How Opioids Became an American Epidemic

Science Features Opioids
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How Opioids Became an American Epidemic

Drug overdoses are on the rise and are now the leading cause of accidental deaths in the U.S., outnumbering car accidents by 150 percent and claiming more than 143 American lives a day.

A major driver behind this shocking trend is the dramatic increase in the use of heroin and other opioids, which currently account for 3 out of every 5 drug-related deaths. While heroin has reached nearly all demographics across the country, no one has been hit harder than millennials. In fact, heroin deaths among those aged 25-34 have quadrupled since 2010.

And don’t look to the big cities either. The highest rates of heroin overdoses are actually in small towns and suburban Middle America, in places like Ohio, Kentucky and West Virginia. Simply put, the U.S. is facing a major opioid epidemic.

What Is Heroin?
heroin vs morphine.jpg Image by Joel Rindelaub
Heroin is classified as an opioid, a class of drugs that are derived from the opium poppy. In addition to heroin, the opioid family includes many drugs prescribed in the U.S., such as OxyContin® (oxycodone) and Vicodin® (hydrocodone).

Chemically related, opioids have very similar effects on the body, leading to a powerful euphoria that can be used to treat excessive pain. Opioids are also depressants, meaning they slow down breathing and heart rates, which can lead to death at large enough doses (i.e., overdoses).

Despite its prevalence as a street drug, heroin does have uses in a clinical setting as it is essentially a more potent version of morphine.

Unfortunately, opioids are very addictive and have intense withdrawal symptoms, making it one of the most difficult drugs to kick.

active:lethal dose.jpg Image by Thundermaker, CC BY-SA 3.0

Additionally, since street heroin is manufactured in an unregulated environment, dangerous impurities mixed with the drug can lead to bacterial infections, poisoning and unforeseen overdoses. Sharing injection needles also poses the risk for hepatitis and HIV transmission.
Interestingly, administering the pure substance in a clinical setting is much safer as the long-term side effects are limited to addiction and constipation.

Behind Heroin Use: America and Its Painkillers
One major factor contributing to heroin use across the country is the skyrocketing number of opioid painkiller prescriptions.

Opioid painkiller prescriptions have nearly quadrupled in the U.S. since 1999, with more than 300 million prescriptions in 2015. That’s enough for every adult in America to have their own bottle of pills.

With a seemingly insatiable appetite for opioids, the U.S. consumes 80 percent of the world’s painkillers, including 83 percent of all oxycodone and 99 percent of all hydrocodone. Fourteen states even have more painkiller prescriptions than residents.

High use of opioids, even as prescribed, puts people at high risk for addiction. This is especially true for young users, as high schoolers who have used prescribed painkillers are 33 percent more likely to encounter opioid addiction after graduation.

od deaths :year by drug.jpg Image by Joel Rindelaub. Data via the Centers for Disease Control and Prevention.

And, since prescription opioids and heroin are so similar, many addicts turn to the street drug when they run out of money for pills because heroin is more available, easier to abuse, and much less expensive. A bag of heroin can actually costs less than a pack of cigarettes in some states.

In all, over 80 percent of all heroin users started on opioid pain relievers.

The Push from Big Pharma
While there are several factors behind the increase in opioid prescriptions, perhaps the deepest impact has come from the pharmaceutical industry.

Using aggressive sales techniques that mirror the lobbying industry of the political sphere, which includes expensive perks and kickbacks in some cases, pharmaceutical companies have successfully reached prescribing doctors and have banked billions of dollars along the way.

Instead of using a multidisciplinary approach to treating pain through promotion of a healthy lifestyle, psychological evaluations and therapy, doctors are now urged to solely prescribe opioids.

Insurance companies are also on board with this methodology because opioids are seen as a cheaper, quicker and easier solution for pain treatment.

img 4 opiods.jpg Photo by Elizabeth Roy, CC BY-SA 3.0

While the increase in pharmaceutical sales in itself isn’t necessarily detrimental to medicine, the way Big Pharma did it was reprehensible.

Pharmaceutical companies used their strong influence to push inaccurate information regarding their products. The most damaging falsehood preached was that opioid painkillers were not very addictive.

That’s right: drugs in the same class as heroin were being sold as addiction-proof alternatives for pain.

This, of course, was not backed by any peer-reviewed scientific literature, and the pharmaceutical companies knew it. Eventually, so did the rest of the U.S. as major drug companies, such as Purdue Pharma and Pfizer, pleaded guilty to “misbranding” their products, receiving record fines.
But, alas, the damage has already been done. Addiction has moved into pharmacies everywhere and found homes with a new generation.

Despite the dangers, there are still many appropriate uses for opioids, thus eradicating them is not the answer. But America does need to rethink how pain is handled and create treatments that do not depend so heavily on opioid pills.

Because—in the end—an opioid is an opioid, whether you get it from a doctor or a dealer.

Main photo by obviously_c, CC BY-SA 2.0. Lead photo by Sam Metsfan.


Joel Rindelaub is an active scientific researcher and Ph.D. chemist based in Minnesota.

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