The United States is in the middle of an opioid crisis that has killed hundreds of thousands of Americans.
The first wave in the modern opioid epidemic began in the 1990s because of an increased amount of opioid prescriptions, but the opioid epidemic is not new.
“We talk about the opioid crisis all the time, but in reality, we’re in the midst of a drug epidemic that’s been going on for decades,” Community Medical Services CEO Nicholas Stavros said. “We’re in the midst of this drug crisis, it happens to be opioids, but the root cause of all of this is actually, I think, something very deep.”
The history of opioid addiction
Opium has been used in medical and recreational drugs since ancient times.
In the early 1800s, a German pharmacist named Friedrich Wilhelm Adam Serturner was the first to successfully isolate and extract “alkaloid” from tarry poppy seed juice.
He named the chemical morphine after the Greek God of Dreams, Morpheus.
After decades of an opium war between European powers and China, the Chinese brought the opium habit with them to California during the 1849 Gold Rush, according to History.com.
On the other side of the country, the Civil War broke out and the country imported morphine for wounded soldiers.
An estimated 400,000 soldiers became addicted and stayed addicted after the end of the war. However, moving farther into the 19th Century, women began to make up the majority of morphine addictions.
“So if you were a white woman who could afford prescription drugs and you went to the doctor for, say, a cough or menstrual cramps, you were way more likely to leave with a prescription for morphine than anyone else,” NPR co-host and producer of Throughline Rund Abdelfatah said in a podcast. “One doctor, Frederick Heman Hubbard, wrote in 1881, uterine and ovarian complications cause more ladies to fall into the opium habit than all other diseases combined.”
In the 1890s, heroin as a morphine substitute started being used in medicine. In fact, German pharmaceutical company Bayer started using heroin as a cough suppressant for children suffering from coughs and colds.
“This is not a new problem,” Dignity Health’s Arizona General Hospital Chief Medical Officer Frederick Johnson, M.D., said. “In 1896 or 98 it was legal to give heroin… how long do you think it took to eliminate heroin as a pharmaceutical agent? 25 years. Almost 100 years later…we get back to the same problem, the cycle repeats itself over again.”
The modern opioid crisis
According to the Centers for Disease Control and Prevention (CDC), the current opioid crisis began in the 1990s when overdose deaths involving prescription opioids increased; the second wave began in 2010 when there was a rapid increase in overdose deaths involving heroin; and the third wave began in 2013 with significant increases in overdose deaths involving synthetic opioids like fentanyl.
“Fentanyl, you see that 50 to 100 times more potent than the other medications. It’s synthetic and it’s been causing more problems on the streets than just about everything else,” Destiny Springs Healthcare founder Martin Newman, M.D., said. “You take that, and you start combining it with other drugs, other medications… and now things get really dicey for patients because the combinations of these medications actually cause death.”
Between 1999 and 2017, more than 700,000 people died from a drug overdose, almost 400,000 of those involved opioids.
In Arizona, a suspected 3,585 people have died from opioids since June 2017.
While the nation and states are starting to take action on the issue, research shows the opioid epidemic is far from over.
“All of the research tells us that the opioid crisis is going to get much worse, despite everything you’ve seen,” Stavros said. “That’s in spite of everything we’ve seen on the news and the billions of dollars that have been allocated to this. The analysis said that the recent interventions will have about a three percent impact on the crisis. There’s still so much that has to be done.”
According to the American Academy of Family Physicians (AAFP), if there is no change in the current scenario, the number of opioid overdose deaths will hit a high of nearly 82,000 by 2025 — that means more than 700,000 people will die between 2015 and 2025.
However, AAFP estimates that if prescription opioid misuses continue to decrease at a rate of 7.5 percent per year, the number of overdose deaths would peak at 75,400 in 2022 and remain around there afterward — this would mean a total of 674,000 opioid deaths between 2016 and 2025.
Either way, the number has yet to peak.
The opioid crisis’ cause
According to Maryville University, the confusion around opioid addictive qualities might stem back to the 1980s when two Boston University professors published a letter claiming addiction from narcotics was rare in patients, the letter was cited by Purdue as well as researchers and physicians.
Doctors started prescribing more opioids in the early 1990s and by 2012 there were more than two and a half times more opioid prescriptions than there were in 1992. This number decreased between 2013 and 2017, but during that time synthetic opioids began to skyrocket.
Early in the crisis “people [were] put into positions, especially physicians, that say listen you need to keep the patients happy. Just keep them happy. Write what you need to write,” Newman said.
But now, “the amount of prescriptions are handled by a very small amount of physicians. It’s really interesting. 85 percent of the prescriptions are written by about 20 percent of the physicians,” he added.
Newman, Stavros and Johnson all agree that the underlying problem with the opioid crisis — and any drug crisis — is the lack of understanding around addiction.
“Addiction’s an extremely complex problem and a lot of people have a lot of different addictions for a lot of different reasons… People still thinking it’s a moral failure that led to someone’s addiction in the first place and even how we treat addiction, how we treat people suffering,” Stavros said.
According to Stavros, dealing with trauma, especially in childhood, is the biggest component to addiction.
“Us as a society don’t actually do a great job of coping. We don’t have a lot of coping mechanisms,” he said explaining how his daughter’s hamster had recently died and his first thought was just to replace it, shielding her from the pain associated with death.
“In reality, that’s not teaching a kid coping skills, so we didn’t buy the hamster and we said, ‘hey this is okay, animals die. It’s okay to be sad.’ And our society doesn’t do that, it’s always a quick fix,” he said.
Stavros added that pain is the number one thing that gets someone addicted to an opioid. Most people addicted first used prescribed opioids from a doctor.
Opioid users develop a tolerance, and this means that although the recommended dosage may continue to kill pain it will not trigger the same dopamine release and therefore there will not be an increase in pleasure to the brain. An increase in dosage is then needed to experience pleasure.
It becomes especially dangerous when mixed with other drugs and medications.
“[People] need to be educated on the fact that multi substance abuse issues need to be addressed as well because of the compounding of these drugs and medications actually cause serious issues,” Newman said. “Taking opioids is an issue in and of itself but when you start compounding it with other things, your risk for death goes through the roof.”
Fixing the problem
There is no one way to solve the epidemic, but state and federal governments are working on addressing the issue.
In Oct. 2017, President Donald Trump declared the opioid crisis a public health emergency and his administration has applied an “all-of-government approach” through a range of actions.
Arizona Governor Doug Ducey has also championed solutions to the opioid epidemic through his 2018 Arizona Opioid Epidemic Act that took steps to prevent and address opioid use disorder, hold bad actors accountable, expand access treatment and provide life-saving resources to first responders and community partners.
According to Newman, both the state and federal governments are spending most of their budget on rehabilitation rather than prevention.
“They’ll spend 98 percent of their budget for rehabilitation and two percent for prevention… So, most of it is geared towards rehabilitation and solving a problem after the water’s already passed a dam, but they’re not doing enough to keep it dammed up and for prevention,” he said.
The main solution for a lot of government entities and organizations is reducing the number of drugs that are available from a medical standpoint, according to Johnson that is the wrong way of addressing it.
“The current proposals for treatment are probably going to make the problem worse,” he said. “We have a demand problem. They’re treating it with a supply-side solution. We’re going to restrict prescribing, we’re going to make sure you don’t get it but it’s still not doing anything for demand, so they find alternative ways to satisfy it, oftentimes illegally, dangerous so forth and so on.”
“Cracking down on prescribing actually leads to higher overdose death rates, yet governments are constantly doing it,” Stavros said. “Then their doctor cuts them off and they turn to heroin on the streets.”
All the doctors also agreed on the fact that the main way to reduce the problem would be keeping individuals opioid naïve.
“A significant portion of resources should be devoted to prevention and the easiest target is to identify those people who are opioid-naive and keep them that way,” Johnson said. “Closeout the pipeline…So many people want instant solutions, but you got to close down the pipeline.”
For more information on Newman and Destiny Spring Healthcare, click here.
For more information on Johnson and Arizona General Hospital, click here.
For more information on Stavros and Community Medical Services, click here.