Opioid Epidemic

Opioid Epidemic: American Origins

The views expressed in this piece are my own, it should be noted this is an opinion piece. A lot can be learned from the past in order to better understand how the opioid epidemic got where it is today. All opioids are derived (or synthetically created) from Opium. People have been using opium for centuries. Since ancient times not much changed until the early 1800s when German pharmacist Friedrich Sertürner isolated morphine from opium. Hailed as a miracle drug; people begun using morphine to treat everything from pain, anxiety and respiratory problems to constipation and feminine cramps.

Dawn of a New Age

By the mid-1850’s morphine made its way to the US. The drugs addictive properties went unnoticed and it grew in popularity until sometime post-1865, after the Civil War. America recognized the country’s first Opioid Epidemic when tens of thousands of soldiers came home addicts.

Recreational use of morphine was on the rise and with the growing number of addicts Bayer Pharmaceutical Company set out to find a new, less addictive, morphine. Near the end of the 19th Century, Bayer scientists settled on heroin (a drug discovered sometime earlier, Bayer commercialized it). Which, interestingly, is an acetylated form of morphine that is one and a half to two times more potent than morphine itself.

The Start of the 1900s

In 1908, riding a populist wave fresh off being elected to his second term as president Teddy Roosevelt recognized a problem. The President appointed Hamilton Wright as the countries first Opium Commissioner. I hope to find more information on Dr. Wright and what he accomplished, unfortunately, it’s proving difficult to track information down. From what I can tell he’s basically the precursor to Nancy Reagan, a cheerleader in opposition of drug use. I imagine Dr. Wright played some role in Congress passing the Opium Exclusion Act in 1909. The Act made it illegal to import opium for the purpose of smoking.

The countries first major drug policy followed the Harrison Narcotics Tax Act of 1914. The Act put a tax on narcotics and required physicians and pharmacists register to distribute opioids. The first major steps in the regulation of this drug classification and the government profiting from their distribution. *It’s worth noting the government did begin taxing opium in 1890.

Despite the government’s efforts, by the 1920s an opioid epidemic was underway as the number of opiate-addicted Americans had reached an all-time high. To combat this, the government passed the Heroin Act in 1924 banning the substance nationwide and doctors begun only prescribing opioids to the dying with acute pain rather chronic issues.

A Shift in Opinion

After a few years, the country returned to normalcy and life went about its merry way without much change for the next 60 years with two exceptions. Spoiler alert: war tends to lead to addiction. The first one beginning after World War II and the second during the latter part of the Vietnam War. Both drug crises lasted roughly ten years.

It’s my opinion that we started to see a shift by the medical field regarding the perception of pain management in the 1980s. Here are some of what I attribute to this changing in beliefs:

  1. The American Pain Society begun advocating for more readily available, non addictive, pain relief.
  2. Percocet and Vicodin became approved by the FDA.
  3. The Joint Commission on Accreditation of Healthcare Organizations begun developing a performance monitoring system.
  4. Development of the Indicator Measurement System for healthcare providers and the Wong-Baker Faces Pain Rating Scale (WBFPRS) in 1983.

Have you ever been to the doctor and wondered where in the hell the smiley faces of pain came from? It’s called the Wong-Baker Faces Pain Rating Scale. These events set the stage for the adaptation of pain as the fifth vital sign in medicine.

Changing The Narrative

As mentioned, up to this point in American medicine opioids (Oxycodone included) prescriptions were only for the acute pain of terminal patients.  Purdue Pharma combined oxycodone with a time-release ingredient, making OxyContin the only opiate that offered multiple hours of pain relief. In 1995 the FDA approved the drug. The love child of capitalism and Purdue Pharma, America’s current opioid epidemic was born in 1995. Purdue spent two hundred seven million dollars on OxyContin marketing in 1998. In other words, the year shit hit the proverbial fan. Patrick Radden Keefe of the New Yorker, in his October 30, 2017 article “Empire of Pain”, had this to say about the sales campaign:

A major thrust of the sales campaign was that OxyContin should be prescribed not merely for the kind of severe short-term pain associated with surgery or cancer but also for less acute, longer-lasting pain: arthritis, back pain, sports injuries, fibromyalgia. The number of conditions that OxyContin could treat seemed almost unlimited. According to internal documents, Purdue officials discovered that many doctors wrongly assumed that oxycodone was less potent than morphine—a misconception that the company exploited.

Patrick Radden Keefe

A Nationwide Crisis

The rest, as they say, is history. From 1997 to 2002 the following opioids saw the following increases: morphine prescriptions by 73%, Hydromorphone by 96%, Fentanyl by 226%, and Oxycodone by 402%.

To recap: our species utilized the natural forms of opium relatively unchanged for thousands of years until 1806 when German chemist Friedrich Wilhelm Adam Sertürner isolated morphine (named after Morpheus, the god of dreams). Following the conclusion of the Civil War in 1865, there were all sorts of newfound junkies running around and the problem of opioid addiction grew too large to continue turning a blind eye towards.

In the early 1900’s Bayer began producing heroin as a safe alternative to morphine (truth’s stranger than fiction, I know). Uncle Sam took an interest over the early part of the 20th century and enacted present-day drug policy. Over the next 60 years there were two significant spikes in opiate use, both corresponding with times of war, but for the most part, everything was hunky dory for over half a century. However, in the 80s opinions begun changing in regard to pain management. In conclusion, this created the perfect storm for Purdue Pharma’s miracle drug Oxycontin.

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Sources/Additional Readings

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