During the end of 2017, the white house declared a state of emergency on opioids. How did we get here?
According to the National Institute of Drug Abuse, opioids consist of the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. All opioids are chemical variants or come from Opium. Opium was the first ever opioid and comes from the milky sap of a flower called the opium poppy. The Opium plant has been used for over 5400 years. During that time opium was grown by the Mesopotamians and Sumerians. It then spread to the Assyrians, Babylonians, and Egyptians and finally the Greeks introduced it to India and Persia, who grew it in large amounts. During the 1700’s, opium was used as a pain reliever for cancer and childbirth, as well as other common ailments like menstruation and even to help calm crying children. The British became very lucrative from its sale of Opium to China. The Qing Dynasty at the time attempted to curb the havoc caused by the drug and outlawed its importation and cultivation. This conflict started the Opium Wars which lasted from 1839-1842, and 1856-1860.
Opioid History in America
The 1860’s
During the Civil War from 1861 to 1865, medics used morphine as an anesthetic for wounded soldiers and administered intravenously. Morphine is one of the most potent opioids and carries one of the highest potentials for addiction. Because of its extensive use in battle, many American soldiers became physically dependent. Morphine addiction became a problem even long after the Civil War ended.
1898
The Bayer Company produced a new drug called Heroin. It was meant to be less addictive than Morphine. Heroin was popular for anesthetic procedures as well as more common commercialized medicines. Medicine shows began to become popular peddling “cure-all elixirs” (sometimes referred to as snake oil). Most of the time, these would contain some trace of heroin. Cocaine also became widely popular during this time. Liquid cocaine was used for anesthesia purposes as well. You would not be surprised to find these types of drugs in everyday products. For instance, Coca-Cola initially manufactured their product with cocaine.
1914
The Harrison Narcotics act regulated and taxed the production, importation, and distribution of opiates and coca products. This act required a prescription from practicing doctors to obtain narcotics like opioids and cocaine. Not only was the sale of heroin regulated, but the manufacturers and distributors of these substances were now required to register with the Treasury Department and pay taxes for their products.
1924
The United States Congress legally banned heroin’s manufacture, sale and importation with the Anti-Heroin Act.
1970’s
The Comprehensive Drug Abuse Prevention and Control Act of 1970 required the pharmaceutical industry to maintain strict record keeping and security for certain types of drugs. During this Act, controlled substances were divided into five schedules by their potential for abuse, accepted medical use, and accepted safety under medical supervision. Heroin is classified as a schedule I drug while other opiates including morphine, fentanyl, oxycodone and methadone are schedule II. This Act made way for the pharmaceutical market to start designing new drugs. New drugs like Vicodin and Percocet were created to provide short-acting pain relief.
1980’s
An article published in the New England Journal of Medicine displayed a study of the level of addictiveness of patients treated with opioids. The article said there was a low-level of abuse which led to the commercialization of opioids outside of hospitals. Unfortunately, the study was not entirely accurate; the findings were based on hospitalized patients who were carefully examined and monitored by staff.
1995
Addictive properties of Vicodin and Percocet are now known. OxyContin, manufactured by Purdue Pharma, is approved by the FDA for prescription use. The drug marketed as a safer alternative opioid used to treat a variety of problems, ranging from
1996
When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000 Purdue Pharma used aggressive marketing tactics by providing bonus incentives to sales representatives and targeting physicians who heavily prescribed opioids. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000
1998
Actiq, a drug for chronic pain management in cancer patients, is approved by the FDA. Antiq is made up of Fentanyl and transitioned the restricted drug to medicated use. Fentanyl has a high potential for overdose. It is 50 times stronger than Heroin.
2000’s
As more physicians began to prescribe more and more opioids, opioids become the most abused drug in the country - especially in rural areas like Maine, West Virginia, eastern Kentucky, southwestern Virginia, and Alabama. From 1998 through 2000, prescribed hydrocodone and (non-OxyContin) oxycodone were 2.5 to 5.0 times more than the national average.
2003
Medical practitioners grow aware of the adverse side-effects of opioids like OxyContin. Marketing strategies by pharmaceutical companies still had not fully disclosed the effects in their marketing campaigns. The Food and Drug Administration sent a letter of warning to one particular company, Purdue Pharma regarding their misleading ad campaigns and said Purdue Pharma had failed to adequately disclose OxyContin’s potential for abuse and its fatal risks. The FDA said these actions were “especially egregious and alarming in its potential impact on the public health.” Purdue Pharma stated they did not believe the ads misled physicians about the risks of the drug. This statement finally led to a Federal Case that brought the Opioid Crisis to the limelight.
2007
A multitude of court cases plagues Purdue Pharma. Several state governments sue the company for “misleading and defrauding physicians and consumers.” The company pleaded guilty and paid a total of $634.5 million in fines.
2010’s
New forms of OxyContin were created and approved by the FDA. They were an abuse-deterrent meaning they could not be crushed, making snorting or injection impossible. This new form decreased the misuse of OxyContin by 36%, but people ended up resorting to Heroin. During the same time of the decrease in OxyContin, there was a 42% increase in Heroin use. Unfortunately, these new abuse-deterrent forms did very little to decrease the percentage of people addicted to opioids in the short term.
2015
In response to the increased abuse and trafficking of pharmaceuticals in the areas of Arkansas, Alabama, Louisiana, and Mississippi, the DEA created operation Pillutied. The operation took 15 months and concluded with 280 arrests. 22 of the arrests included doctors and pharmacists. Operation Pillutted became the largest-ever prescription drug bust in DE history.
2016
The Centers for Disease Control and Prevention (CDC) published a set of strict guidelines for prescribing opioids for chronic pain management. Thes guidelines recommended the use of over-the-counter painkillers and physical therapy as immediate responses to chronic pain - leaving opioids as a last-resort option only.
2017
President Trump campaigned against the opioid crisis, and during his time in office, he established the President’s Commission on Combating Drug Addiction and the Opioid Crisis. In October 2017, the President declared the Opioid Epidemic a National Public Health Emergency.