The History of Opioids and their Unremitting Epidemics 

The History of Opioids and their Unremitting Epidemics – First Draft It appears that most everything in life is cyclical, and opioid abuse is no exception. Over the past twenty years alone, roughly 400,000 people died from an overdose involving an opioid. In 2019, roughly 130 Americans, on average are dying from an opioid overdose every day, making the drug epidemic deadlier than gun violence and car accidents. What’s concerning is this isn’t the first time in our nation’s history that we’ve found ourselves in this situation.

Throughout my text, I will provide considerable information detailing what opioids are and their intended use as well as a detailed analysis regarding the drug’s history and how we have reached the catastrophic level of epidemic many times over. To better understand how we’ve found ourselves in the throes of such a fatal drug epidemic, we must first educate ourselves as to what is ultimately at the source of the whole issue, the drug.

According to Poison Control’s National Capital Poison Center, the terms opiate and opioid are often used interchangeably, however, er they refer to two types of narcotic‑pain-relieving drugs with similar actions and side effects.

The term opiate describes drugs that come from opium. Opium comes from the opium poppy plant and over time has had many chronicled uses including treating pain and inducing sleep as well as a long record of abuse. The most common forms of opiates include codeine, morphine, opium, and the illegal drug heroin.

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The term opioid refers to drugs that are completely or partially synthetic, or man-made, and mimic the effects of opiates. The most common forms of these synthetic and semi-synthetic opioids are called fentanyl, methadone, hydrocodone (or Vicodin®), and oxycodone (or OxyContin®). While there are many ways to classify the types of opiates and opioids that are available through both legal and illegal means, it is now common practice to call them all opioids. Considering what we now know about opioids, it is remarkable to ponder how not only the distinct illegal forms of the drug but also the legally obtained varieties have become the makeup of the opioid epidemic, both presently and throughout history. While the phrase “opioid epidemic” may be new to some audiences, it is important to understand that the drug’s use, and abuse, have roothaveating as far back as the 19th century. Opioid’ss history in the United States is as old as the nation itself. In the earlier days, before the 1900s, opioids were mainly administered by physicians and doctors in the form of morphine injections to patients in pain, primarily middle-class white women. Charles Earle’s documented in his 1880 Chicago survey on opium and morphine users that an astounding 71.9 percent of their respective samples were female. It was these women that would become the first known faces of the American opioid epidemic.

As time went on, the face of the opioid addict began to slowly change, not only women, but men, as well as the doctors and physicians liberally dispensing the drug, became vulnerable to its addictive qualities into the defense of the doctors though, in those days there weren’t a whole lot of alternatives in the form of medical pain treatment. They were just working with what they had available to them at the time. However, there were other factors at play driving what we now know as the first opioid epidemic, greed being a primary one. Even as medical journals at the time were being published with warnings as to the dangers of opioid addiction, many doctors turned a blind eye in favor of financial gains from the demand for opioids from well-off users as well as competition from other doctors and pharmacies willing to supply narcotics. On that note, in 1880 Charles W. Earle inquired at 50 drug stores scattered throughout Chicago and discovered 235addict customers, or 4.70 per store, further helping to reinforce the sheer number of users at that time as well as pharmacies willing to supply their habit. Finally, in the la1890s0, with the help of the new pain-relieving drug aspirin, advances in public health, such as x-rays and vaccines, and new programs to help educate doctors on proper pain treatment and opioid prescribing, the medical community began to see a decrease in the number of new patients turning to opioids for pain relief. Further helping to curb drug use at the time were several new regulations effectively restricting the sale of opiates, more specifically morphine, to only patients with a valid prescription, resulting in at the end of their availability as over-the-counter drugs. It was also around this time that heroin was synthesized, marketed, and sold by the pharmaceutical company, Bayer. The drug company proclaimed that the new drug, a powerful opioid, would work effectively as a cough suppressant, provide relief for labor pains, and more fittingly, hoped it would work as a tool to impede addiction to morphine. However, it too was widely abused, as users quickly found that they needed repeat administering of the drug in the development of tolerance, which ultimately would lead to addiction and once again another unintended epidemic. According to Hoszatafi S, in his article, The History of Heroin, “In the early 1910s morphine addicts “discovered” the eurphorsing properties of heroin, and this effect was enhanced by intravenous administration. Heroin became a narcotic drug and its abuse began to spread quickly.” The free reign of heroin at that time resulted in an astonishing 200,000 addicts in New York City alone. With addiction steadily rising, the Public Service Hospitals in the United States began discontinuing their disbursement of heroin at relief stations. Soon after in 1920, the House of Delegates of the American Medical Association at its 71st annual session adopted the following resolution: “that heroin be eliminated from all medicinal preparations and that it should not be administered, prescribed, nor dispensed; and that the importation, manufacture, and sale of heroin should be prohibited in the United States.” This view was heavily supported by authorities, especially the police, as there were growing numbers of crimes taking place in larger cities.

In New York in 1924, heroin addiction was blamed for many of the city’s murders. Special Deputy Police Commissioner at the time wrote, “Ninety-four percent of the criminal drug addicts arrested in New York fopercent intin  heroin regularly.” This prompted Congress to finally step in and outlaw the importation of opium for manufacturing heroin in 1924, essentially ending the legal production of the drug in the United States. Although the legitimate production of heroin practically ceased after 1924, the demand, albeit fluctuating over time, remains to this day, making notable comebacks in the 21st century. As time went on, illicit drug use remained a fundamental issue in the United States, nevertheless, the medical community remained firm in its stance on avoiding opioid prescribing to its patients. Cancer patients through the 1950s were encouraged to wean themselves off opioids until their lives “could be measured in weeks”. This outlook persisted well into the twentieth century as a nationwide “opiophobia” was embraced by not only medical patients but doctors and physicians alike. It wasn’t until the mid-1980s that World Health Organization released their Cancer Pain Monograph detailing the under-treatment of postoperative and cancer pain, expressing that “using a limited number of drugs, pain relief was a realistic target for the majority of cancer patients throughout the world”. Not long after other publications further questioned after other the state of pain under treatment, not just for cancer patients but all suffering from chronic pain. These divisions of thought ultimately led to the definition of malignant and non-malignant pain, effectively allowing opioids to be associated with chronic non-cancer pain treatment. With opioids now having newfound acceptance within the medical community, in the mid-1990s, the American Pain Society, backed by the Veteran’s Health Administration, set forth with their “pain as the fifth vital sign” campaign. Their mission was to standardize the treatment of pain symptoms. Patients essentially reported their pain levels to their medical provider and their medical provider in turn determines the appropriate plan for managing said pain, all based on the standards set by The Joint Commission. This in combination with the Federation of State Medical Boards and the Drug Enforcement Agency issuing statements at the time “promising less regulatory scrutiny over opioid prescribers”, therefore allowing the doctors and physicians to be less reluctant in prescribing more “liberal” amounts of opioids.

This created concern among hospital administrations that if these new Joint Commission standards were not met, then they were less likely to receive federal healthcare funds. When just years before, Doctors were labeled as inhumane for prescribing opioids to their patients for pain, they were now facing backlash scrutiny if they chose to do the opposite. Now more than ever in the history of opioids a perfect storm had been created, allowing for the floodgates of widespread opioid over-prescribing to be opened, thus leading to a new reality of users becoming addicted and heavily abusing the drug. With the floodgates opened, the pharmaceutical company, Purdue, introduced new formulations of opioids, such as extended-release oxycodone, or oxycontin, as it is more commonly known, which were frequently prescribed because of an advertised lower likelihood of abuse, while instead, they were found to be highly addictive. From 1997 to 2002, OxyContin prescriptions increased from 670,000 to 6.2 million. Overall opioid use continued to climb throughout the 2000s in the USA, rising from 46,946 kg consumed in the year 2000 to a peak of 165,525 kg in 2012. Purdue was instrumental in the resurgence of opioid abuse as it took extraordinary steps to ensure its product, OxyContin, was heavily prescribed and easily made to make its way into the hands of new and existing users. From using sophisticated and targeted marketing data to all-expense-paid trips to pro-OxyContin national pain seminars, Purdue was successfully able to influence doctors prescribing habits across the country. They even created a patient starter program that provided patients with a free limited-time prescription for a 7-to 30-day supply. Upon the program ending in 2001, roughly 34,000 coupons had been redeemed nationally. That was just the beginning though. Lucrative bonus programs and an increased internal sales force aided in allowing the sale of OxyContin to increase dramatically. It is estimated that Purdue paid out over $40 million in sales incentives to its roughly 700 sales representatives in the year 2001 alone, but where Purdue cashed in on this epidemic is by recognizing who the true bulk of the opioid users were, the non-malignant ones.

In 1999, an overwhelming 86 percent of the total opioid market consisted of non-cancer-related pain sufferers. Knowing this, Purdue’s promotion of OxyContin for the treatment of non-cancer-related pain increased tenfold from about 670,00 in 1997 to about 6.2 million in 2002. By falsely advertising OxyContin’s addictive qualities and aggressively promoting the drug’s overprescribing across the nation, Purdue is arguably the number one reason why opioids made such a huge resurgence near the end of the twentieth century, kicking off what would become the deadliest phase in the history of the drug’s existence. Throughout the early twenty-first century more awareness and exposure were raised concerning safetyewfoundconcerningo the ever-mounting prescription rates and subsequent overdoses that followed, the medical community took notice, and once again new laws were passed that tightened the enforcement of opioid prescribing. In hindsight, these new laws appeared to help curb the high prescription rate and in return lower the number of newly addicted users, however, the reality is the existing prescribers who had become accustomed to a higher, more frequent dosage were now finding themselves cut off and turned away by their doctors, resulting in them taking desperate measures to navigate pain relief on their own. It is this dire situation that is fueling the latest wave of the opioid epidemic, the sellin,g, and consumption of illicit synthetic opioids such as fentanyl. Among the 42,248 opioid-related deaths in 2016, 19,413 involved synthetic opioids, surpassing both prescriptions as well as heroin.

This number has only continued to grow. Now knowing that the current state of this drug and its users stems back to an even earlier epidemic of untreated pain, which ultimately led to the dramatic increase in prescription opioid production, has opened my eyes to the potentially limitless acts of stupidity and deceptiveness by numerous actors and agencies that the public relied on for their concerning safetyuses and health. How many times will history repeat itself before we find a workable solution to this deadly epidemic?