The Opioid Crisis
From Miracle to Mayhem
Today in America more than 115 people will die from overdosing on opioids. The crisis is serious and is going to require real grit to make an impact on our nation. What are opioids? How did opioids get there beginning? How are they affecting the public? And, what can we do to conquer this problem that has plagued our country since its infancy? These are among the many questions we will answer. So let us start by talking about what is an opioid. According to the Nation Institute on Drug Abuse, an opioid is a class of drugs that includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available by legal prescription such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine and many other.
Heroin, is an opioid drug made from morphine, which happens to be made from the resin of a poppy plant. This opium is refined to make morphine and further processed to create heroin. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. This drug is a pharmaceutical that is given to patients in severe pain though injection, a skin patch or a lozenge absorbed inside the mouth. Drugs like oxycodone and hydrocodone are both synthetically produced from thebaine and used to treat moderate to severe pain. Codeine is found in small amounts in the opium poppy, therefore it is often synthesized from morphine, and lastly, we cannot discuss opioids without talking about morphine. Morphine is the first medicinal plant alkaloid ever isolated.
It was late 1870 when Dr. Charles Shuppert, a surgeon from New Orleans was called to help a man who was injured in a bar fight that left him bloody. Dr. Shuppert, like many doctors of his time, decided to use the most effective drug available to him, morphine. He reported, “This acted like a charm, as he came to in a minute from the stupor he was in and rested very easily.” By 1895 this had begun to an addiction epidemic. Prior to 1900, the average opiate addict in the United States was an upper-class or middle-class white woman, but from around 1895 to 1935 there was a new user, lower-class, urban males. It was during this time, 1914 to be exact that the Smoking Opium Exclusion Act was passed. This was a series of laws, which included the Harrison Narcotics Tax Act, requiring doctors, pharmacists, and others registered with the U.S. Department of Treasury to deal with narcotics, to pay a fee and keep records regarding dispensary. In 1924 Heroin became illegal.
The history of opium in America is as old as our country itself. Opium was used during the American Revolution to treat sick and wounded soldiers. Even leaders like Benjamin Franklin used opium in his later years to deal with pain from bladder stones; and Alexander Hamilton used a tincture of opium mixed with alcohol after his deadly duel with Aaron Burr. The Civil War also had a great hand in fueling the opioid epidemic. It is said that the soldier of the Union Army were issued nearly 10 million opium pills, and an additional 2.8 million ounces of opium powders and tinctures. It is not know home any of those soldiers went home addicted, but it was believed that the soldiers would meet with the physician that were make it available and they too would become addicted.
As advancement in medicine continued, the United States would be introduced to the hypodermic syringe in 1856 and by the 1870s it was used extensively for delivering morphine. It was not curative, but pain was easily and quickly controlled using the morphine. A few short decades later, the Bayer Company began production of heroin on a commercial scale. It was thought of as a “wonder drug,” but soon addicts found that my injecting it, the effects would be intensified. Heroin and other opiates were used as effective cough suppressants and pain relievers, especially in light of the fact that there were not a lot options.
World War II brought with it severely injured soldiers, and this became a turning point for doctors as they treated pain. “Nerve block clinics” were opened in the 1950s and 1960s by anesthesiologists to manage pain with so patients would not have to succumb to surgery, still not longer after the drug use in America escalated. As the 1970s are advancing, the drug problem was growing fast. This forced President Gerald Ford to create a task force to study the drug problem.
By the mid-and-late1970's drugs like Percocet and Vicodin joined the market, and despite doctors being taught to avoid prescribing this addictive opioids, the New England Journal of Medicine printed a short letter in January 1980 changing it position. In the letter, Jan Porter and Dr. Hershel Jick, whom analyzed 11,882 patients who used narcotic treatment, stated, “The development of addiction is rare in medical patients with no history of addiction.” Jick went on to tell the Washington Post that in 1977 he conducted a study that had shows that less than 1% of the patients he studied died from a reaction to the drugs. This compelled doctors. Terminally ill patients and patients with chronic pain were now finding doctors and researchers who wanted to treat themOpioid with prescription opioids.
A few short years later another doctor, Dr. Russell Portenoy, a pain-management specialist documents his treatment of 38 patients receiving opioid treatment for non-cancer pain. Two patients suffered addiction issues with the drugs, but he concluded that they could be a safe and humane alternative to chronic pain. This furthered the priority of pain treatment. And as we entered the ‘90s a shift began to occur. Pain became the “fifth” vital sign.
It is during this time that Purdue Pharma pioneered the time-released form of oxycodone, Oxycontin. Purdue aggressively marketed their opioid painkiller by espousing the drug was low risk for addiction. Part of their campaign was to recruit doctors, nurses, and pharmacists to serve on the Purdue's speakers' bureau. The company also offered a bonus system to its pharmaceutical representatives to boost sales. It should be noted that the average bonus exceeded the sales reps' annual salaries. This led to skyrocketing sale. Oxycontin treatment for non-cancer related pain, soared from about 670,000 in 1997 to about 6.2 million by 2002. By all accounts, there were patients who benefited from this push; the under-treated.
In 2001, $200 million was spent by Purdue to market Oxycontin, and they hit an all time as their sales topped $1.5 billion in 2002. The number of opioids prescribed annually in the United States has increased from 76 million to 207 million between 1991 and 2013. In like, there has been an increase in addiction, overdose, and death. This prompted the Department of Justice to take notice. Purdue was charged with misbranding the drug's potential to be abused; and in 2007 Purdue pled guilty, forcing them to pay upwards of $600 million in fines. That same year, Purdue also reached a settlement near $20 million with twenty-six states and Washington, D.C. This resulted in Purdue reformulating Oxycontin with an “abuse-deterrent mechanism”, which makes it harder to crush or dissolve. The originally formula was withdrawn from the market in 2013. And yet another lawsuit was settled with the state of Kentucky.
This opioid epidemic has put drug maker on notice and they are fighting countless lawsuits by states, counties, and cities, stating that there aggressive marketing of painkillers was deceptive and the impact too far reaching to ignore. To date, fourteen states have sued Purdue and they are also facing federal investigation by the U.S. Attorney's Office in Connecticut. You might be asking yourself, “What areas have been hit hardest and how is this affecting our nation, our state, our counties and our cities”. According to the Center for Disease Control and Prevention, opioids took the lives of more than 42,000 people. This is the most recorded to date. It is also worth noting that forty percent of all deaths that result from opioid overdose involve prescription opioids.
The hardest hit cities across our nation include: Wilmington, NC, Anniston, Alabama, and Panama City, Florida. Wilmington claims that 11.6% of their citizens who use prescription opioids are abusing and the Cape Fear region has the highest rate of abuse. Fifty-four percent of prescriptions filled in the area of about 112,000 are in the end abused. Anniston has the second highest rate of prescription drug abuse. With a population of approximately 22,000, about 11.6% are abusing, while 46.6 are misusing. Panama City, Florida, located on the gulf coast, has the third-highest rate of opioid abuse in America with approximately 11.5% of all people using prescribed opiates misusing and 52% of the filled prescriptions are being abused. Like many town, some of the addicts eventually turn to heroin, which leads to overdoses. A few more interesting statistics worth mentioning include the following: roughly 21 to 29 percent of patient who have chronic pain and are prescribed opioids misuse them, Between 8 and 12 percent of user develop disorders associated to opioids, 4 to 6 percent of those who misuse prescription opioids will turn to heroin and a staggering 80 percent of people who previously used heroin misused prescription opioids.
Here in Florida, there were 5,725 opioid-related deaths in 2016. This is up 35 percent for the previous year. That is 15 people per day. Heroin-related deaths increased by 62 percent. Deaths caused by fentanyl has a drastic increase of 97 percent. Palm Beach County, has not walked away unscathed. It has become the epicenter in the state. Drugs like Heroin and fentanyl took a record number of lives. In 2016 alone, 571 lives were lost. This was up 110 percent from 2015 and that trend continues with the county reporting nearly 600 fatalities in 2017. In an interview with Todd J. Bonlarron, Assistant County Administrator for Palm Beach County, he shared his ……..
South Florida is responding to this crisis. The Southeast Florida Behavioral Health Network has partnered with Palm Healthcare Foundation, Hanley Foundation, and the Town of Palm Beach United Way. This partnership will bring the Rapid Results Institute (RRI) to Palm Beach County. Together they have launched the 100-Day Challenge . This challenged began on February 2 and the goal is to achieve significant results toward executing a recovery system. RRI has used its organization Rapid Results Approach in more than a dozen countries in Africa and in the U.S. has been actively involved in combatting homelessness.
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