The opioid epidemic is making headlines in 2016 but this menace has been around for thousands of years, killing and receding, before coming to a head in our current era of pharmaceutical free-for-all. To understand a problem, you must know its history. Here’s how opioids evolved from ancient poppy farms in Mesopotamia, to labs in the United States, to the streets where it’s killing thousands today.
The Beginning of the Problem
The earliest reference to opium growth and use is from 3400 B.C. when the opium poppy was cultivated in lower Mesopotamia. The Sumerians referred to the opium poppy as “Hul Gil” – the “Joy Plant,” and would pass the plant and its euphoric effects onto the Assyrians, who in turn passed it on to the Egyptians. Limited use in both the east and west followed for centuries, giving rise to the opium dens that spread across the world in the 19th Century.
Opioids in America
Fast forward to the U.S. Civil War. Veterans with injuries were routinely treated with morphine and faced high rates of addiction. But “drugs were already on the scene and being consumed at alarming rates long before the start of the war,” according to Mark A. Quinones, who studies drug abuse during the Civil War. Even before chemists began really exploring the power of these drugs, they were already wreaking havoc on Americans.
In 1898, the Bayer Co. started the commercial production of heroin. Considered a “wonder drug” starting with its first clinical trials, it was soon discovered by addicts who injected it, magnifying the potency. Bayer continued to sell the drug through the 1910s.
In the early 1900s, the U.S. Saint James Society, a community group, began a campaign to supply free samples of heroin through the mail to morphine addicts who were trying to give up their habits. Drugs like heroin were used as cough suppressants and pain relievers when there were not many other options. This attempt to wean addicts off of morphine by using heroin would prove to be very misguided.
The First Shot in the Drug War
In 1909, Congress passed the Opium Exclusion Act barring importation of opium for the purposes of smoking. The Opium Exclusion Act is often considered the first act in the U.S. war on drugs. More laws followed In 1914 with the Harrison Narcotics Tax Act, which imposed a tax on those making, importing or selling any derivative of opium or coca leaves.
The Emergence of Synthetic Opioids
A few years after Bayer stopped the mass production of heroin due to hazardous use and dependence, German scientists at the University of Frankfurt first synthesized oxycodone in 1916 with the hope that it would retain the effects of morphine and heroin, but with less dependence.
By the 1920s, doctors were aware of the highly addictive nature of opioids and tried to avoid treating patients with them. Heroin became illegal in 1924. It made the importation, manufacture and possession of heroin illegal in the U.S. for any use, including making medicinal use illegal. During this time period mixed views on addiction and opiates existed in the medical community, with many physicians believing opiates served as an alcohol substitute for those dealing with an alcohol addiction.
In 1938, the Food and Drug Administration (FDA) was formed with The Food, Drug and Cosmetic Act giving it authority to oversee the safety of food, drugs and cosmetics, and drugs Many prescription medicines derived from opioids, including codeine, morphine and oxycodone, were still allowed to be used by physicians.
Opioids in Wartime
World War II was a turning point for physicians treating pain in severely injured soldiers. Anesthesiologists opened “nerve block clinics” in the 1950s and 1960s to manage pain with the goal of avoiding surgeries. The FDA approved Percodan®, combining oxycodone and aspirin tablets in 1950.
Applying the 12 Steps to Opioids
Narcotics Anonymous emerged from the Alcoholics Anonymous Program of the late 1940s as a 12-step program. In 1953 Narcotics Anonymous, originally called AA/NA, was founded in California by Jimmy Kinnon and others.
Vietnam and the Reintroduction of Heroin
Since the early 1960s, abuse of prescription opioids containing oxycodone has been a continuing problem in the U.S. The country saw a resurgence in illegal heroin smuggled in during the Vietnam War.
Further complicating the issue, in 1969 the World Health Organization (WHO) changed its position that the medical use of morphine always led to dependence stating that “tolerance and physical dependence did not in itself constitute ‘drug dependence,’ a diagnosis characterized by typical behaviors, including difficulty in controlling the assumption of drugs, compulsive use of the substance and inappropriate social behaviors.” Meaning that both heroin and morphine were back on the market.
The Creation of Drug Schedules and the Official War on Drugs
The 1970 U.S. Controlled Substances Act started the process of consolidating all of the regulated prescription narcotic/opioid drugs under existing federal law with five separate schedules. Schedules were based upon a few factors: the medicinal value, harmfulness and potential for abuse or addiction. Schedule I is reserved for the most dangerous drugs that are no longer allowed to be prescribed.
The “War on Drugs” is coined by former President Richard Nixon who, in 1973, proclaimed that “America has the largest number of heroin addicts of any nation in the world. Heroin addiction is the most difficult to control and the most socially destructive form of addiction in America today.”
Narcotics in the 80s
Vicodin®, the prescription that blends hydrocodone and acetaminophen was introduced to the U.S. in 1978 by German pharmaceutical company Knoll. It became available as a generic formulation in 1983, reducing its price. More and more doctors began to fear prescribing opioids in this period. In 1984, cocaine was reportedly used regularly by 4 to 5 million people compared to 500,000 Americans who were reported to be hooked on heroin. President Ronald Reagan and First Lady Nancy Reagan, asked Americans to join the national crusade “Just Say No to Drugs.”
The Prescription Epidemic Begins
During the 1990s, the prescription opioid landscape changed dramatically, with physicians prescribing opioids much more freely and new prescription drugs coming to the market. Extended release medicines like morphine, fentanyl, oxycodone, and hydromorphone were widely prescribed. In 1994, Purdue Pharma started testing OxyContin as a long-term painkiller. It went on the market in 1996. This period also included stepped-up big pharma marketing efforts to healthcare providers that continued through the 2000s. By 1999, an estimated 4 million people, about 2 percent of the population age 12 and older, were using prescription drugs non-medically. Of these, 2.6 million misused pain relievers, 1.3 million misused sedatives and tranquilizers, and 900,000 misused stimulants.
Opioid Abuse in the 21st Century
In the mid 2000s, a number of pharmaceutical companies began research efforts into formulations of pain medications that would be harder to abuse. Formulations of both extended-release and immediate-release opioids that contained some properties meant to deter abuse were approved by the FDA. None of those formulations prevented oral abuse, however.
At the same time, the field of pain management grew with backing of the Joint Commission, a nonprofit that sets standards and accredits hospitals and medical centers. Prescriptions for brands including OxyContin, Vicodin, Percocet and Lortab increased significantly in the early-to-mid 2000s, doubling between 1998 and 2008. By 2002, 6.2 million Americans were abusing prescription drugs, and emergency room visits resulting from the abuse of narcotic pain relievers had increased dramatically. The misuse and abuse of prescription painkillers was responsible for more than 730,000 emergency department visits in 2009, a number that nearly doubled in just five years.
In August 2010, the makers of OxyContin released a newly formulated version of the drug, one that they claimed had an “abuse deterrent.” They hoped to make make it more difficult to crush and abuse by snorting or injecting it. Abusers continued to abuse OxyContin or moved on to heroin, claiming that it is easier to use, more available and cheaper on the street.
Fast forward again to 2016 and scientists and the FDA and Centers for Disease Control (CDC) are studying the opioid abuse epidemic and are gathering data about long-term use of prescription opioids. “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently,” said CDC Director Dr. Tom Frieden, writing in March 2016 in the New England Journal of Medicine and releasing the following facts:
- Most trials have lasted six weeks or less, and the few that have been longer had “consistently poor results.” In fact, several studies have showed that use of opioids for chronic pain may actually worsen pain and functioning, possibly by increasing pain perception.
- Opioid dependence may be as high as 26% for patients using opioids for chronic non-cancer pain.
- One out of every 550 patients started on opioid therapy died of opioid-related causes a median of 2.6 years after their first opioid prescription.
At Infinite Recovery, our support families who are experiencing substance use issues is continuous. We specialize in treating opioid abuse and heroin abuse using our 8 Dimensions of Infinite Wellness. If you or someone you know needs help, our admissions team is available 24/7. Contact us online or by our confidential hotline at (844) 206-9063.