s easier, cheaper and easily available. The

study also showed that 66% of those surveyed switched to other opioids.

Portenoy, the doctor who wrote one of several studies that claimed there was little risk

of addiction in using opioids to treat chronic pain, spoke out in 2011 about his own role in the

epidemic. He said, “What I was trying to do was create a narrative so that the primary care

audience would…feel more comfortable about opioids in a way they hadn’t before. In essence,

this was education to destigmatize, and because the primary goal was to destigmatize, we often

left evidence behind. Clearly if I had an inkling of what I know now then, I wouldn’t have spoken

in the way that I spoke. It was clearly the wrong thing to do (Moghe).”

Now that things have gotten so out of hand, what can be done to fix it? The U.S.

Department of Health and Human Services has comprised a 5-point strategy to combat the

opioid crisis. The first point is Access: Better Prevention, Treatment and Recovery Services. HHS

issued $800 million in grants to support access to opioid-related treatment, prevention, and

recovery. This also makes it easier for states to receive waivers to cover treatment through

Medicaid. HHS also published resource and media materials to raise awareness. Second point is

Data: Better Data on the Epidemic. HHS is improving our understanding of the crisis by

supporting more timely, specific public health data and reporting, including through
accelerating CDC’s reporting of drug overdose data. The third point is Pain: Better Pain

Management. HHS wants to ensure everything we do, payments, prescribing guidelines, and

more – promotes healthy, evidence-based methods of pain management. Fourth, Overdoses:

Better Targeting of Overdose-Reversing Drugs. HHS works to better target the availability of

lifesaving overdose-reversing drugs. The President’s 2019 budget includes $74 million in new

investments to support this goal. Finally, fifth, Research: Better Research on Pain and Addiction.

HHS supports cutting edge research on pain and addiction, including through a new NIH public-

private partnership. (U.S. Department of Health and Human Services)

Help is out there. There are 14,000+ substance abuse facilities in the U.S. (U.S.

Department of Health and Human Services). There is also a National Helpline 1-800-662-4357.

Research has shown that combining behavioral and pharmacologic treatments is the most

effective approach to overcoming opioid addiction. Some people believe that using medications

to treat opioid addiction in just substituting one drug for another. This is a common

misconception. According to National Institute on Drug Abuse,

“Although it is possible for individuals who do not have an opioid use disorder to

get high on Methadone or Buprenorphine, these medications affect people who have

developed a high tolerance to opioids differently. At the doses prescribed, and a result

of their pharmacodynamic and pharmacokinetic properties (the way they act at opioid

receptor sites and their slower metabolism in the body), these medications do not

produce a euphoric high but instead minimize withdrawal symptoms and cravings.”
 There are three medications commonly used to treat opioid addiction, it doesn’t treat

the addiction as much as it helps with the withdrawal symptoms and cravings. Methadone,

Buprenorphine, and Naltrexone. Methadone is a clinic-based opioid agonist that does not block

other narcotics while preventing withdrawal while taking it. It is a daily liquid dispensed only in

specialty regulated opioid treatment clinics. Buprenorphine is office-based opioid

agonist/antagonist that blocks other narcotics while reducing withdrawal risks. It is a daily

dissolving tablet, cheek film or 6-month implant under skin. Naltrexone is an office-based non-

addictive opioid antagonist that blocks the effects of other narcotics. It is a daily pill or monthly

injection. These medications are not meant to be taken for life, however, it can take months to

years to gradually wean off these maintenance medications (Medications to Treat Opioid Use

Disorder). There are several treatment options, from facilities to medications. (U.S. Department

of Health and Human Services)

In conclusion, the opioid epidemic has been around for a long time but it has reached an

all time high. The government is taking steps to overcome this crisis, but is it going to be

enough? Only time will tell. We are losing too many people to these drugs. I think what we can

take from this is to use prescription drugs as little as possible for the shortest amount of time as

possible.
Works Cited
Levinthal, Charles F. "Drugs, Behavior, and Modern Society." Levinthal, Charles F. Drugs, Behavior and
Modern Society. Pearson, 2014. 124.

"Medications to Treat Opioid Use Disorder." June 2018. National Institute on Drug Abuse. 31 July 2018.
<www.drugabuse.gov/publications/medications-to-treat-opioid-addiction/what-are-
misconceptions-about-maintenance-treatment>.

Moghe, Sonia. "Opioid history: From 'wonder drug' to abuse epidemic." 14 October 2016. CNN. 31 July
2018. <www.cnn.com/2016/05/12/health/opioid-addiction-history/index.html>.

"Opioid Overdose Crisis." March 2018. National Institute on Drug Abuse. 31 July 2018.
<www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis>.

"The Opioid Crisis." n.d. The Whitehouse. 31 July 2018. <www.whitehouse.gov/opioids/>.

U.S. Department of Health and Human Services. U.S. Department of Health and Human Services. n.d. 31
July 2018. <www.hhs.gov/opioids/treatment/index.html>.