While there are other countries that have opioid problems, Americans purchase about 80 percent of the world’s supply of opioids and abuse them more than anyone else. In 2014, an estimated 2 million Americans had an opioid use disorder. This includes using painkillers like OxyContin and Percocet, and then another 586,000 people are addicted to heroin.
Sadly, opioids have ravaged some parts of the country, and several counties are worried that the drugs will wipe out an entire generation of people.
Some notable people who have lost their lives recently because of opioids are Prince, Whitney Houston, Phillip Seymour Hoffman, Amy Winehouse, Michael Jackson, and Heath Ledger.
But just before we start, often when reading or hearing about this heartbreaking topic, people often use the words opiate and opioids interchangeably; we certainly did before looking it up. Opiates are drugs that come from poppies, like heroin, and opioids used to mean just synthetic opiates, but now refer to the whole family of opioids and opiates.
10. Its Availability is Built on Faulty Science
One question surrounding the opioid epidemic is why the FDA allows doctors to sell a drug that is so dangerous and addictive?
Before the 1980s, opioids were used for short term pain, like for surgery and end of life care, but then in the January 10, 1980, issue of The New England Journal of Medicine a one paragraph letter to the editor was published that would change America. It was submitted by Dr. Herscel Jick and his graduate student, Jane Porter, who were from the Boston University Medical Center. The letter was entitled “Addiction Rare in Patients Treated with Narcotics.” It reads:
Recently, we examined our current files to determine the incidence of narcotic addiction in 39,946 hospitalized medical patients’ who were monitored consecutively. Although there were 11,882 patients who received at least one narcotic preparation, there were only four cases of reasonably well documented addiction in patients who had a history of addiction. The addiction was considered major in only one instance. The drugs implicated were meperidine in two patients, Percodan in one, and hydromorphone in one. We conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.
What some people drew from this letter to the editor, which wasn’t peer-reviewed, was that less than one percent of people who use narcotics become addicted.
What wasn’t included with the letter were the actual results of their study. When people went back later to examine the results, they found out that his experiment was done over a short time and the subjects were given a small dose of narcotics in a controlled environment when they had acute pain. That is a whole lot different than giving someone narcotics they can take home and do whenever they want over a long period of time. In other words, Jick absolutely did not show that less than one percent of people get addicted to narcotics.
However, by the time people examined the results of his study, it was too late. In 1986, a paper citing it was published in Pain, which is a journal published by the International Association for the Study of Pain. In the paper, the authors, Dr. Russell Portnoy and Kathy Foley, said that their study found that opioids “…can be safely and effectively prescribed to selected patients with relatively little risk of producing the maladaptive behaviors which define opioid abuse.” In their study, out of 38 cancer patients with chronic pain who were given opioids over a short term, only two of them became addicted. The paper advises long term studies, which never happened.
Around the same time, several pharmaceutical companies, like Johnson & Johnson and Purdue Pharma, were developing their own opioid drugs. They started to market them to doctors in high end publications citing the Portnoy article and Jick’s letter to the editor. They even went as far to start non-profit groups to push the use of opioids for long term chronic pain, like back and neck pain, even though there were absolutely no studies that supported the idea that opioids should be used long term.
In 1996, the American Pain Society and the American Academy of Pain Management published a consensus, partially written by Portnoy, stating that opioids were addictive to less than 1% of users so doctors could prescribe opioids for chronic pain. Also in the consensus, they said that there was little risk that people will become addicted and/or overdose.
Of course, that consensus was dead wrong because it wasn’t based on facts, and opioids are addictive and do lead to overdoses.
In 2011, Portnoy spoke out against the idea that opioids for chronic pain don’t lead to addiction. He said: “None of [the papers] represented real evidence, and yet what I was trying to do was to create a narrative so that the primary care audience would look at this information.”
9. Can be a Gateway Drug to Heroin
There are several reasons that people turn from prescriptions to heroin. One reason is that they start to build up a tolerance to the opioids so they start using more pills. However, doctors should only be doling out a certain amount of pain pills. So the person looks for ways to supplement their pills and sometimes they will turn to heroin because it has similar effects as prescription painkillers, but is much cheaper. Generally, for a 60 milligram painkiller pill, for an uninsured person, it is $60. For the same amount of heroin, it’s about one-tenth that price.
Another reason that people turn to heroin is because they get cut off from their painkillers for some reason and they no longer have access to them. This becomes a problem when the government cracks down on prescription drugs because people aren’t going to instantly stop doing opioids if they can’t get them. Opioids are so addictive that abusers will kill other people to get their next high and some abusers won’t even quit when they get their children taken away. So simply limiting access to painkillers isn’t the solution, because users will simply switch to a cheaper alternative that is provided by organized crime syndicates; usually the Mexican cartels and the Taliban in Afghanistan. Heroin is also much more dangerous because users can never be sure what is in it. For example, it could contain fentanyl.
8. What is Fentanyl?
Fentanyl is a synthetic opioid that was first developed in the 1960s. It is incredibly strong and it can be anywhere from 50 to 100 times more powerful than morphine or heroin. Two milligrams, which is two grains, are enough to cause an overdose.
It was originally developed in the 1960s to be given to patients for surgery and to people with severe pain from metastatic, colon, and pancreatic cancer. It first started being abused by people working at the hospital. It was then later made into take-home patches, which people quickly began to abuse. They would soak the patches in water and drink fentanyl like a tea.
In the 1980s, fentanyl was sold under the street name China White. Also around this time, heroin started to be laced with fentanyl, which made the heroin much more potent. Today, fentanyl can be found in cocaine, heroin, and in counterfeit painkiller tablets.
As for how it kills someone, the president of the American Society of Anesthesiologists, Dr. J.P. Abenstein, says, “What happens is that people stop breathing on it. The more narcotic you take, the less your body has an urge to breathe. And it makes sense that a lot of people are overdosing on it because they aren’t sure how much to take.” The most notable person who died from a fentanyl overdose was the musician Prince, who passed away in April 2016.
One reason that fentanyl is so dangerous is because illegal labs are making it from scratch using dangerous toxins. This makes the drug a lot more unpredictable, so it is much easier for people to overdose. It is also tasteless and odorless, so sometimes people using counterfeit painkillers or doing heroin don’t even realize they are taking fentanyl.
One place that is particularly hard hit with fentanyl overdoses is Canada. In British Columbia, half of all deaths in the province are from fentanyl overdoses. It has gotten so bad that funeral directors in British Columbia give naloxone nasal spray, which helps prevents opioid overdoses, to the friends and families of overdose victims, just in case they turn to opioids to deal with their grief. The funeral directors, who host about four funerals a month for people who overdose on fentanyl, said that they are tired of seeing so many families destroyed by the drug.
7. It Was Fueled In Part by the War on Drugs
The War on Drugs was launched in 1971 by President Richard Nixon and it’s been a losing battle ever since. Over a trillion dollars has been spent on it trying to go after manufacturers, traffickers, and distributors of narcotics, but as of 2016, over 20 million Americans have a substance abuse problem, there are a record number of drug overdoses, and the drug cartels are as powerful and as deadly as they have ever been.
There are some critics of the War on Drugs who think that it helped fuel the opioid epidemic because of its misguided policies. Specifically, it shouldn’t have targeted marijuana, which is relatively harmless compared to opioids. Notably, there are no confirmed records of anyone overdosing on marijuana and some experts think that it is impossible to overdose on marijuana. According to a DEA briefing, someone would have to smoke 1,500 pounds of weed in 15 minutes to overdose. Another benefit that marijuana has over opioids is that it’s not nearly as addictive.
Several medical marijuana studies have shown that marijuana is effective for the very thing that opioids are now prescribed to treat – chronic pain. In a study, 80 percent of people were able to substitute marijuana for painkillers. It can also be seen in the real world and not just in studies. In areas where medical marijuana is available, deaths from opioids drop anywhere from 15 to 35 percent.
However, because marijuana was vilified in the War on Drugs, it is still illegal in 40 states, but legal opioids continue to ravage the country.
6. Could Lead to Dozens or Even Hundreds of HIV Outbreaks
One of the biggest side-effects of the opioid epidemic is that it could lead to increased levels of HIV because of users sharing needles. Since 1993, HIV infections from sharing needles has dropped by 90 percent. However, that number is expected to increase, because while a lot of people take advantage of needle exchange programs, one study found that one-third of people who injected drugs intravenously admitted to sharing needles.
In 2016, 22 cities in America saw an increase in HIV infection rates from needle sharing and the Center for Disease Control says that there are 220 rural communities that are highly vulnerable to an outbreak of HIV and Hepatitis C.
One small town that has already experienced an HIV outbreak because of needle sharing is Austin, Indiana. Out of the town’s 5,000 residents, there are 190 diagnosed cases of HIV and more people have yet to be tested. The source of the HIV is a drug den, which is a single story brick house, and at any given time, half a dozen people live or squat there, and many of them are addicted to an opioid called Opana.
Needle exchanges were illegal in Indiana and the addicts’ needles were shared hundreds of times. When asked why they shared the needles at the risk of getting HIV, one user said they just didn’t think it would happen.
5. It’s Hard to Get Treatment
When someone stops taking an opioid that they’re addicted to, their body begins to go through withdrawal. They get tremors, a terrible fever, they vomit, have diarrhea, and experience other terrible flu-like symptoms. They also get very depressed and there is an intense feeling of hopelessness. Unfortunately, once someone is on the other side of their withdrawal, they aren’t instantly cured of their addiction and relapses are possible. So while some people can quit drugs on willpower alone, it’s not as easy for most. The problem is that the brain structure and function change in people who abuse opioids, so some people need professional help or they will not be able to get off the drug. Unfortunately, many people can’t get the help they desperately need.
Drug addiction treatment is expensive, and in some cases, drug users have sold everything they own and live on the streets to support their habits. How are they able to pay for treatment? Even for people who aren’t living on the streets, it’s hard to get treatment for addiction because most health insurance plans don’t cover addiction treatment.
While there are public treatment facilities, unfortunately, the beds are always full and there are waitlists to get help. This is one of the most heartbreaking aspects of the epidemic. People who may have hit rock bottom and are anxious to get help take a huge step by reaching out and asking for it, and they get told to “call back in two weeks.” Two weeks can be a long time to spend in a pit of despair that is created by addiction.
In 2013, 316,000 people with substance abuse problems tried to get treatment, but were turned away.
4. More People Die from Overdoses than Car Crashes and Gunshots
The death stats for opioids are as shocking as they are depressing. Between 2001 and 2014, the number of deaths from overdoses increased six fold. However, the deadliest year on record, so far, was 2016.
Deaths from heroin overdoses rose 23 percent from 2015 to 2016, totaling 12,989. Deaths from synthetic opioids, like fentanyl, spiked by 73 percent to 9,580. However, the most devastating drug of them all was prescription painkillers like OxyContin and Vicodin. 17,536 people died from overdosing on them in 2016.
That is a total of 52,404 opioid overdose deaths, which is an overall increase of 12 percent from 2015. Deaths from opioid overdoses dwarfed the fatalities from car accidents, which was 37,757, and gun deaths, including homicides and suicides, which was 36,252. It is also more deadly than the AIDS epidemic was when it was at its peak.
3. Enough Prescriptions for Opioid Painkillers Are Written Every American Adult to Have Their Own Bottle
One question that inevitably arises: why are there so many opioids available? Unfortunately, it’s because too many doctors prescribed too many of them. In 2012, physicians wrote 259 million prescriptions for opioid painkillers. That is enough for every adult in America to have their own bottle of pills. Of course, not all of these pills were used by the patients. Some of them made it to onto the black market, patients have them stolen, and some share them (or sell them) with friends and family.
Amazingly, in Canada, which is another country that is having an opioid epidemic (as we mentioned above), the rate of prescriptions for opioids increased from 2015 to 2016. In 2015, doctors gave out 19.9 million prescriptions, but that number increased to 20 million in 2016. Meaning despite knowing the dangers, physicians are still liberally prescribing opioids.
2. The Opioid Orphans
One major casualty of the opioid epidemic is the children who are affected by it. Horror stories in the news about young children finding their parents dead or dying from an overdose are becoming way too common.
However, many children of addicts do not happen upon their parents’ bodies or them dying because many times the children are taken away because one or both of their biological parents are too addicted to opioids to take care of them. That is how powerful the addiction to opioids is; people will continue to do drugs at the expense of losing their children.
The overall number of kids orphaned or put into foster care because of their parents’ addictions is hard to figure out; but what is known is utterly depressing. For example, Kentucky’s Appalachian ridge area is one of the hardest hit areas of the country for opioid addiction. According to the 2010 census, 86,000 children in Kentucky were being raised by someone who wasn’t their biological parents, usually their grandparents. While not all of the children that are living with someone that is a non-biological parent are the result of opioid addiction, it’s believed to be one of the biggest reasons.
In Vermont, one-third of the calls made to family services hotlines involve opioid addictions and between 2013 and 2016, the state saw a 40 percent increase in foster care cases. Meanwhile, West Virginia, another state ravaged by opioid addiction, saw an increase of 24 percent in foster care cases between 2012 and 2016.
1. Purdue Pharma
You may recognize Purdue Pharma from entry #10 as one of the companies that pushed for opioids to be used for long term pain by citing misleading studies and creating fake non-profits that pushed for opioids to be prescribed. Well, Purdue is also considered responsible for setting off the whole epidemic.
Purdue Pharma was purchased in 1952 by three brothers, who were all psychiatrists. One of the brothers, Arthur Sackler, was a pioneer in medical marketing. He was famous for finding enough uses for Valium that it became the first drug to make $100 million. Sackler was also one of the first medical advertisers to develop relationships with doctors where they would give the doctors free stuff (and/or money) in the hopes that the doctors would prescribe their products.
In 1996, Purdue introduce their new drug OxyContin. It was a time released oxycodone, which is a semi-synthetic opioid that is manufactured by modifying a chemical called thebaine, which is an organic chemical found in opium. It’s chemically similar to morphine and codeine.
Purdue spent $200 million marketing OxyContin and between 1996 and 2000, more than doubling their sales force. The average yearly bonus for salespeople was $70,000 and some were as high as $500,000.
In the first year, OxyContin made Purdue $45 million.
There is evidence that Purdue knew that hundreds of doctors were recklessly prescribing OxyContin as early as 2002. In 2016, Purdue was aware that at least 1.1 million OxyContin pills ended up being sold by organized crime syndicates like the Armenian mafia and the Crips. However, in all that time, Purdue has done very little to stop reckless prescribing or to curb OxyContin trafficking. They didn’t pass on their findings to law enforcement or even cut off the supplies to offending parties.
In 2016, the revenues from OxyContin were at $31 billion.