Over the years, the opioid epidemic has made quite an impression on America. From its beginnings of opiate use back in the late 1900s to its current state of crisis, the epidemic has been sweeping the nation and continues to do so, seemingly without pause. This bleak outlook leaves many questioning what can be done about the problem. Pharmaceutical companies are often pointed at when considering who caused the opioid epidemic. After all, they did encourage doctors to prescribe opioids in increased rates in the late 20th century. But are pharmaceutical companies really to blame for the epidemic? And if so, what can be done about it now? What are some opioid epidemic solutions?
The Opioid Epidemic Today
- Approximately 1 in 4 patients who are prescribed opioids for the purpose of pain relief end up misusing the medication.
- In a report revised in January of 2019, the National Institute on Drug Abuse found that over 130 people in the United States die from an opioid overdose daily.
- Approximately every 15 minutes, a baby is born already suffering from opioid withdrawals. This is called neonatal abstinence syndrome, and it has seen an increase over 5-fold in the last decade and a half. These babies are born underweight and with an underdeveloped respiratory system.
- An increase in the rate of intravenous opioid users causes higher risks of catching bloodborne diseases like Hepatitis and HIV. The Center for Disease Control reports that approximately 10% of patients who test positive for HIV say they got the disease from using dirty needles.
How Did We Get Here?
While its’ lurking presence can take some by surprise, the opioid epidemic has been in the making for an incredibly long time. Throughout history, opium has been touted as a pain reliever, a cure-all, and a substance able to alter a man’s personality within a minute. But what are opioids and where did they come from? Are they useful? And how dangerous are they really?
What Are Opioids?
Opioids are a class of drugs derived from the poppy plant. This class of drugs includes both heroin, an illicit substance, as well as a number of lab-created pain relief medications that continue to be prescribed over the counter. Opioids are beneficial in a medical setting as they have positive effects on those dealing with severe, oftentimes chronic pain. The most commonly prescribed opioids include codeine, fentanyl, oxycodone, hydrocodone, and morphine (the substance heroin is made from).
Different strengths of these prescription medications are offered, as well as different ingestion methods, depending on the situation and pain level. Medications are typically ingested orally, either in pill form or as lozenges. Some medications are administered intravenously, and some are processed through a patch placed on the skin.
Opioids work by entering the body and attaching to various opioid receptors throughout the body, namely within the brain, spinal cord, and gut. The location of these receptors is what makes opioid prescriptions so popular among those with chronic headaches and severe back pain. Once bound to these receptors, opioids block pain signals from reaching the brain.
From Medicine to Drug
Despite their effectiveness at treating pain, prolonged misuse of opioids can lead to dependence and addiction. There are a number of ways to misuse opioids, even if they were initially prescribed by a doctor. While typically safe when taken in the correct dosage and for short amounts of time, misuse of any type of opioid can lead to substance abuse problems down the line. Taking medication in an abnormal way can lead to addiction. This can mean either altering the dosage of the medication being taken or changing the method of consumption – i.e. snorting crushed up pills as opposed to taking them orally as prescribed.
Taking medication that was prescribed for another person is also a form of substance abuse, as is taking medication such as opioids for effects other than the prescribed effect. This sounds confusing, but means instead of taking the medication for pain relief as the doctor intended, it is being taken for other reasons like to feel a ‘high’ feeling.
The use of opioids carries with it a number of different side effects, both short-term and long-term in nature. Short term opioid effects typically include a high feeling, sleepiness, nausea, and constipation. The gut-related side effects are due to the opioids interaction with receptors throughout the gut, causing an upset stomach. Long-term opioid effects of misuse are much more serious. In fact, opioids do have the potential to cause an overdose when breathing is depressed past the point of providing the brain with adequate amounts of oxygen. Other long-term side effects of opioid misuse include loss of consciousness, slow heart rate, and shallow breathing.
History of Opioids
While the opioid crisis in America continues to increase in severity, it is important for those looking into the opioid epidemic to have a brief understanding of the history of opioids and their abuse. Believe it or not, the use of opiates as narcotics began around the year 3400 B.C. First cultivated in Mesopotamia, the opium poppy was known to produce juice which caused feelings of euphoria when consumed. Over the next couple thousand years, opium production and consumption continued to expand, popping up in Egypt, where Egyptians, Assyrians, and Babylonians were all known to use the plant for both medical purposes as well as executions.
By the year 460 B.C., Hippocrates, a Greek physician commonly known as the father of medicine, noted that opium was a useful drug for treating various forms of pain. A century after this observation was made, opium production traveled the globe again, this time migrating to Persia and India thanks to Alexander the Great. Arab traders traveling to China later introduced the plant to farmers.
Back in Europe, around the year 1300, the Holy Inquisition brands the drug as evil, and opioids were not documented there again for several hundred years. During the mid-16th century, opium was reintroduced to Europe after a philosopher named Paracelsus brings the substance back from a trip to the Middle East.
Opioids in Modern Times
The opioid crisis of modern times did not really pick up much steam until the 1990s. This is the period of time during when doctors began to notice the number of people experiencing severe pain. Believing chronic, severe pain to be underdiagnosed, and at the encouragement of both pharmaceutical companies and the federal government, doctors began handing out prescriptions for opioids. However, these medications soon became vastly overprescribed. To put the prescription increase in context, in the year 1991, 76 million prescriptions were written for the painkillers. By the year 2016, over 289 million prescriptions for painkillers were written annually. Of course, mirroring these numbers, there has been an increase in the number of people seeking opioid substance abuse treatment, as well as an increase in opioid-related deaths in the United States. As the rate of prescriptions written increased, so did the strength of the medication being prescribed. By the early 2000s, over 10% of those being prescribed opioids were given medication stronger than morphine.
When it comes to determining how opioids are being obtained, things get a little tricky. Reports as of 2013 state that almost 75% of opioid users got their medication from a doctor (either their personal doctor or a friend or family member’s doctor). Because the prescription medication is being passed from person to person, collecting accurate data on the problem can be difficult, making opioid epidemic solutions even harder to find.
Lawsuits Against Pharmaceutical Companies
As time has progressed, more and more of the populous has come to find pharmaceutical companies at least in part for the rise of the opioid epidemic. In fact, currently, there are thousands of lawsuits directed at pharmaceutical companies both from private citizens, local municipalities, and even entire states. One such case is currently taking place in the state of Alabama. The company Johnson and Johnson is under scrutiny, alleged to have let greed overtake the company, promoting dangerous drugs as cure-all pain killers.
Oklahoma is getting a lot of attention in the news when it comes to this case, as the state has been losing the battle with the opioid epidemic for some time. Statements taken at the testimony for this trial cited a number of opioid statistics within the state of Oklahoma. The crisis has severely affected people in Oklahoma, with over 4,500 Oklahomans dying of opioid overdose between 2007 and 2017.
Those battling Johnson and Johnson in court say the company acted not out of concern for the wellbeing of their patients but out of the greed of a drug ‘kingpin.’ The epidemic has cost not only the lives of its citizens but has also cost state billions of dollars with the cost continuing to rise as time goes on.
Will Punishing Pharmaceutical Companies Help Addiction?
Only time will tell if punishing pharmaceutical companies will help to mitigate the damage done by the opioid crisis. Those who believe pharmaceutical companies should be held responsible site the advertising strategies of these big pharma companies. Those lobbying against the pharmaceutical companies say painkillers are oftentimes misrepresented as a fix-all medication despite the glaring evidence to the contrary. It is argued that pharmaceutical companies completely disregard the warnings from the medical community about the dangers of opioid addiction.
On the other hand, big pharma companies argue that a considerable number of people use opioids as painkillers without developing any further dependence. They posit that taking opioids off of the market or punishing companies for making opioids would be to the detriment of all of the people who never have an issue with substance abuse and instead receive only pain relief from the medication.
It seems that there is a chance the answer lies somewhere in the middle. While it is true that some people do reap various benefits from taking prescribed opioids correctly, there is no doubt that something must be done about the opioid crisis in America. Possible points of improvement when it comes to battling the opioid crisis include:
- Improving access to treatment. Allowing people more efficient access to affordable treatment programs may help to mitigate the continued abuse of opioids, as those affected will be able to seek treatment.
- Promoting overdose-reversing drugs. While it may not improve the number of people facing substance abuse problems, making overdose-reversing drugs like Narcan available to those facing opioid addiction can help limit the number of deaths caused by the epidemic.
- Strengthen our understanding of the epidemic. The act of doing research into the opioid epidemic is more vital now than ever. Understanding trends, cultural and societal influences on the opioid epidemic could work in part to help mitigate its consequences.
- Increasing research into addiction and addiction therapy. Better understanding opioid addictions and how they work allows for better addiction management treatment programs to be created. These programs help those facing substance abuse problems. Keeping these programs funded and continuing research into addiction may help provide additional solutions for the opioid crisis.
- Advancing pain management options. Looking further into pain management and alternative ways of managing pain may help those dealing with chronic pain stay away from opioids, therefore helping to determine opioid epidemic solutions. Finding other possible medications or techniques for relieving symptoms of chronic pain could potentially help to decrease the need for prescription opioids.
In the United States and throughout the world as a whole, the opioid epidemic shows no sign of stopping anytime soon. However, this does not mean that nothing can be done to mitigate the damage caused by the problem. Changes within the pharmaceutical industry may be the answer to the opioid epidemic, at least in part. Along with additional research into these drugs, their addiction rates, and pain management, placing responsibility on pharmaceutical companies will hopefully help end the opioid crisis.