A Brief History of the Opioid Epidemic

Deaths attributed to the ongoing opioid epidemic have been continually increasing over the past several decades. According to data from the U.S. Department of Health & Human Services, an average of 91 people each day die due to opioid overdose. How did we get to this point, and what is being done in an effort to combat the ongoing opioid crisis across the country?

What is the Opioid Epidemic?

The opioid epidemic is a plague of opioid addiction and overdose that has swept over the United States in recent decades. The majority of these addictions do not stem from the use of hard and illicit drugs, such as heroin; rather, many addiction to opioids begin during the use of prescriptive opioids that are legally prescribed for pain.

Some examples of common legally prescribed opioids include:

• Methadone
• Oxycodone
• Hydrocodone
• Hydromorphone
• Oxymorphone
• Morphine
• Codeine

The below opioid epidemic statistics are taken from studies done by the U.S. Department of Health and Human Services for the year 2016:

• 116 people died from opioid-related overdoses each day.
• Over 42,000 people died from opioid overdoses over the course of the year.
• 1 million people had an opioid disorder.
• 17,087 deaths were caused by overdoses on commonly prescribed opioids.
• 19,413 deaths resulted from the use of other synthetic opioids other than methadone.
• 15,469 deaths were attributed to heroin overdose.

The Science of Opioids

Opioids are commonly prescribed by doctors to treat severe pain in their patients. Opioids work by binding to receptors in the brain and spinal cord that block pain, and in some cases produce a feeling of euphoria.

This “high,” however, can quickly become problematic. As treatment continues, your body continually becomes accustomed to the drug over time, requiring higher dosages in order to maintain potency. This frequently leads to a dependency and dangerous addiction to opioids, and the feeling of euphoria can lead to drug misuse, or serve as a gateway to more dangerous drugs, such as heroin, in order to achieve the desired level of effect.

As opioids are frequently prescribed by doctors despite the dangers present, the number of people addicted to opioids continues to rise each year. The number of opioid-related deaths has become so severe in recent years that, in 2017, the United States declared the opioid epidemic to be a public health crisis.

History of Opioid Use in the US

The use of opioids to treat pain first rose to prominence during the Civil War during the early 1860s as a way to treat wounded soldiers. Soldiers were often treated with morphine, leading to subsequent dependencies and addiction to the drug in veterans during and immediately after the war’s conclusion.

In 1898, the Bayer Company first introduced heroin onto the market as a “wonder drug” that could effectively treat pain without the debilitating effects of habit-forming morphine. Much not was known about heroin during its early years on the market, but once addicts discovered that its effects could be amplified upon injecting the drug into their system, a worrying new opioid epidemic began to take hold at the turn of the century.

Throughout the 1910s-1920s, the U.S. placed restrictions on opioids and other narcotics, requiring that formal prescriptions be written in order to obtain these potentially dangerous substances. In addition, the U.S. outlawed heroin in 1924 as a way to combat the growing opioid problem.

As the mid-century passed, efforts to combat illegal distribution and use of opioids culminated in the Controlled Substances Act of 1971, establishing federal U.S. drug policy under which the manufacture, importation, possession, use and distribution of certain substances is regulated. The act created five schedules (or classifications) of substances still used to this day.

In 1995, Purdue Pharma introduced OxyContin (a variant of oxycodone) to the market as a gentler and less addictive opioid pill. Over the next two decades, doctors increasingly prescribed OxyContin (and other legal opioids) as a means of treating pain. Echoing the widespread distribution of legal opioids a century earlier, many more patients found themselves addicted to OxyContin as the U.S. prepared to enter the 21^st century.

Despite measures and lawsuits that have been taken against Purdue Pharma and other legal opioid manufacturers and distributors, the effects of the opioid epidemic have ravaged the entire country up to the present day. Opioids are continually prescribed to patients even with the risk of addiction and dependency being common knowledge, and as a result, the overall number of addicts and overdose-related deaths have skyrocketed in the past two decades alone.

Recent Causes of the Opioid Epidemic

Since the history of opioid use to treat pain dates back centuries, it can be difficult to pinpoint how (and why) opioid use has inflated to epidemic proportions in recent years. Besides dependency and addiction in patients, doctors and pharmaceutical manufacturers have also played their own hands in contributing to the growing number of addicts and deaths related to opioid use.

The roots of the opioid epidemic can ultimately be traced back to the over-prescription of opioid drugs to treat pain, rather than seeking alternative (and less addictive) treatment options. It has been found that opioid pills are generally more covered by insurance policies rather than alternative treatments and therapies. This means that a doctor may prescribe potentially dangerous opioid pills as less-expensive alternatives to solving a patient’s pain problems.

Drug companies have also aggressively marketed their opioid products as “non-habit inducing” and “moderate,” despite a lack of research to substantiate these claims. Unfortunately, this marketing has proven effective, and has even swayed doctors to prescribe even more opioids to patients in exchange for lucrative incentives, such as free meals.

Combating the Opioid Epidemic

As a result of the ongoing opioid epidemic, professional medical experts are now calling for medical students to be taught to prescribe opioids to patients much more carefully. This education process includes training the up-coming doctors how to properly identify pain and the best treatment for it, and then teaching how to apply for waivers so that they are able to prescribe alternative treatments and therapies to opioids.

Since the United States was officially declared to be in a state of public health crisis due to the opioid epidemic, state and federal governments have since put plans into action to tackle the crisis and reduce its causes.

The federal government has developed a five-point strategy to fighting the opioid crisis:

• Improve accessibility of treatment and rehabilitation services.
• Promote the use of overdose-reversing drugs.
• Strengthen public understanding of the epidemic through improved public health surveillance.
• Support research on reducing pain and addiction.
• Advance better practices in the first place for pain management and reduction.