A Series on Opioid Abuse: The Beginning
In 2017, the U.S. Department of Health and Human Services announced that the public was facing an opioid crisis. Opioids are a class of drugs that include the illegal drug heroin and synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. These drugs induce euphoric feelings, along with reducing pain, which is why most people become addicted. The National Center for Health Statistics reported that in 2018 two million Americans live with an opioid condition, and 46,802 died as a result. Another report in 2020 stated that 10.6 million Americans misused opioids, and 1.6 million of those suffered an opioid disorder. Most opioid consumers suffer from chronic pain and are prescribed opioids as treatment for the pain. The problem with frequent prescriptions is that opioids are known to hijack the brain's receptors causing addiction and withdrawal symptoms after a few weeks of use. The sudden onset addiction to opioids has labeled them as ferociously addictive. It is safe to conclude that the opioid crisis has mercilessly attacked American life.
Pain management has long been one of the most difficult aspects of medicine. Under-treating pain can lead to frustration and poor quality of life in patients, and overprescribing can lead to drug abuse. Historically speaking, opioids have been an addictive drug since they were discovered. Opioids first made an appearance in 1803 when Friedrich Serturner, a German Pharmacist, derived morphine from opium. Following morphine’s derivation, the drug was commercially produced and hypodermic needles were produced to inject morphine into patients. In 1877, Eduard Livenstein, a German physician, described morphine addiction as a morbid craving. He was even able to detail the withdrawal and relapse stage, which he considered a physiological response. As scientists continued to research new drugs to kill pain, it became obvious that a drug was needed to reverse the effects of the opioids after an overdose. In 1961, a drug labeled Naloxone (Narcan) was created to reverse the effects of a drug overdose. Much of the research that was done included several attempts to control the distribution and use of opioids. Opioid therapy programs were also researched with little success. It was determined that the recognition of pain as a debilitating and destructive disease was reason enough that opioids were essential for the treatment of many forms of acute and chronic pain. Still, many physicians avoided treatment with opioids due to the conceptions of addiction and abuse.
Due to the inhibiting nature of opioids, many physicians shied away from prescribing them. In the late 1990s, pharmaceutical producers ensured doctors that patients would not become addicted to opioids. Physicians quickly began prescribing opioids at higher rates, especially to cancer patients and patients recovering from surgery. Thus began the first wave of addiction for many Americans. From 1990 until 1995, there was an increase in 2 to 3 million opioid prescriptions yearly. In 1995, Perdue Pharma developed Oxycontin and claimed that the drug was safe for non-cancer pain management. Physicians began prescribing Oxycontin for long-term pain management for ailments such as arthritis. Between 1999 and 2016, more than 630,000 persons in the United States died from drug overdoses—most of these drug-related deaths were due to opioids prescribed for pain.
In 2018, the National Institute on Drug Abuse partnered with the National Institute of Health to launch HEAL (Helping to End Addiction Long Term). This program offers treatment strategies for pain and opioid use disorders and continuing research in underdeveloped areas of treatment. The HEAL program is a broad-spectrum response to several groups of patients who use opioids either as part of their daily medication routines or who suffer from opioid use disorder. HEAL has identified 26 areas of research that they plan to focus their investments on. Each area is broken down into areas of opportunity to expedite the research and produce faster results. Even though HEAL plans to expedite these areas of research, they still expect the research to take anywhere from 3-5 years. This timeframe leaves a large gap between opioid users and the end of their addictions.
Some researchers have been able to identify possible short-term solutions for replacing opioids. Dr. Trabulsi, a urologist from Pennsylvania, began operating without opioids about a decade ago. Following a recommendation from a colleague, Dr. Trabulsi began using a TLC cocktail on his surgery patients. The "cocktail" consists of Tylenol (paracetamol), Lyrica (pregabalin), and Celebrex (celecoxib). When combined these drugs can ease nerve pain and provide anti-inflammatory responses. This combination of drugs has cut the request for opioids in half says Dr. Trabulsi. Alternatively, cannabis has been studied for opioid replacement. Cannabis has recently gained a large following from many people across the U.S. as it can be used to treat a variety of ailments with little to no side effects. Cannabis has been used for several years to treat chronic pain similar to opioids but without the extra side effects and risk of relentless addiction. There is a lot of research left to do on these solutions before they are considered treatments or replacements for opioids. Pain management has many obstacles to cross before the public can see the end of opioid abuse, but it is important to know that researchers and physicians are searching for the answers until then. Patients can help by following their doctor's directions after a prescription.
Opioids have been around since 1803 and even then were causing "morbid" addictions.
For several years physicians didn't prescribe opioids because of the addictive nature of the drugs.
In the 1990s, Perdue Pharma falsely claimed that their opioids were not addictive, this led to physicians prescribing the drugs regularly to patients with chronic pain.
Since then, scientists have been searching for ways to avoid using opioids. Some of the research has involved using cannabis as a substitute.
If anyone is battling opioid addiction please call: SAMHSA’s National Helpline: 1-800-662-HELP (4357)