An Overview of The Rise of The Opioid Epidemic

It seems that as long as mankind has been present on this earth, our species has sought various forms of escapism. A lot of the times, this need to escape manifests in the use of drugs. Whether it was marijuana and other hallucinogenic drugs of the 1960’s or the opium dens of the 1800’s, recreational drug use has been and most likely always will be a prominent part of human society. While some drugs, such as marijuana, can have mild effects that if used in moderation cause little to no damage, there are other drugs that can virtually kill an individual on the first use. Opioids are one such class of drugs that can have a myriad of negative consequences if abused over large periods of time. Even with the wealth of knowledge on opioid addiction and the various campaigns to minimize drug use, American’s are currently in the midst of an opioid epidemic that affects individuals from all walks of life. As a result of the current opioid crisis facing our society, this paper will attempt to exam the rise of this epidemic, the negative effects of repeated opioid abuse, and the difficulties of withdrawal.

The opioid crisis is a relatively recent development in society corresponding with the introduction of several opioids into the pharmaceutical market in the late 1990’s. During this time period, there was a large push from several interest groups such as The Joint Commission on The Accreditation of Healthcare Organization to remedy the under treatment of pain (Manchikanti et al., ES10). This groups as well as others aggressively lobbied for the use of large doses of opioids in non-cancer pain management. In combination with equally aggressive lobbying from pharmaceutical companies, medical boards eventually relaxed laws on opioid usage and several pharmaceutical brand opioids flooded the market. According to the article titled “Opioid Epidemic in the United States,” this relaxation of opioid laws was also based on weak evidence that “opioids are safe and highly effective in persons with non-cancer pain,” however, two decades later the truth of this is yet to be confirmed by research. Thus, opioids became more readily available without conclusive evidence that it would actually be helpful. Although opioids can take the form of several different types of drugs, the most common form of opioid abuse is with prescription pain killers. In a 2010 survey, researchers found that Hydrocodone was the number one prescribed drug at one hundred and thirty six million prescriptions with narcotic analgesics in total exceeding a sum of two hundred and thirty eight million prescriptions (Manchikanti et al., ES10). In this same survey, it was also discovered that the United States produces more than seventy five tons of oxycodone a year as compared to the eleven and a half tons that were produced in 1999 (Manchikanti et al., ES24). Unfortunately, of all the prescription pain killers that are being prescribed, the abusive way in which they are used stems mostly from people who have obtained these drugs illegally. In other research findings discussed in this same article, it was discovered that “among persons aged 12 or older in 2009-2010 who used pain relievers non-medically in the past 12 months, 55% of obtained pain relievers from a friend or relative for free” (Manchikanti et al., ES22). This accounts for the 22.6 million Americans who are designated as opioid abusers (Manchikanti et al., ES22). Given the relaxed laws that regulate opioid prescription and the frequency with which they fall into the hands of who were not prescribed them in the first place, one clearly sees how opioids went from a small issue to a large problem.

Opioids, although increasingly used casually and recreationally, have several adverse effects that can seriously deteriorate the quality of life for an individual. As with any other kind of drug addiction, opioid abuse affects the chemistry of your brain. In general, drugs work by “eliciting the same pleasure responses that eating, sleeping, and sex produce” (Raisch, Fye, and Boardman et al., 313). Opioid usage is no different and the repeated use of this drug causes one to have to take higher and higher doses to illicit this pleasurable response (Riasch et al., 313). More specifically, “opiates directly affect the mesolimbic reward system” (Kosten and George). This is the system that is responsible for the released of the pleasure chemical dopamine. Since dopamine is also released during activities such as eating, sleeping, and sex it becomes that much more difficult to override the brains attraction to drug use (Kosten and George). Since it is extremely difficult to break this habit, abuse can quickly turn into dependence give that “repeated exposure to opioid drugs induces the brain mechanisms of dependence” (Kosten and George). Once your brain has been chemically altered to believe that it needs opioids to survive, the negative effects of long term abuse become prevalent. Opioid abuse has a negative impact on almost all parts of the human body. As far as the respiratory system is concerned, opiate abuse can cause respiratory depression, a phenomenon that will slow your breathing and could result in death (The Effects of Opiates on your Body). As it pertains to opioid painkillers, the abuse of this can lead to nausea, vomiting, and constipation (The Effects of Opiates on your Body). Other negative effects of opioid abuse include psychomotor impairment, increased susceptibility to infection, and liver damage (The Effects of Opiates on your Body). Not only can opioid abuse create problems internally, there are several other problems that can arise due to needle sharing. This includes problems such as pain, HIV, hepatitis and other sexually transmitted diseases (Raisch et al., 315). In general, the cons of opioid use far outweigh the very few pros. In fact, “Opioids are shown to contribute to one death every 36 minutes in the United states in 2008” (Manchikanti ES15). Given the myriad of issues associated with opioid use, this statistic makes perfect sense.

Although opioid abuse is linked with an assortment of various life threating problems, there is one thing that seems worse to opioid abusers: withdrawal. Withdrawal in and of itself is a chemical ordeal that abusers must undergo in order to quit any kind of abusive habits, however withdrawal from drugs can be nearly excruciating. For most long term abusers, withdrawal is not an experience that can be survived without the use of counteractive drugs. There are several opioid replacement drugs that can aid this experience, the two most popular being methadone and buprenorphine (Raich et al., 313). Methadone is a “long-acting” opioid medication that helps to alleviate compulsive drug use (Kosten and George). Methadone also helps to regulate hormonal imbalances associated with abusive opioid use. It helps behaviorally as well and makes it so that abusers can focus on returning to normal activities such as cultivating relationships and holding jobs. According to “Chemistry for Changing times” methadone is also highly addictive, but if an abusers uses while on methadone it blocks the euphoric rush associated with that drug and thus reduces the temptation to use (Hill and McCreary 580). Most opioid abusers start on low levels of this medication increasing to the full dosage which completely eliminates opioid cravings. Research shows that relapse is less likely if long term abusers stay on this medication for at least 3 years (Kosten and George). Buprenorphine also works in the same manner as methadone in low dosage and due to its safety, is especially helpful for addicts who are experiencing several other health issues associated with opioid abuse (Kosten and George). Finally, there is the drug Naltrexone which acts to rapidly detoxify an individual. This drug works by occupying opioid receptors and disrupting the euphoria that is typically associated with drug use (Raisch et al., 316). Since this drug rapidly precipitates withdrawal, it is usually used after the detoxification process. While there are several chemical ways in which abusers may undergo detoxification, the relapse rate of detoxification as the sole means of withdrawal is high. Abusers must also deal with the underlying problems that instigated their abuse in the first place. There are various reasons why abusers initially turn to drugs. Some are simply predisposed to abuse if they have a history of alcohol abuse, depression, or other psychological issues (Manchikanti et al., ES12). These are issues that need to be addressed before rehabilitation can take place. Therefore, drug replacement therapy in combination with psychological therapy is the best way to successfully withdraw and ensure long term opioid avoidance. If an abusers successfully completes this process, there are several positive outcomes for them and for society. Rehabilitation results in reduced criminal activity, an improvement in employment ventures, and a decrease in high risk activities (Raisch et al., 314). Although a difficult process to endure mentally and physically, withdrawal is certainly worth it.

Opioid abuse seemingly has absolutely no positive outcomes. Although there was a large push in the late ‘90’s to promote large doses of opioid use, the research still remains inconclusive on whether or not opioids are actually helpful in this way. Yet and still, opioids continue to be produced in mass quantities by pharmaceutical companies and fall into the wrong hands. Regardless of all the negative health effects of opioid abuse, the epidemic is only growing and the death toll continues to climb. Thanks to chemistry however, there are a large range of drugs that can successfully aid in the process of withdrawal. This in combination with intense psychological therapy can help those who are trapped in the vicious cycle of opioid abuse. Hopefully in future years, law makers will re-strengthen their grip on opioid legislation and society can get a handle on this epidemic.