Opioids are a class of synthetic, and semi-synthetic opium-like compounds that are derived from natural opium alkaloids. Although opioids are primarily used for legitimate pain relief and prescribed by a doctor, the drug affects the “pleasure” sequences of the brain, releasing high levels of the dopamine chemical that gives off a feeling of euphoria and other sedative-like effects. This, in turn, causes the drug to be extremely addictive. The opioid crisis in America is a growing epidemic and has resulted in over 33,000 deaths since 2015.
In the US alone, opioid and opiate-related deaths have quadrupled since 1999, affecting mostly men and women between the ages of 24-54. This, amongst many other reasons, is why seeking professional treatment at an addiction treatment facility is so necessary for those suffering from opioid addiction.
Deaths caused by overdosing on opioids have reached epidemic levels. In the United States alone, drug overdoses have become the leading cause of death among those under the age of 50 and have quadrupled since 1999. More than 183,000 citizens in the U.S. have died as a result of overdosing from prescription opioids (source). The most commonly overdosed opioid’s today are Hydrocodone (Vicodin), Methadone, and Oxycodone (OxyContin). So how has this once readily prescribed pain reliever developed into an opioid crisis; into something so large that the president of the United States has declared it a national emergency? There is an answer and it dates back to several decades ago.
Going back nearly 100 years ago, there were little known facts and a lack of evidence on these addictive substances. Rather, they were often openly administered to patients as a pain reliever without much thought given to their adverse addictive effects and likelihood of dependency. Over time, opioids became increasingly abused and misused which has ballooned into what is known today as an opioid epidemic.
Timeline of Opioids: Past to Present
Opioid use was not always as concerning as it is today (Source). The FDA did not always have stringent codes in regards to prescribing opioids, so they were more readily available to patients in former decades than they are current day, although a doctor’s prescription is needed in order to obtain opioid painkillers today (Source). Opioid prescriptions have soared to 300 percent over the past 10 years, with Vicodin, a Hydrocodone, being the most commonly prescribed drug in the U.S. market followed closely by Oxycodone such as Percocet (Source).
This brief timeline depicts information about noteworthy events in relation to opioid’s and how they gradually became misused over time (Source).
- 1900s: Saint James society in the U.S. issues samples of heroin to morphine addicts who are trying to overcome their addiction. Opioids were openly prescribed to treat severe pain.
- 1916: The University of Frankfurt made the first synthesized oxycodone hoping that it would have the same effects as morphine and heroin except with a less likelihood of addiction.
- 1924: The Heroin Act declared manufacturing and possession of heroin illegal due to an increased amount of patients noticeable abusing the drug. A number of medications derived from opioids, such as codeine, Oxycodone, and morphine, were still able to be prescribed by doctors.
- 1950: FDA approves oxycodone to be prescribed to patients which began the start of the continuing drug problem in the U.S. today. Over-prescription of opioids by doctors has contributed significantly to the dependence on the drug.
- 1969: The World Health Organization (WHO) disregarded the fact that morphine was highly addictive.
- 1970: The Controlled Substance Act passed in this year more vigorously regulated the issuing of prescription drugs.
- 1983: Vicodin was introduced in the U.S. market by a German pharmaceutical company. Also during this year, doctors in the U.S. were becoming increasingly hesitant to prescribe heavily addictive substances in fear that patients would become dependent on them.
- 1990: U.S. citizens urged doctors to prescribe them opioids for all sorts of pain.
- 1995: OxyContin controlled-release was approved by the FDA
- 2000: Morphine, Fentanyl, Oxycodone, and Hydromorphone came in an extended release form.
- 2000-2008: Use and misuse of opioid drugs as well as the prescribing of opioids doubled between 1998-2008.
- 2009: 730,000 people admitted to emergency due to misuse of opioids, double the amount just five years prior. At the same time, the FDA held programs that were intended to educate doctors on the risks of prescribing painkillers.
- 2010 – today: The FDA issued a Draft Guidance on Abuse Deterrence for companies than manufacture opioids.
- 2015: FDA announces last guidance on the evaluation and labeling of abuse-deterrent opioid’s (Source)
How Opioids Were First Derived
Opium, which can go by common street names such as Dreams, Gum, and Midnight Oil, was first discovered as a mind-altering substance around 3,400 B.C. in the Mediterranean regions (Source). It was first used as an anesthetic as well as for rituals and medicinal purposes. Opium gained in popularity throughout the American Civil War for its medical properties and its ability to numb the physical and mental pain endured by personnel during this time period. Before fully understanding the addictiveness of opium, it was frequently used in recreation without worry. It was used to remedy nervous disorders as well, as it was a sedative that promised tranquilizing effects (Source).
Also known as the ‘joy plant’, the opium poppy gained in adoration, sparking an increased demand for it. Used for ancient medicine, opium was referred to by ancient Greeks and Romans as a very effective pain reliever.
In 1803, morphine, the primary ingredient in opium, was removed from opium and was marketed on its own, being called the ‘miracle drug’. Codeine, along with heroin, was further derived from opium and these two are the most commonly abused drugs on the market till this day. In 1924, the use of heroin for any reason became illegal by U.S. federal law.
Companies that Manufactured the First Opioid
So which companies fueled the opioid epidemic of today? The largest manufacturer of opioids is Purdue Pharma (Source). Since the company’s inception in 1892, they have been the most well-known pharmaceutical company to manufacture opioid’s to date. In 1995, Purdue Pharma, a Connecticut-based pharmaceutical manufacturer, brought in $45 million in sales after OxyContin’s first year on the market. That blossomed to over $1.1 billion in a four-year time span and continued to inflate for a decade thereafter (Source).
There are 5 main companies that are facing a lawsuit for their contribution to the opioid epidemic of today:
- Purdue Pharma
- Endo Health Solutions
- Teva Pharmaceutical Industries and Subsidiary Cephalon
- Johnson & Johnson and subsidiary Janssen Pharmaceuticals
The lawsuits are still underway. By virtue of doctors exaggerating the benefits of using these highly addictive prescription drugs to patients, pharmaceutical companies have successfully convinced doctors across the United States to issue opioid’s to patients who are looking for pain relief. The opioid epidemic is being blamed greatly on pharmaceutical companies for their unethical promotion of the drug to doctors and pharmacists.
What are Opioids?
Simply defined, opioids encompass a range of drugs that are either legal such as through a prescription, or illegal, meaning they are manufactured illegally on the streets by concocting various chemicals together. Oxycodone, Hydrocodone, codeine, and morphine are available to those who are seeking pain relief but must be prescribed by a physician. Heroin, on the other hand, is an illegal opioid that is made up of synthetic agents (source).
History of Heroin: Heroin was initially manufactured in 1898 by Bayer, a large drug manufacturer in Germany, and was given to patients who were suffering from tuberculosis. It also doubled as a means to remedy addiction to morphine (Source).
How do Opioids Work? Opioids work by producing a euphoric sensation by virtue of interacting and then altering receptors in the brain. When used sparingly, and under doctors’ orders, they are safe and can provide the necessary relief needed to help mitigate minor to severe pain. It is when these drugs are overused, over abused, and over prescribed, that they start to become a dependency problem. Opioids are so heavily addictive due to the euphoric effect they have, keeping people hooked on them in an effort to constantly feel in a state of elation. In turn, patients become dependent on these drugs and doctors may feel obligated to keep issuing the prescription for them.
How Opioids Have Developed Into an Epidemic
The opioid epidemic did not happen overnight. It was a problem 20 years ago and has developed into an epidemic over the course of two decades. Did you know that opioid overdoses currently kill more U.S. citizens than AIDS/HIV did at its prime in 1995? This number is so exponential that it has surpassed multiple epidemics such as the crack epidemic, meth epidemic, and heroin epidemic (Source).
This outbreak made its debut in the 1990’s, as doctors were becoming more aware of the difficulties that patients were experiencing with chronic pain. There didn’t seem to be something on the market that was powerful enough to cure their despair. Pharmaceutical manufacturers saw this as a prime opportunity to convince doctors that prescribing their patients opioids would bring in consistent funds for them while keeping patients pain at bay. Through false and misleading information regarding the safety of opioids, patients were unaware of the adverse effects that these drugs would soon have on them. Doctors were at a loss when dealing with patients who have tried every drug on the market but failed to find one that treated their chronic pain. That is until opiates were prescribed to patients which in turn changed the entire market for the worse and would have a domino effect that currently could leave an estimated 650,000 people deceased in the next decade.
The opioid epidemic is now the largest public health crisis that the U.S. is facing. In 1999, deaths related to opioid overdoses lingered in the 6,100 range. Fast-forward to 2015 and that number ballooned into 17,500 opioid related deaths. By not fully comprehending the damage that opioids are causing on the nation, and putting the reality of it on the back burner, we have created a horrible result; we have created an epidemic.
Over the last several decades, painkillers that were, and still are, manufactured through pharmaceutical companies, continually flood the market. When patients can no longer get their prescription opioids filled, they turn to illicit drug traffickers to obtain synthetic, illegal, man-made opioids such as heroin in order to fill the void and satisfy the craving.
The Future of Drug Use
The FDA is making large efforts to provide guidance, knowledge, and advisory to the public on the harms of abusing prescription drugs. Making citizens aware of the harms of misusing opioids can have a beneficial effect on the future of drug use in the U.S. Opioids carry a large risk of dependency and there needs to be more resources available to those who are at risk of abusing opioid’s so that they understand how these drugs can easily become addictive.
Whereas former decades did not have the advocacy of organizations that set out to inform the public of the harms associated with drug misuse, today the resources are plentiful. The overarching goal is to help doctors and patients make informed decisions when considering these powerful drugs to treat pain.