The opioid epidemic we face now is not unfamiliar. For over a century it’s plagued communities, touching all walks of life and seemingly leaving no demographic unaffected. Pinpointing the root cause of the epidemic of opioid addiction isn’t a simple task since an “epidemic” is defined as any sudden increase in the number of cases beyond a normal range, which can occur at any given time. There have been several spikes in the abuse of opioids, which have resulted in numerous deaths, but the current opioid epidemic is unprecedented.
During the Civil War, morphine was readily available on the battlefield, with soldiers carrying doses on their persons and doctors administering the drug to injured soldiers. From this practice thousands of soldiers became addicted to the drug and continued using it after the war ended. During this time, an addiction to morphine took on the nickname “Soldier’s Disease,” and marked what could be considered the nation’s first recorded opioid epidemic.
Heroin came on the scene in November 1898, when German-based Bayer Co. began to widely produce and commercialize the drug for the general public under the guise that it was safer than morphine. Employees of Bayer Co. first tested the drug and spoke of feeling “heroic,” which led the inventor of the drug, Heinrich Dreser, to name the new substance heroin. Though Dreser, employed by Bayer Co. made heroin a household staple, heroin (diacetylmorphine) was first invented by Charles Romley Wright, an English chemist, in 1874. At that time, the main goal was to create a substitute for the highly addictive painkiller morphine. Bayer Co. claimed their new drug, heroin, was non-habit-forming. The Boston Medical and Surgical Journal backed up Bayer’s claims in 1900, stating heroin “possesses many advantages over morphine. It’s not hypnotic, and there’s no danger of acquiring a habit.”
Bayer Co. sent flyers to physicians claiming heroin was the miracle remedy for an array of ailments: from aches and pains, to sleeplessness, coughs, colds and anxiety. With pneumonia and tuberculosis as the top two leading causes of death at the time, heroin was marketed as a cough medicine that Bayer Co. claimed was ten times more effective than codeine, with only a tenth of the toxic effects.
Heroin was available by prescription, and for a short time could even be delivered straight to your door. For the cost of just $1.50, the Sears & Roebuck catalog advertised two needles and two vials of Bayer heroin in a fancy carrying case.
Obtaining the drugs was simple for a while, but between 1899 and 1905, after the publication of no fewer than 180 clinical trials on heroin, the drug’s addictive properties could no longer be ignored. And by 1924 the newly emerging FDA banned the drug, allowing its use only in very rare medical circumstances.
By 1970, with heroin now banned, President Richard Nixon signed the Comprehensive Drug Abuse Prevention and Control Act, shifting attention to highly addictive prescription opiates and focusing less on cocaine and marijuana enforcement. Doctors began to drastically scale back the number of opioid prescriptions they were willing to write to treat patients experiencing pain, and the number of opioid-related deaths dropped drastically.
During the ‘70s and ‘80s, after watching chronic pain patients and individuals with horrific injuries suffer, doctors began to have a change of heart and birthed the solution of long-term opioid therapy. In the late 1970s, researchers from Boston Medical Center analyzed 11,822 patients who had received narcotics during their hospital stay and found only 4 of those patients showed “reasonably well documented” symptoms of addiction. In 1980, Dr. Hershel Jick and Jane Porter penned a letter to the editor in the New England Journal of Medicine that included their analysis of the study, writing, “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.” Jick later stated their letter did not include chronic pain patients who regularly took opiates. Jick and Porter’s letter was considered a go-to resource for advocates of patients seeking long-term pain management, allowing them to claim less than 1% of patients treated with opioids became addicted. To date, the letter has been cited more than 900 times in different case studies on the addictive properties of opiates.
In the early ‘90s, physicians began using the pain scale chart to help assess patients’ pain levels. Prescriptions for opiates increased by 2 to 3 million each year. Pharmaceutical companies began to supply doctors with pain medication that, due to the addictive properties in the drugs, literally sold itself. Misleading marketing campaigns were quickly developed and subsequently peddled by drug companies to doctors, which commenced the capitalization on compassion.
By 1996, the American Pain Society claimed pain would be treated more effectively if it were considered “the fifth vital sign,” and by the year 2000, the Veteran Health Administration recognized pain as the fifth vital sign and added it to their national pain management strategy.
In 1998, Purdue Pharma released over 15,000 copies of a promotional video called “I Got My Life Back,” which stated OxyContin was harmless and non-addictive. The year after this ad ran, prescriptions for opioid painkillers jumped from 2-3 million to over 11 million. Millions upon millions of dollars went from pharmaceutical companies to the American Pain Foundation, which produced dozens of pamphlets promoting the misleading benefits of opioid treatment. Purdue also spent over $207 million to market OxyContin to doctor they’d concluded, via a database, were likely to prescribe pain relief medications to patients. In addition, sales representatives received substantial bonuses when doctors in their assigned territories reached large numbers of prescriptions. Purdue’s marketing campaign also included t-shirts, hats, and even toys adorned with the OxyContin logo, while their conferences continued to promote the out-of-date 1980 case study results, ignoring newer case studies that showed opiates to be highly addictive.
By the 2000s, lawsuits began to spring up from patients claiming they had become addicted to OxyContin, not by abusing the medication, but by taking their recommended dosage. Purdue defended the drug and claimed it was less addictive because of its 12-hour dosing schedule, and therefore harder to abuse. But doctors were prescribing OxyContin every 8 hours, not 12. Sales representatives for Purdue recommended the solution of increasing the milligram dosage rather than the frequency, which, of course, increased sales dramatically. This also increased the potency of the drug patients were now being prescribed, as well as their dependency and tolerance. More and more pain patients who were prescribed opiates were not only addicted but were having to take larger doses of the medication than they were originally prescribed just to maintain an ever-growing tolerance. This led to patients running out of their prescriptions, which immediately sent them into opiate withdrawal. This created an entirely different problem. The symptoms of opiate withdrawal can include sweating, nausea, diarrhea, anxiety, depression, insomnia, tremors, and increased heart rate. In order to combat these withdrawal symptoms, many patients who were originally prescribed opiates by their doctor began to seek heroin and other opiates from the street just to stay “well” and avoid withdrawal until they were able to obtain their next round of prescriptions. Heroin is much cheaper and can be obtained without a prescription. The CDC reports that 75% of those who currently use heroin were first prescribed opiates by their doctors.
Though the opioid epidemic we currently face is not new, it is the worst we’ve encountered thus far. By 2008, opiate-related fatalities surpassed those of traffic accidents as the leading cause of death in 30 states nationwide, with opioids involved in over 40% of drug-related deaths that year alone. According to the CDC, opioids were involved in over 63% of drug overdose deaths in 2015, and 66% in 2016.
The opioid epidemic we currently face was carefully manufactured and backed by “big pharma,” costing countless lives. As we continue to look for solutions, new prescriptions are being written daily and fentanyl-laced heroin is crossing over our border. The new administration, which has shone a light on the state of the epidemic in our country, is taking steps to combat the current crisis. In 2016, Congress passed the 21st Century Cures Act, which included $1 billion to help fight opioid addiction in 2017 and 2018. Two months later, President Trump signed an executive order that officially declared the opioid epidemic a national emergency, cracked down on fentanyl trafficking, and expanded access to lifesaving Naloxone. These are just the first few steps in what will surely be a long journey, but one that must be traveled in order to heal our nation and prevent this epidemic from expanding any further.