By Roy Benaroch, M.D., Emory University
Paramedics in America have got so used to calls about opioid overdoses that it has become more of a routine for them than an emergency. But the opioid crisis has not happened overnight. Why has it come to such a state to be termed as a crisis, and how has it grown over the years are the questions that need to be answered.
The opioid crisis is a very serious issue and needs to be understood deeply. The health and the political media have given a lot of attention to opioids. Reading and seeing these stories have affected our understanding of the opioid crisis.
To understand the issue, there are some definitions that must be understood. There might not be an agreement about the best possible solutions, but it is important that everyone speaks the same language. Substance dependence refers to the physiologic and psychologic need to keep taking a drug. For example, oxygen and food are essential to us. Without them, we may not feel well. So we are dependent on them to feel good. It is the same with some drugs like opioids. Once you have taken them for some time, you may develop a dependence on them. And when you stop taking them, it can make you feel not only physically sick, but it can have psychological effects also. Thus, the opioid crisis.
Learn more about media’s take on mental health.
Dependence and Abuse
The dependence on drugs may develop over days, weeks, or months. It depends on pattern of use, genetics, and some other factors. But taking opioids for the long term will always develop dependence. However, this dependence itself may not be much of a problem. People who depend on opioids or any other drug can work normally, indulge in their hobbies, and can run their lives without any harm to themselves or others. Though dependence can be a risk factor for developing abuse, dependence and abuse are not the same thing.
In contrast to dependence, substance abuse refers not to the reaction of the user’s body and mind, but to the manner of use. A typical definition of substance abuse is using a drug in a manner outside of societal norms. A drug used as a doctor ordered it isn’t considered abuse, and smoking cigarettes is not considered abuse. But taking prescription drugs that weren’t prescribed or smoking crack cocaine are examples of substance abuse.
Addiction and the Opioid Crisis
A step ahead of substance abuse is addiction. It’s defined by the societal impact of abuse. An addict will continue using despite clear negative consequences, like losing a job or needing to be resuscitated by an ambulance crew.
These definitions are to some degree in flux, but the important thing to remember is that not everyone who is chemically dependent on a drug is a substance abuser, and not every person who is a substance abuser develops an addiction. Though they’re interrelated, it’s not helpful for news stories to lump all of these conditions together, as their consequences are vastly different. Dependence may not be a problem, but addiction is always a problem.
This is a transcript from the video series The Skeptic’s Guide to Health, Medicine, and the Media. Watch it now, Wondrium.
History of Opioid Use in America
There are some important lessons to be learned from the history of opioid use in America. The Washington Post published an interesting review with the title “From Teddy Roosevelt to Trump: How Drug Companies Triggered an Opioid Crisis a Century Ago”. The article put the blame squarely on pharmaceutical firms.
The United States developed a pernicious narcotics habit in the decades after the Civil War. Anguished veterans were hooked on morphine. Genteel ‘society ladies’ dosed up with Laudanum—a tincture of alcohol and opium. The wonder drug was widely used as a cough suppressant, and it proved very effective at treating diarrhea in children.
The story made another parallel with the current opioid crisis, quoting from a 1900 medical journal’s discussion of heroin: “It possesses many advantages over morphine. It’s not hypnotic, and there’s no danger of acquiring a habit.” Drug companies saw heroin as an improved, safer morphine, which it wasn’t. One-hundred years later, they promoted Oxycontin and similar drugs the same way.
The Guardian Story
The Guardian’s story, “America’s Opioid Crisis: How Prescription Drugs Sparked a National Trauma,” provides some chilling details. Oxycodone, that had been developed in the early 1900s, had traditionally been used to treat cancer pain. But in the 1990s, Purdue Pharmaceuticals started marketing this compound under the brand name Oxycontin for treating all kinds of pain. Purdue hosted thousands of doctors, nurses, and pharmacists from 1996 to 2001 at beautiful locations around the country under the garb of “pain management symposia” and doubled its sales force. The result was that the sale of Oxycontin grew by over 1,000% in six years. Purdue minimized the risk to itself by mentioning in the promotional material that the risk of addiction was minimal.
The Guardian story also points out that though Purdue was fined $600 million for their misleading advertising in a 2006 case, that figure is dwarfed by the billions made by the owners of Purdue Pharmaceuticals.
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Availability of Drugs
In the US, the ready availability of prescription drugs sometimes borders on ridiculous. According to a story reported by NPR in January 2018, two pharmacies four blocks apart in Williamson, West Virginia, dispensed 20.8 million painkiller pills between 2008 and 2015. It also tells that in 2007, in just two days, more than 39,000 hydrocodone tablets were distributed. In 2008, a pharmacy in Kermit could have supplied, on average, 5,600 pills a year for every man, woman, and child in the city.
Such centers have been called pill-mills. They involve many bad people, all working for a profit motive: a doctor for inappropriate prescription, a pharmacist for needed supply, and a distribution center to overlook the extraordinary use.
So in short, the opioid crisis is complicated. But, it is not about the drug companies and doctors and pills that are considered solely responsible for the crisis—it is ultimately about people who are suffering and their families.
Common Questions About The Opioid Crisis
Opioids prescribed by doctors are normally used to treat pain. Some opioids are used for the treatment of cough and diarrhea also. Opioids are sometimes used for non-medical reasons as well, as they make people feel comfortable and relaxed.
The opioid crisis is linked to the misuse, abuse, and addiction of opioids. These opioids include heroin and synthetic opioids like fentanyl. This has become a major crisis in the United States, gravely affecting the health of the public and society.
According to a survey, 63% of people said that pharma companies were directly responsible for the opioid crisis. Doctors have also been blamed by a significant number of people for their part in the crisis. However, some people put the blame on the users.