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The Opioid Epidemic

It all started back in the 1800s with the abuse of a drug called laudanum which is a

mixture of alcohol and opium which was used for treatments such as pain, coughing, anxiety,

diarrhea, and sleeping disorders. This drug was found to be very addictive to patients prescribed

it, but doctors still were using it across the country. Although opioids eventually became

regulated and have historically been dispensed for only severe trauma, cancer and pain

associated with life-limiting illnesses, over the past several decades they have been increasingly

prescribed for many non-acute conditions. Opioids that include oxycodone, Percocet,

hydrocodone, Vicodin, and morphine are the most efficient prescribed drugs for chronic pain.

The main question we have in this perspective is: When does it get to the point that these

effective prescribed drugs are being misused and are irresistible by patients? In addition, why are

these “prescribed” drugs considered safe, yet heroin is illegal when the molecular structure of all

opiates is almost identical? It is a popular and controversial debate that these opioid drugs lead

directly to the heroin addiction, but the facts state that the heroin epidemic has increased

exceedingly in the past few years over heroin addictions, and the possible solutions include

better education on these topics, finding alternatives to treat the chronic pain and stricter laws on

doctors that prescribe these harsh drugs (“History” 1).

The definition of opioid drugs are substances that act on opioid receptors to produce

morphine-like effects. The main purpose of the drug is to give the receiver temporary relief from

pain by changing the way the body receives this pain felt. The drug OxyContin is the most

popular opioid that is given to patients who have constant pain and need the relief medicine.

Oxycontin is similar to heroin because when it is in pill form it “works as a time-release pain
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medication” however when crushed into a powder form it causes an intense euphoric high.

(“Oxycontin Acting”, 1). So, to summarize, this explains the reason that the drug Oxycontin

becomes so addictive to these patients because it is much like heroin because of the fact that you

can crush and snort it. On the other hand, much like Oxycontin being crushed, heroin can

become so addictive because you have the option to inhale, smoke, or inject it, so the drug

reaches the brain much quicker. The main difference between Oxycontin and heroin is that one is

prescribed to the patient and one is not. Also, additives and toxic contaminants are usually

embedded in heroin that can cause dangerous side effects when it is sold off the streets. On the

other hand, doctors usually make and produce pure Oxycontin themselves. People are able to

obtain the same euphoric high when using both heroin and prescription drug because these drugs

are narcotics that can become highly addictive.

The opioid epidemic has specifically soared in the United States, and from 2000 to 2013

have “quadrupled [in the number of heroin related deaths, including those by overdose] ” (“The

Numbers” 1). Because only one gram of heroin can “deliver up to 20 doses, or highs” paired

with the fact that with the drug sells for “$100 a gram” on the street, most addicts are diving into

the cheaper opioids. The opioids on the street “generally sell illicit street market at around $1

per milligram. A one-time high from an 80-milligram oxycodone pill for an experienced user

would run roughly $80.” (“OxyContin Gateway” 1). So, to summarize, the same exact high

exists from prescribed drugs for a fraction of the price of heroin. Heroin prices on the streets are

continuously increasing, so it makes it more logical for buyers to get their high from the

prescription drugs for, once again, much less. Additionally, long time users need more substance

to generate the same high and this endless cycle of self-deterioration has become a cancer in

middle America. This being said, it is apparent that this is the ultimate reason that heroin related
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deaths and increasing addiction is rising every single year that passes. This epidemic affects all

ages, races and social classes, although most people often think it is usually African Americans

and white men in poverty. Surprisingly, wealthy white Americans are most likely the people who

suffer from addiction. Though heroine affects the affluent, John Wertheim states, “Heroin use

cuts across demographics” (Wertheim 1). This being said, people of all socioeconomic

backgrounds are at risk of coming in contact and or trying this extremely harmful drug.

Although it seems as though the opioid epidemic is a popular social problem in modern

society, opioids affect almost all aspects of society. The main group involved would be

pharmaceutical companies, as they can often use unethical tactics to get these drugs into the

marketplace. Doctors and the healthcare industry go along with the pharmaceutical companies in

the fact that they can treat chronic pain with these drugs while over-prescribing opioids. It was

found from a study carried out by people from The College of Medicine at Yale University that

people who use Oxycontin for non-medical purposes are in fact very notable from other non-

medical opioid users. Lauretta Grau states in her article that “the problem seems not intrinsic to

the drug or its formulation, but rather in users’ desire to consume opioids primarily for pleasure

or as a consequence of addiction” (Grau 171). Even Federal and State Governments are involved

in the opioid epidemic by not regulating the distribution of the drug, reducing the overdose

deaths, promoting the medically appropriate treatment of pain, etc. A research study resulted in

more than half of the patients followed who received consistent opioid treatment for 90 days

were still receiving opioids more than four years later. Many people who unknowingly become

addicted to opioids will eventually run out of their prescription and resort to illegally buying it

off the streets or even flat out stealing it from others’ medicine cabinets.
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It should be apparent to all doctors that they need to explain to the patient the dangers and

life-threatening side effects about to be prescribed these medications like Oxycontin. Three

years ago, there was a study followed for two years in the state of New York to determine the if

the number of deaths decreased from prescription drugs before and after legislation passed the

new Internet System for Tracking Over-Prescribed/Prescription Monitoring Program (I-

STOP/PMP). The I-STOP/PMP “requires all prescriptions to be electronically transmitted,

thus improving safeguards for the distribution of specific prescription drugs that are prone to

abuse. [And it should] should solve the problem of prescription pad theft and forgery.”

(Sgarlato 1). As the results came through, it was concluded that there was only 4% of patients

that the fatalities were due to non-opioid medications or heroin. It specifically states, “Over the

2 years of our study, there were a total of 1286 fatal intoxications.” (Sgarlato 1). And the same

author also states that “There were 62 fatalities due solely to non-opioid medications.” This

study clearly revealed that there is a problem with these prescription drugs and one is just not

worse than the other due to the fact that they measured the addiction of different types, all being

very high percentages. Doctors today are given too much freedom in regard to what prescriptions

they can write and the number of prescriptions. Doctors in the modern era have become too

lackadaisical when evaluating patients, and more often than not simply write a prescription

without assessing the mental health of the patient and his or her predisposition to addiction. This

being said, doctors should be required to assess the patient’s mental health before writing a

prescription. Moreover, due to the influx of prescription drugs on the streets, it would be

beneficial for society as a whole for doctors to implement a quota system in which doctors are

allowed a certain number of prescriptions.

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Children, starting a young age, should be educated on the negative side effects of

addiction, including the physical pain that withdrawal brings. Programs like D.A.R.E, Across

Ages and other drug prevention courses certainly aid in educating the youth, however, these

courses are brief, and students seem to lose sight of the seriousness of drug usage. If drug

prevention courses are offered starting in elementary school and continue throughout high

school, there is less of a chance that students forget the magnitude of side effects that a drug

addiction can bring. In an article by Daniel P. Alford, he brings to light the idea that education is

the key to stopping this epidemic in its tracks. Alford states that education is a “more finely

tuned approach to addressing the opioid-misuse epidemic” and goes on to state that

“individualizing the care on the basis of a patients’ needs” allows for a more accurate approach

to treating those already addicted. Additionally, Alford claims in regard to education, “That, after

all, [opioids are] the way we manage all chronic diseases,” and then “Education can empower

clinicians to make appropriate, well-informed decisions about whether to initiate, continue,

modify, or discontinue opioid treatment for each individual”, illuminating the fact that even the

most prolific epidemics throughout history have been treated through studying them, informing

the public, and then coming to a resolution (Alford 1). The root of many addictions lies within

the fact that most patients blindly trust doctors to make the right decision when writing a

prescription. This being said, a simple drug education course taught to students in school may

enlighten them on the topic of combatting addiction. Moreover, if students learn that they do not

have to accept a prescription if they feel uncomfortable using powerful prescribed drugs, the

addiction problem in our country may substantially decrease. The LTM Foundation states that

programs aimed at targeting the youth and educating them in the field of addiction has had an

extremely positive effect and is aiding in the decreasing number of heroin related deaths.
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Additionally, society needs to stop viewing addicts in a negative light, because as long as this

occurs, “we’re not going to make any progress” (Amsden 1). This troubling epidemic can be

combatted in numerous ways; however, it takes the initiative of both the American public, the

government, and local schoolboards in order to make a change.

From the College of Social Work at Florida State University, Mrs. Ellen Piekalkiewicz

has hosted many community events in Tallahassee and on campus to help people understand the

detrimental effects this epidemic has caused to our society so we, as a community, can focus on

prevention. Mrs. Piekalkiewicz states that “There are two levels on how we can treat this

epidemic. The first level would be prevention and the other would be treatment. The prevention

topic would include educating the public and physicians about the addictive nature of opioids

and making sure that people are really cognizant of the medication that they’re taking and

prescribing. In the United States, there is an over-abundance of prescription for opioids and other

countries including Europe and Asia do not compare to ours.” says Piekalkiewicz. “And on the

treatment end, there are other treatments available such as the medication methadone [which aids

in treating narcotic drug addiction]. It is so important for people to get into treatment if they need

it, and realizing they need it is the first step.” As for overdoses, Mrs. Ellen Piekalkiewicz states

“first responders, family members and friends need to be aware of the medication Naloxone.

That drug has been proven to be very effective in preventing a death from opioids [in an

emergency situation].”

To conclude, if changes are not made and solutions are not reached to decrease the

growing amount of deaths related to heroin and prescription opioid drugs this epidemic will

continue to increase substantially. Oxycontin and other prescription narcotics are inadvertently

gateway drugs to heroin which needs a solution if this is ever going to end. Other alternatives
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such as medical marijuana, radio frequency therapy, acupuncture are just some ways to fight

chronic pain patients deal with on a daily basis. Mark Olfson wrote an article titled Cannabis

Use and Risk of Prescription Opioid Use Disorder in the United States in which he writes

“Recent work that has been examining medical cannabis laws has concluded that the passage of

such laws decreased the rates of opioid mortality by a quarter and reduced the rates of opioid

prescriptions between an estimated 265 and 1,826 daily doses per physician per year.” (Olfson

1). These prescription drugs need to be reworked by doctors to prescribe less often and have less

intense side effects. Our nation simply cannot afford to lose billions of dollars on these drugs just

in the black market alone. And our nation clearly needs to put a stop to millions of people dying

from this epidemic at alarming rates. Every patient who has suffered from addiction needs proper

rehab facilities that are less expensive and more sufficient at aiding patients with withdrawal

symptoms, so they do not relapse. All patients in these rehab facilities deserve the right to a

second chance; to recover and become healthy again. When comparing the risks and effects of

street heroin to every other opioid painkiller available through prescription by doctors, they are

virtually interchangeable. The only major difference is that the prescription drugs are easily

accessible and legal provided by doctors, while heroin is not either of those. The opioid

epidemic risks should be made known in society to prevent patients from even trying these

harmful drugs in the first place, so they can consider themselves safe.
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Works Cited

AMSDEN, DAVID, and FREDRIK BRODEN. "The New Face Of Heroin." Rolling Stone 1206 (2014): 50-57.
Academic Search Complete. Web. 24 Oct. 2016.

"Education and Awareness." LTM Heroin Awareness and Support Foundation, Inc. |. LTM Heroin
Awareness and Support Foundation, Inc., n.d. Web. 14 Nov. 2016.

Grau, Lauretta E., et al. "Illicit use of Opioids: Is OxyContin® a “Gateway Drug”?" The American Journal
on Addictions 16.3 (2007): 166-73. Print.G

"History of Prescription Drugs." Narconon International. N.p., n.d. Web. 06 Dec. 2016.

"OxyContin Gateway Drug to Heroin - OxyContin Detox." Novus Medical Detox Center. N.p., n.d. Web.
20 Oct. 2016.

“The Numbers Behind America’s Heroin Epidemic.” The New York Times. The New York Times, 29 Oct.
2015. Web. 31 Oct. 2016.

Wertheim, L. Jon, and Ken Rodriguez. "Smack Epidemic." Sports Illustrated 122.25 (2015): 66-71.
SPORTDiscus with Full Text. Web. 24 Oct. 2016.

Sgarlato, Anthony. “Prescription Opioid Related Deaths in New York City: a 2 Year Retrospective
Analysis Prior to the Introduction of the New York State I-STOP Law.” Link-Springer-
Com.proxy.lib.fsu.edu, 2 Aug. 2015, link-springer
com.proxy.lib.fsu.edu/article/10.1007/s12024-015-9699-z.

Alford, D. P. (2016). Opioid prescribing for chronic pain — achieving the right balance through
education. N Engl J Med, 374(4), 301-303. 10.1056/NEJMp1512932 Retrieved
from https://doi.org/10.1056/NEJMp1512932

Olfson, Mark, et al. "Medical Marijuana and the Opioid Epidemic: Response to Theriault and
Schlesinger." American Journal of Psychiatry, vol. 175, no. 3, Mar. 2018, pp. 284-285.
EBSCOhost, doi:10.1176/appi.ajp.2017.17101149r.