The first opioid epidemic in the United States came after the Civil War (1861-1865). This problem was caused, in part, by the administration of morphine to soldiers for their pain and injuries. The civil war ended, but the morphine habit has persisted.
Today, America is in the midst of another opioid nightmare. Six out of ten overdose deaths involve an opioid. According to Tom Price, MD, U.S. Secretary of Health and Human Services, “The numbers are absolutely daunting — 52,000 overdose deaths in 2015; 33,000 of those approximately related to opioids. The numbers in 2016 are no better, and the numbers in 2017 are even worse than 2016.”
A few years ago, Jack was an honor student and star linebacker on his H.S. School’s football team. He looked forward to college and football. While in his senior year in H.S., he tore his right ACL and missed the rest of the football season. The surgery was successful but the post-operative care was a disaster.
Hydrocodone (Vicodin)
His surgeon prescribed hydrocodone (Vicodin) for his pain. When Jack complained of pain, his doctor prescribed Vicodin. One Vicodin ‘high’ lead to another.
His parents notice that he wasn’t participating in school activities and his grades suffered. His dream of playing football was shattered and he wasn’t interested in going to college.
After H.S. graduation, he started using heroin because it was cheaper. In and out of rehab, the only thing that was progressing was his deterioration. Jack’s supportive family was devastated and his future was in shambles
People with an addiction problem have been derided as junkies, druggies, dope fiends and worse. However, Psychiatrist Andrew Kolodny cautions, “Don’t blame opioid-addicted people for America’s opioid crisis. The real culprits are the rapacious Pharma companies, politicians who colluded with them and regulations who approved one opioid pill after another.”
Others have characterized the opioid epidemic this way — Drug companies are the suppliers, the doctors are the pushers and the government is the enabler. The root problem is not the person with addiction on a street corner but with the above trifecta.
Opioids
Opioids are narcotics often prescribed by doctors to relieve severe pain. They can be naturally produced by the body, (endorphins), come from the environment (poppy plants) or made in the laboratory (synthetic).
Common types of opioids are codeine, hydrocodone (Vicodin), oxycodone (OxyContin), morphine and methadone. Heroin is an illegal opioid and Fentanyl a synthetic (man-made) opioid,
Opium may the oldest drug on record. Sumerians before 4000 BC knew about the white liquid of the poppy plants. Heroin and morphine come from poppy plants.
In 1803, Serturner isolated morphine from opium and it became the most important 19th century drug in the doctor’s bag. It was used according to Walter Way, MD ‘for anxiety, cough, diarrhea and insomnia. Morphine was praised by Sir William Osler as “God’s own Medicine.”
How Do Opioids Work
The body cannot produce enough natural endorphins to cause an overdose or to stop severe or chronic pain.
The opioid system is involved with pleasure-reward, relief of pain and addictive behaviors. Specialized opioid receptors, part of the nerve cells, are located in the brain, spinal cord and the G.I. tract. These tiny receptors that sound like the name of a college society are called delta, kappa mu. They help control the level of dopamine in the system.
Dopamine is a chemical that acts as a messenger (neurotransmitter) carrying information from one brain cell to another.
Edges of two brain cells: Orange stars show dopamine leaving one cell and attaching itself to the receptors (blue) of a neighboring cell.
National Institute on Drug Abuse
Opioids, whether internally or externally produced, bind to the above mentioned receptors. They reach the brain by way of both pain and pleasure pathways and unleashed dopamine into the system.
Opioids decrease the feelings of pain. They can create feelings of pleasure and relaxation. They can slow breathing and stop coughing. They can cause overdose deaths.
Drug Overdose Deaths in the United States Continue to Increase 2015
“I Want to But I Can’t Stop”
”Drug addiction is a disease of the human brain” writes Nora Volkow, MD Director of the National Institute of Drug Abuse. It’s an evil dragon that overwhelms the psyche of its subjects. It’s like a car moving 50 miles per hour going straight downhill with no brakes. “No matter how much you want to stop, you will not be able to do it.”
The brain has been rewired and the frontal area of the brain that regulates self -control has been compromised. People with addiction want to stop. They try to stop and fail. They try once more, fail again. “No brakes!”
But there’s hope. Pharma, doctors and government are making efforts to provide and coordinate their research, resources and education to quell the current drug epidemic.
The next time we see a person standing on the street corner consider how he got started using drugs and why he is still using them. It might have been the result of a devastating trifecta. Hopefully, things will soon change and change for the better.
Glossary
The name morphine was proposed by Serturner after Morpheus, the Greek god of dreams.
Morphine was first totally synthesized in 1952 by Gates and Tschudi
References
Tom Price, MD, U.S. Secretary of Health and Human Services, August 7, 2017
Chris McGreal; Don’t blame addicts for America’s opioid crisis. the Guardian, August 13, 2017
Gary P. Guy Jr. PhD; Kun Zhang, PhD; CDC Vital Signs, Changes in Opioid Prescribing in the United States, 2996-2015 Weekly/July 7, 2017
AllGOV; U.S.; 5 % of World Population; 80% of Opioid Consumption; December 15, 2014
CDC Understanding the Epidemic Drug Overdose Deaths in the United States; December 16, 2016
Walter Way, MD and E. Leong Way; Opioid Analgesics and Antagonists; Basic and Clinical Pharmacology; Lange Medical Book, 1987
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.