The Opioid Crisis. How Did We Get Here?


By: Mallory Stufsky, Substance Abuse Navigator

When you hear "poppy flower," you probably have memories of 'The Wizard of Oz,' and Dorothy being carried out of the poppy field by her new friends. Although beautiful, poppy flowers were first discovered to have euphoric, potentially dangerous, effects when crushed and mixed with water. We do not know who the first person was to discover this, but there is indication that the poppy plant dates back 6,000 years.

In Modern-day America, derivatives of the plant, such as opium, heroin, morphine, and other synthetic opioids, like fentanyl, are impacting more than 2 million Americans with a substance use disorder and overdoses. The Drug Policy Alliance states, "More Americans died from a drug overdose in 2017 alone than died in the entire Vietnam War." Unfortunately, our society has stigmatized substance use and addiction, becoming numb to these increasing numbers of preventable deaths.

We have to ask ourselves, "How did we get here – into a 'crisis' with opioids?" While discussing addiction, we have to recognize the stigmatizing language that is used, such as "lazy, stupid, worthless," understanding that most people are none of these things, that these powerful drugs actually change the chemical makeup of one's brain.

We also forget to discuss why some start using substances in the first place, such as anxiety, depression, and trauma – a means to an end of ongoing pain.

In an article published in New York Magazine, Andrew Sullivan writes, "it can easily become a lifelong entanglement for anyone it seduces, a love affair in which the passion is more powerful than ever the fear of extinction." 

This article makes mention of the constant search to feel numb from pain and sadness, walking through life "like drunk ghosts." It is often seen that someone revived from an overdose often hates the EMS worker who saves them with Naloxone (Narcan) for "ruining their high," not realizing that the alternative, dying, may not be the route they actually want to take.

Sullivan notes that, "the United States consumes 99 percent of the world's hydrocodone and 81 percent of its oxycodone, estimating using 30 times more opioids than is medically necessary." The use of these drugs dates back to The War of Independence (1775 –1783) to assist with wounded soldiers on the battlefield. The poppy plant was used through the 19th century to assist with stomach ailments such as diarrhea or any other pain, only increasing further in use during the Civil War. 

During the Civil War, it was reported that "10 million opium pills and 2 million ounces of opiates…were distributed" leaving veterans addicted, later known as "Solder's Disease."

Medical professionals throughout the centuries have made attempts to transform opium into a pain reliever without its addictive properties, later known as morphine and heroin. During the 1990's, OxyContin was developed in hopes to remove cravings and addiction, based on a single study with a small collection of subjects. This made it easier for individuals to obtain opioids, as in earlier years, there was no direct streamline to a doctor with a script. As years passed, doctors and medical professionals understood the larger scope of the addictive properties of prescription opioids. Due to the increase in overdose deaths caused by prescription pills, "between 2010 and 2015, opioid prescriptions declined by 18 percent." Well-intended by medical professionals, but harmful to the addict, opioid-seeking individuals to turn to street drugs such as black-market pills and heroin ("the first opioid of the streets").

First developed in 1959, and still widely used today, Fentanyl was used for pain relief through lozenges or transdermal patches. Fentanyl, having a concentration with 50 times the strength of heroin, "is one of the most dangerous drugs ever created" in its raw form. In 2018, a shipment of fentanyl was seized in New Jersey, containing enough poison to kill the combined populations of NJ and NYC, fitting only into the trunk of a car. As Sullivan states, "that's more potential death than…a small nuke." Fentanyl slows the respiratory system, suffocating users while falling asleep. What makes fentanyl so dangerous, besides its potency, is the difficulty keeping it out of the United States due to its small size and ability to be transported through the regular postal service.

In order to reduce stigma, minimize overdoses, and save lives, supervised injection sites have been established, intended to eventually assist users off drugs while linking to resources such as counseling, vocational training, and housing. Research shows that "deaths from heroin overdoses plunged by 35 percent" after the first injection site opened in Vancouver. In order to utilize these services in the United States, we would have to be ready to shift focus to rehabilitation, and away from criminalization and incarceration, which the U.S. doesn't appear ready to do on a larger scale.

Andrew Sullivan says it best when he writes, "Until we resolve these deeper social, cultural, and psychological problems…poppy will flourish."

Photo by Matthew T Rader on Unsplash

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Thursday, 28 May 2020

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