The Opioid Crisis: A Timeline

The opioid crisis has metastasized from its relatively humble beginnings as an urban scourge to a national epidemic. This problem is not without precedent, nor was it impossible to see that introducing mass quantities of addictive drugs to the market would do massive harm to society. However, if we have a greater understanding of how the problem arose, perhaps we will have an easier time solving it.

Essentially, the current opioid epidemic began when pharmaceutical companies developed and pushed high-powered, dramatically addictive painkiller medications. Their marketing campaigns prompted doctors to write more prescriptions, and thus, more people became users and, soon enough, addicts. When addicts become more desperate, they resort to criminal behavior. That can mean robbery, prostitution, illicit drug use, doctor shopping, and more.

When whole towns are overwhelmed by opioid addicts, social decay sets in. Families and businesses are severely damaged, if not destroyed. Some towns have become virtual ghost towns as a result of the opioid epidemic.

Addiction also brings a more terrifying result: overdose. While it’s difficult to track use and abuse in terms of numbers of addicts, it is somewhat easier to track overdoses. However, even these numbers can be unreliable. Coroners and medical examiners don’t always attribute death to opioids. Nonetheless, there is enough evidence to proclaim the opioid problem is a full-blown epidemic.

Deep History of Use

Opium has been a part of human history since the earliest civilizations. There are records of its use that date back to 3,400 BCE. It is derived from special poppy flowers much like those depicted in The Wizard of Oz. Ancient civilizations used opium for medicinal purpose and probably for recreational use, too.

Use of opium is thought to have begun in Mesopotamia. Its use spanned from Persia and India to ancient Rome. It even seems that an early victim of opium addiction was none other than Marcus Aurelius, emperor of Rome, who relied on the drug for sleep and to cope with the stresses and burdens of war.

Eventually, Arab traders brought the drug to China, where it found an eager audience. Meanwhile, the drug was seemingly eradicated from use in the West, as the Holy Inquisition deemed all Eastern influence as akin to devilry and sin. The drug has no known references in literature until 1527 when Paracelsus wrote of the opioid drug Laudanum. The use of opium expanded in the 15th and 16th centuries, as monks prepared the drug for delivery in a wide range of herbal preparations. Indeed, there are still codeine cough syrups available by prescription.

Mass Opium Addiction and Ensuing Opium Wars in China

Once Arabian traders introduced opium to China, trouble was around the corner. The Chinese experience with opium is perhaps the first opioid epidemic on record. The earliest indication that a problem was imminent is found in 1729 when Emperor Yung Chen outlawed opium sales and the opium dens which facilitated recreational, and addictive, use of the drug.

Similarly, the first English governor of India, Warren Hastings, sought to control and limit use by monopolizing cultivation and sales. When the market was thus controlled, misuse of the drug was limited. However, the opium market remained artificially restricted. This problem was eliminated when the Chinese market was discovered. With such profit at stake, English traders encouraged the cultivation, processing, and shipping of the drug to Chinese shores.

Despite imperial edicts, the Chinese opioid problem metastasized. With such massive profits at stake, even high-profile figures such as John Jacob Astor became involved in smuggling opium to China. Astor would eventually pull his opium operations out of the Chinese market and seek his profits solely from England.

Eventually, the Chinese problem came to a head when Lin Tse-Hsu, a Chinese commissioner, forbade all foreign traders from importing the additive substance to the nation. This sparked the First Opium War, as the British were not interested in relinquishing such a profitable business. The Chinese lost this conflict and ceded Hong Kong to the British.

Since the Chinese continued their ban on opium imports, the French and English joined forces to wage a Second Opium War. The Western forces were again victorious, and they were able to convince the Chinese to release their restriction on the deadly and destructive product.

Opioid Painkillers

Opioids have always been used as painkilling medications. Since their discovery in the earliest civilizations, humans have used them to assist in surgeries or to numb the pain of injury. They have also been used to aid sleep, and it would seem that Roman Emperor Marcus Aurelius used opium to assuage his painful emotions regarding war.

Contemporary people use opioids in much the same way. In fact, most people are introduced to opioids after surgery. People are often issued an opioid prescription after having their wisdom teeth removed. Other common ailments, such as kidney stones and tonsillectomies, are also deemed worthy of an opioid prescription.

People who suffer from chronic pain also receive regular prescriptions for opioid medications. Since their symptoms never abate, this puts them in the position of living a life of addiction. In effect, they trade a life of clear-headed sobriety for pain management. Many find that this is an equitable trade because their pain is so great.

These days, there is a wide range of medications to choose from. There is the relatively mild codeine and there is the incredibly strong Fentanyl, which is often implicated in overdose deaths. There are also many ways to deliver the drug into one’s system. The most common drug-delivery method is in pill form, but doctors can choose IV delivery, transdermal patches, and even drinkable forms.

Heroin’s Part in the Epidemic

Heroin is perhaps the #1 opioid that comes to mind for people when they think of addiction and overdose. For most people, heroin’s only availability has been on the streets. Cartels in Asia and Mexico have been effective in converting poppies from Afghanistan, and elsewhere, into a relatively mild tar form or a potent powder.

It may be surprising to learn that heroin first was created by Bayer AG, a German pharmaceutical company that still exists today. It was created as a substitute for morphine. Though morphine is addictive, heroin is far more so. The addictive nature of the drug is what makes it very valuable to the black market. Since it takes relatively little to create an addict, black market dealers can create a devoted clientele in short order.

These days the black market is seeking new and better ways to produce and market its heroin. The Mexican cartels used to produce and sell milder black tar heroin, but they have discovered how to mimic the Asian methods for creating powerful powder forms. They are also discovering how to introduce amphetamines to the drug so that users can remain alert during their high. Fentanyl is also used to create super-addicts due to the pharmaceutical’s extreme potency and short-lived effects. Fentanyl also tends to induce massive overdoses when a spiked batch hits a market.

When a patient becomes addicted, or strung out, on prescription opioids, they often resort to street drugs to assuage their cravings. This is how and why heroin is making its way out of the inner cities and throughout the nation. Since doctors are induced to prescribe opioids in every town, and every chain drugstore carries those products, it’s easy to create new addicts. When an addict’s prescription runs out, it’s common to seek relief on the black market with either illicit opioids or heroin.

While heroin has always been a significant factor in overdose deaths, its role in overdose took off starting in 2010. Between 2010 and 2017, heroin overdose death increased by 400%. According to the CDC, a chief risk factor in heroin overdose is an addiction to prescription opioids. Heroin killed 15,482 people in 2017. Thankfully, heroin overdose rates appear to be at a plateau. However, without a serious decrease in over-prescription of pharmaceutical opioids, it is unlikely that heroin will leave the picture.

The Crisis Begins

The opioid epidemic that we are now fighting can be linked back to 1995. In that year, Purdue Pharmaceuticals was approved by the United States Food and Drug Administration to manufacture and sell OxyContin. The drug was so powerful that its high created new addicts within a few doses. When that high became insufficient, addicts began to crush the pills for IV injection.

Purdue made the initial claim that their drug was not very addictive. However, this claim was found to be false and deliberately misleading. Now, the drug maker is dogged by lawsuits. The Sackler family, owners of the company, have faced civil and criminal charges in state and federal courts as a result of the devastation their profits have wrought.

However, the Sacklers discovered a way to offset their court fines and make new markets. They developed treatments for the addictions they themselves were accused of causing. Whether this business scheme will be deemed a criminal conspiracy is yet to be determined. Since their unethical, if not criminal, behaviors have been exposed it’s possible doctors will think twice about following recommendations from their pharmaceutical representatives.

Overdose Rates on the Rise

According to the Center for Disease Control, 130 people die every day from an opioid overdose, and around 700,000 died of a drug overdose between 1999 and 2017. Of those overdoses, over half, 400,000, were attributed to opioids. The CDC cites three separate but coinciding waves of overdose deaths. The first starts with naturally sourced and semi-synthetic prescription opioid drugs, heroin fuels the second, and the third is comprised of synthetic opioids.

The first wave of overdose deaths began in the 1990s. When doctors started prescribing opioids on a large scale, those drugs began causing more deaths than heroin. The pharmaceuticals outstripped heroin for many years, at times producing several times more overdose deaths than heroin. Regardless, doctors continued to prescribe these deadly drugs.

The second wave of overdose deaths is charted from 2010 when the number of overdose deaths associated with heroin spiked. In a mere seven years, heroin caused 400% more deaths than in previous years. Though heroin and naturally sourced prescription opioids have done terrible harm to communities, families, and individuals, they have new competition.

Synthetic opioids are now far outstripping the devastation wrought by naturally sourced opioids, semi-synthetic painkillers, and heroin. Since approximately 2013, Fentanyl has taken the spotlight as the deadliest opioid in the nation. In the span of a mere year, from 2016 to 2017, synthetic opioid overdose deaths spiked by 47%. The drugs took 28,400 lives in 2017 alone. To make matters worse, it appears that black market chemists have discovered how to manufacture Fentanyl, so the black market no longer has to rely on doctor shopping or other cumbersome procurement methods.

Since the black market is, of its very nature, completely unregulated, it is difficult for a user to know what he or she is purchasing. Users who purchase heroin might receive a spiked batch that contains Fentanyl. Some will experience a dramatically stronger high followed by a rapid come-down which triggers even stronger cravings. Others will not be able to handle the extreme potency of Fentanyl and will go into respiratory distress and risk dying from an overdose, even though they took their usual dose.

How to Avoid Overdose

Naturally, the best way to avoid an overdose is not to use opioids. Since that is not a reasonable expectation for those suffering from opioid addiction, there are other ways to avoid this problem. Some involve diligence; others include more pharmaceutical products.

When a patient receives an opioid prescription, it is first wise to discuss the issue of addiction with the doctor. Discuss lower dosages and even prescriptions that expire after a single filling. It’s also wise to discuss alternative ways to manage pain. For instance, your doctor might be able to prescribe high doses of non-addictive, and non-overdose inducing Ibuprofen. Some patients even have good results when they practice mindfulness meditations and breath work to get through the pain.

If an opioid prescription is inevitable, precautions are necessary. One simple way to ensure that patients stay on track with their prescribed doses is by purchasing a simple pill organizer. These allow patients to dole out their medications in advance. This helps to avoid overdose because it strives to eliminate simple human error. Elderly patients, in particular, might not recall whether they’ve taken their allocated doses for the day and accidentally take too much. A pill organizer allows them to see what they have and have not taken easily.

Opioid patients should also have a strong support network of loved ones who are aware of their prescription. Patients should be diligent and tell their loved ones how many pills are in each refill, when the prescription expires, and how many refills are included.

Finally, each opioid prescription should be accompanied by a prescription for intra-nasal Naloxone. This medication can stop an overdose in its tracks. It is a regular part of every EMT’s toolkit, many police officers and more counselors are starting to carry this as well.

Naloxone works by blocking the opioid receptors in the brain. This means that any opioids in an overdose victim’s system are quickly nullified when the drug is introduced. Since the drug can be administered via intracranial spray, it can be easily given by a friend or loved one. Usually, a single dose is enough to save the life of an overdosing person, but if their dose is very large, it may take multiple attempts with Naloxone. Nevertheless, even a single, semi-effective dose might buy the victim enough time for an ambulance to arrive.

Getting Help

When a patient finds that he or she is addicted to the powerful pain medications that their doctor prescribed, they might feel helpless. After all, the very nature of addiction is that it takes all of the power away from a person. They are a slave to their next fix, their next dose of opioid whether that is still a pharmaceutical or an illicit dose from the black market.

When a patient’s life begins to spin out of control, time is of the essence. They must seek help immediately. This is not always realistic since addicts frequently crave their drugs enough that they choose to dive deeper into the depths of addiction. Nevertheless, once an addict is ready, they should admit themselves to a detoxification center.

While many addicts have successfully detoxified themselves at home, a clinical detox center is an optimal choice. That is because the doctors and nurses there can administer the proper medications to ensure a safe detox experience.

While in detox, medical professionals can diagnose any secondary addictions or other problems. If one’s use has gone so far as to include IV drug use, the medical staff can test for HIV and hepatitis. They might find other problems, such as infected injection sites or other health problems that arise from a life of drug addiction.

Detox can also be a great first step towards finding a rehabilitation center. The medical staff will surely have recommendations for local rehabs where a freshly detoxed patient can begin to learn more about their problem and work toward a long-term solution.

When deciding on the best rehabilitation center, patients should seek out programs that extend far beyond the typical 28-30 day treatment centers. That model for sobriety was based on bureaucratic, military realities, and not the realities of addiction and recovery. In fact, relapse rates from 28-day facilities are astronomical. When a patient spends more time, say, 60 or 90 days with a diligent focus on sobriety and the tools of a healthy life, they have far better chances of living a long, happy, drug-free life.

If one’s life circumstances or insurance only allow for a 30-day stay in an inpatient rehabilitation center, make plans to continue working on sobriety through an outpatient program. The inpatient program may be connected with an outpatient program that helps patients maintain a sense of continuity, but other options are out there.

Sober houses are available, and they are known to coordinate with rehabilitation centers as a way to continue treatment. Some sober houses will take patients who, for whatever reason, were prematurely discharged from their rehab for poor behavior or other reasons. These sober houses often have strict rules, regular in-house meetings, and even drug tests that keep residents focused on what matters most: sobriety.

Alternatives to Addictive Opioid Medications

Though the opioid epidemic might seem to present a bleak prognosis, there are glimmers of hope on the horizon. In this era of increased liberalization of cannabis laws, the typical problems associated with opioids seems to be decreasing. States that have robust medical cannabis or even fully legal frameworks for cannabis are showing lower overdose rates. There is even evidence to show that usage rates are falling. People are finding that they can manage chronic and acute pains without resorting to a pharmaceutical solution, which carries tremendous downsides.

Recent discoveries related to cannabidiol, commonly known as CBD, indicate that this less dangerous option can reduce a person’s desire for morphine or heroin. Since CBD is widely available throughout the nation without the need for a full medical cannabis program, pain patients can experiment with this substance to see how effective it is for their pain.

CBD is effective in patients who suffer from a wide range of pains. Since this cannabinoid has been isolated from THC, patients can use it free from worry regarding the disorienting features that accompany THC. Recent studies have also shown that CBD is effective with aiding sleep, easing stress, and quelling anxiety. Since it’s not physically addictive and doesn’t cause overdoses, patients can experiment to discover the specific doses they need. However, it should be noted that CBD can induce drowsiness, so it should never be used while using heavy machinery or delicate instruments, etc.