Opioids: Same Old Devil in a New Hat
We have a long history with that old Devil the opium poppy. Probably its pain-killing properties preceded the discovery of its addictiveness. In 19th Century the British flooded China with opium from India, to offset the huge imports of tea and porcelain. The Chinese government banned the importing of opium, leading to the Opium Wars of the 1840s.
Opium refined into morphine was even more affective, and more addictive. During the Civil War it was about all the field doctors had to relieve pain. Soldiers being discharged were each given a little phial of morphine to wear around their necks and when that was gone, oh well. Little did we know we were creating a generation of morphine addicts.
The even more highly refined form is heroin. It appeared here in the early20th Century, in one form as a children’s cough syrup. It had the word heroin right on the label! By the way, Coca-Cola got its name from the cocaine in the original recipe. Heroin addiction grew over the decades, ravaging countless lives and families, but it was associated with black people, so no one paid much attention.
In the mid 1990s synthetic opiates, or opioids, were developed for a nation in which 100 million — nearly a third of the population — are in chronic pain. If you subtract children, usually absent this malady, it’s nearly half of us, which sounds like a ridiculous number. Someone should do a study on that. The first of these opioids was OxyContin, developed by Purdue Pharma, and FDA approved in 1995. 1996 revenues were $45 million. By 2000 that number was $1,1 billion, and by 2010 over $3 billion. The other pharmaceutical companies quickly climbed aboard with Oxycodone, Hydrocodone, Obana, Methadone, Percocet, Vicodin, and Demerol. They mounted slick promo campaigns while downplaying the addiction and overdose risks, and “encouraged” doctors to increase prescriptions. Keep in mind that only two countries — the U.S. and New Zealand — allow what’s called direct-to-consumer advertising of drugs. That’s why you see them all over TV and magazines. In 2012 there were 259 million prescriptions for opioids. Addiction rates soared, and so did death by overdose. The latter came into more prominence after it was discovered that if you crush the OxyContin, dissolve and inject it, you can get a much more intense high. Drug companies responded by creating non-crushable forms of the drug.
Dr. Thomas Frieden, Director of the CDC, explains how opiates and opioids work: “The attach to one of the opioid receptors found on nerve cells throughout the body. It reduces pain. Concurrently, the drug increases a “reward” chemical called dopamine in the brain, which boosts feelings of pleasure, relaxation, and happiness, a euphorical high.” Unfortunately, it’s not long before the body builds up a tolerance, and so the same amount of the drug must be taken just to prevent going into withdrawal.
In the late 2000s the feds began cracking down on overprescriptions, and many people who were already hooked now suddenly without the drug they desperately needed. The street price could run to $80 or more for one pill, but heroin was much cheaper (about $10) and easier to come by. Today the nation is in the midst of a massive heroin epidemic. We’ve been hearing many news reports states with a severe crisis; New Hampshire, Indiana, West Virginia, Washington. Street heroin is of course much more dangerous due to its unpredictability. How many times has it been stepped on? If it’s really pure and the person isn’t accustomed to it, overdose is always a danger. But how does one overdose on opioids? It’s the same. In heavy doses, which the user must use to get back that high, breathing slows down and can even stop.
How bad is the problem? That should be a plural, because we have two epidemics, opioids and heroin. I’m tempted to throw a bunch of numbers around, but those can be tedious, so I’ll give you a few, enough to illustrate the severity of the crisis. The CDC reported that from 2000 – 2010 deaths due to drug overdose more than doubled, from 17,000 to 38,000. Of the latter, 22,000 deaths were from prescription drugs, mostly opioids. In 2014 o.d. deaths were up to 47,000, and since 2000 nearly half a million people have died from drug overdose. Non-lethal overdoses of heroin have tripled since 2000, and heroin usage is up 65% from 2002. As far as treatment, from 1997 – 2011 there has been a 900% increase in people requesting treatment for addiction. There’s another aspect, too; nearly 25,000 babies born last year were addicted to opioids. In the Seattle area, where I live, they had the highest number of deaths from heroin in twenty years. The news gets even worse. The UN reported a 50% increase of heroin production in Mexico for 2013, and that global poppy production is at the highest level since the 1930s. Here’s another sobering number; 75% of new heroin users formerly had addictions to opioids (Mayo Clinic). As if all that weren’t bad enough, two even more powerful opioids have been introduced: Fentanyl and Zohydro, even more potent opioids, used primarily as palliative care for terminally ill patients. Now they’re the latest abuse craze, and street dealers are also profiting from the higher prices.
What’s being done? Well, all kinds of measures have suddenly appeared, just in the last month. On Mar 1st King Co. Executive Dow Constantine and Seattle Mayor Ed Murray announced a new task force to expand treatment options. Mar. 10th the Senate passed a bipartisan bill, the Comprehensive Addiction and Recovery Act, 94-1. It will allocate $400 million for abuse and treatment. Needle exchange programs have been active for years around the country, because of the added hazards of HIV and Hepatitis C from dirty needles. Mar. 15th the CDC issued new guidelines for prescriptions of opioids, ranging from starting with non-opioids, physical therapies, and more information about the risks of opioids. And President Obama attended the National Prescription Drug Abuse and Heroin Summit in Atlanta, which ran Mar. 28th through the 31st.
Why the fuss all of a sudden? Perhaps this headline from npr.org will offer a hint: “Today’s Heroin Addict is Young, White, and Suburban.” White, you say? A study of 9000 patients showed the number to be 90% white, with the average age of 23. Who knows how many black communities were decimated from heroin over the last hundred years, now it’s white folks, so it’s important. Now it’s the aunt or uncle, or the kid next door, or even your kid. What was once a crime problem, as was the crack epidemic of the 80s and 90s, is now a “public health” crisis. Police departments nationwide are outfitting officers with naloxone, also called narcan, a nasal spray that can dramatically reduce o.d. symptoms. It’s been a real life-saver. Methadone (also an opioid) has long been used for heroin addiction. Another treatment is Suboxone, a combination of Buprenorphine (also an opioids) and naloxone. These drugs don’t give the patient a high, but prevent withdrawal symptoms.
In 1969 I found myself in a conversation with a former heroin addict. He talked about his first time, saying it was the most wonderful, glorious, feeling he’d ever experienced. He went on to say that once you taste that, you will literally do anything, anything, to get that feeling back. He said you’d sell your own mother or anything else you had to do, to get that next fix. This was in 1969.
Where this will all end is anyone’s guess, but at least we’ve begun to actually address the problems. And the increased awareness, treatment and de-tox options will benefit addicts of all colors. Meanwhile, that roughly half of the adult population is still in chronic pain, and still needs some kind of relief. Big Pharma, and to a lesser degree greedy doctors, are largely responsible for this mess. Their lust for profits at the expense of people is beyond shameful, but like the banks, they’re too big to jail. They’re not too big to fine, though, and in 2007 Purdue Pharma, developer of OxyContin, was sued by the Department of Justice. Purdue pled guilty to misleading the public to the dangers of opioids, and were fined $634.5 million. Three of their executives also pled guilty to criminal charges, but none of them spent any time at the gray bar hotel.
Keep in mind that opioids and heroin are only part of the picture. We are the most heavily medicated society on Earth, and by a helluva long way. There are all the anti-depressants, anti-psychotics, anti-anxiety drugs, ADD and ADHD drugs like Ritalin and Adderol, too. 70% of Americans are on at least one prescription drug. Yes, America has a drug problem, but the good news is that America is finally admitting it. That’s always the first step, as I understand it.