In 2017, the Department of Health and Human Services declared a public health emergency–an opioid epidemic–because of the rising deaths and rampant misuse of various prescription medications. Despite a five-point strategy to battle the opioid crisis, in 2019, over 50,000 people died as a result of opioid drug overdose. In 2020, there were upwards of 90,000 opioid-related deaths, confirming the fact that this is an opioid crisis that needs to be addressed sooner rather than later.
But what led to this crisis in the first place? First, let’s take a look at what opioids are commonly used for and why they’re prescribed so frequently.
What are opioids, and what are they used for?
Opioids are a class of pain-relieving medications derived from the opium poppy plant. These drugs are desirable not only for the pain relief they bring but also for their euphoric and sedative effects. When used correctly, opioids are used for acute pain issues as well as post-operatively for pain control. They are used for chronic pain syndromes as well as cancer-related pain. They are often used in conjunction with non-opioid medications. Many physicians will prescribe opioids in a controlled manner depending on the patient and clinical situation. Drugs in the opioid class include illicit drugs such as opium and heroin as well as prescription medications such as morphine, hydrocodone, Fentanyl, oxycodone, OxyContin, methadone, codeine, and various other drugs that have been synthetically derived to obtain increased potency.
Opium, the original opioid, has been used for thousands of years, starting with the ancient Sumerians in 3400 BC. Opium then spread to the ancient Greeks and Egyptians, who used it as a sleep aid and anesthetic. Eventually, the drug made its way to China, where it hooked millions of Chinese people and triggered the Opium Wars of the 1800s. Once chemists figured out how to potentiate opium by converting it to morphine and then heroin, opioid use skyrocketed in the West.
What led to the opioid crisis?
Starting in the 1990s, potent new opioid drugs made their way to market. One drug in particular was called OxyContin, and its maker, Purdue Pharma (Purdue), wanted to cash in on it. Purdue, along with other pharmaceutical companies, launched a years-long campaign to promote the safety, effectiveness, and low addiction potential of the drug.
Through extensive lobbying efforts, incentives, and sponsorships, Purdue convinced doctors throughout the US to prescribe as much OxyContin as possible. Doctors handed out opioid drugs like candy as they bought into the pharmaceutical propaganda about the medications not being addictive. Looking at the timeline, there were three waves of opioid-related deaths. The first wave was in the early 1990s, involving prescription opioids. The second wave started in 2010, with rapid increases in heroin-related deaths. The third wave was in 2013, with an increase in Fentanyl-related deaths, many times in association with common street drugs.
Even at the start of the first wave in 1990, Purdue and its principal officers knew all along that OxyContin was highly addictive and even destructive, but they saw only the profit margin. In 2007, the company was finally brought to trial, where it admitted that OxyContin wasn’t what they said it was. As a consequence, it was fined $635 million–a mere fraction of the $35 billion in revenue generated by OxyContin. However, numerous additional lawsuits have since been filed.
Do opioids have legitimate uses?
As stated earlier, opioids do have their uses, particularly for diseases involving severe pain like cancer. To minimize the risk of addiction, most doctors today take extra precautions when prescribing opioids, and patients are informed about any potential adverse effects.
If you suffer from chronic pain, you may be tempted to ask your doctor to prescribe you an opioid. But these drugs should only be used when other treatment options fail to provide symptom relief. If you must resort to opioids, make sure to follow your doctor’s advice carefully–take your medications only as directed, and call your doctor if you notice any signs of addiction.
- Heroin, Morphine and Opiates – Definition, Examples & Effects – HISTORY
- Tracing the US opioid crisis to its roots
- The Family That Built an Empire of Pain
- What Are Opioids?
- Opioid Overdose Crisis
- CDC: Understanding the Epidemic
Amit Mehta, MD, MBA
Interventional Pain Management
Dr. Mehta is Double Board Certified through the American Board of Anesthesiology in Anesthesiology and a sub specialty in Pain Management. In addition to being the CEO at ABM Pain Consultants, LLC, Dr. Mehta is a Doctorpedia Founding Medical Partner and CMO of Doctorpedia's Pain Channel.