Opioid crisis. Heroin epidemic. However you refer to it, for more than a decade, we’ve been facing what many consider the greatest health crisis in history. And despite what a recent State of the Union address might have you think, we’re nowhere close to being out of the woods.
No matter which facts and statistics are weaponized or propagandized, most people still don’t fully grasp the severity of the issue. So to give you more insight into this disturbing situation, we’re going to take you on a little journey. Today, we’ll be giving you a brief history of the opioid epidemic, from sewn seeds to genesis, from crisis to full-blown epidemic, from cure to curse.
Prelude — 1880s to 1970s
For decades, substances derived from the opium poppy (called “opiates”) were thought to be as harmless as aspirin. In fact, from the late 1800s to the 1920s, heroin was the sort of over-the-counter medicine that your grandmother might’ve given you when you had the sniffles. But eventually, the addictive potential of these substances became more widely known, leading to the Anti-Heroin Act of 1924, which effectively banned the production, importation, and sale of opiates like heroin.
The Anti-Heroin Act did exactly what it was meant to do, which was to keep opioids out of Americans’ hands. It also pushed the pharmaceutical community to begin looking at alternatives to opiates and to experiment with synthetic opiates.
Among the general populace, the Anti-Heroin Act sparked a growing fear of essentially all mind-altering substances classified as illicit drugs. This was reinforced by a string of public service announcements that were designed to spread anti-drug sentiment. So when recreational opioid use did begin to reemerge, it was at a minimal scale.
Musicians were the first to really get an affinity for heroin, which was particularly favored by jazz musicians starting in the 1950s. Although this trend was common knowledge, it wasn’t widely reported on, especially with the ramp-up of the counterculture movement of the 1960s. At the time, marijuana and psychedelics had everyone’s attention.
One major turning point for opioid addiction was the PBS interview with Dr. Robert DuPont, an American psychiatrist doing pioneering research on addiction and recovery. In the interview, DuPont revealed that 40 percent of males admitted to prison tested positive for heroin. This was the first wakeup call for Americans, indicating that opioid use was actually becoming a problem without anyone even realizing it.
Another turning point was the first high-profile death related to recreational opioid use; at the age of 27, Janis Joplin suffered a fatal heroin overdose in October of 1970.
We also found many American soldiers to be returning home from the Vietnam War with addictions to heroin, resulting from having spent many years in a part of the world where heroin was readily available.
By the time the first modern painkillers — Vicodin and Percocet — entered the market in the early 1970s, we were seeing an average of 1.5 opioid deaths per 100,000 people, which was enough for the Nixon administration to declare drug abuse as “public enemy number one.”
Ignition — 1980s to 1990s
Americans were quite apprehensive of opioids by the early 1980s. Even doctors and prescribers were reluctant to prescribe them because of their addictive potential. However, a letter published in The New England Journal of Medicine made the (very inaccurate) assertion that narcotics aren’t addictive when used only in therapeutic applications. This letter may have been what set the opioid epidemic in motion.
Overall, heroin and opioid use had faded since the 1970s. In the 1980s, it was cocaine — and then crack cocaine — that had everyone’s attention, largely due to its associations with violent crime and urban blight. At the time, large quantities of crack cocaine were being funneled into the US through Cuba and Florida, prompting Vice President George H.W. Bush to finalize Nixon’s War on Drugs in 1982. In an effort to deter participation in drug use and trade, the War on Drugs increased penalties for drug-related crimes and remained the government’s primary strategy for almost three decades.
Between crack cocaine and the HIV/AIDS crisis, opioid abuse seemed negligible and, as a result, was easily overlooked.
OxyContin and the Painkiller Blitz
The use of crack cocaine declined by the early 1990s, largely because of its effects on families and communities. With anti-drug sentiment on the rise once again, this created a window of opportunity for oxycodone to really go mainstream.
Oxycodone had been in the United States since 1939, but it wasn’t widely used until its most well-known form — OxyContin — was released in 1996. Made by prominent pharmaceutical company Purdue Pharma, OxyContine was an extremely potent form of oxycodone that was made specifically for the management of severe and chronic pain.
Upon the release of the drug, Purdue marketed OxyContin very aggressively, emphasizing a low potential for abuse and addiction. The pharmaceutical company launched the “Partners Against Pain” initiative, which marked the beginning of a shift in attitudes toward pain management. Similarly, the American Pain Society was promoting “pain as the fifth vital sign,” further pushing healthcare providers to be more diligent about alleviating pain.
Purdue offered rewards and incentives for prescribing OxyContin, which quickly made the drug a top-seller. Purdue’s marketing campaign was so successful, in fact, that Arthur Sackler — a member of the family who owned and ran Purdue Pharma — became the first inductee into the Medical Advertising Hall of Fame.
Before Purdue Pharma released OxyContin, most in the healthcare industry felt the risk of opioid addiction was too great, leaving patients with few options for pain management. But between Purdue and the American Pain Society, the scales completely tipped. Patients were considered to be not only entitled to pain relief but owed it as an essential part of their care.
Among the general populace, the pervading anti-drug sentiment that arose in the wake of crack cocaine had largely remained. However, attitudes toward pharmaceutical drugs were a bit different than how Americans viewed drugs like cocaine and heroin. Notably, OxyContin and other painkillers were legal substances that were being supplied by legal institutions. This is how the OxyContin crisis was able to take everyone by surprise.
By the close of the decade, the death rate for all drugs was 6.1 per 100,000, and three of those deaths were from opioids specifically.
Nuclear — 2000s
Purdue’s triumph in marketing was a direct cause of one of the greatest public health tragedies of the modern era. By the early 2000s, the market quickly became saturated with the drug. Many patients found themselves with such a surplus of the drug, so they began selling it to recreational drug users. We also saw “pill mills” emerge; this was the term for clinics and pharmacies where recreational drug users could pay cash in exchange for prescriptions for OxyContin and other painkillers.
Seeing the amount of money that Purdue Pharma was making, other pharmaceutical companies ramped up their own output. Painkillers that had already been somewhat common, like Percocet and Vicodin, were being prescribed more readily. Meanwhile, more obscure painkillers, like Opana, were also prescribed more freely and becoming more readily available.
It was the mid-2000s when we really began to see the consequences of prescribing narcotic pain medication so freely. Namely, we were beginning to see much higher abuse and death rates from opioids.
From 2000 to 2006, opioid misuse increased at an average rate of 19 percent per year. By 2010, there was an average of 5.4 overdose deaths from pharmaceutical opioids per 100,000 people, compared to 6.1 overdose deaths from all drugs (not just opioids) per 100,000 people ten years prior. In other words, we saw nearly as many deaths in 2010 from opioids alone as there were deaths in 2000 from all illicit drugs. For this reason, terms like “opioid crisis” and “opiate epidemic” were starting to be used. And yet throughout this time, Purdue continued selling massive quantities of OxyContin, earning $3 billion in revenue in 2010 alone.
Fallout — 2010s to Present
By the start of the new decade, officials had become acutely aware of the opioid problem and were looking for potential solutions. One such solution was to force pharmaceutical companies to change their formulas in ways that would make their drugs more resistant to tampering and misuse. For instance, Purdue’s new form of OxyContin was formulated to be extremely difficult to crush. It was also made to be less soluble in water, which meant it couldn’t be injected intravenously.
There were also a number of regulatory changes regarding how narcotics were prescribed. Most states implemented centralized databases to keep track of which patients were prescribed opioids, how much they were getting prescribed, and which providers were writing the prescriptions. Meanwhile, the government was imposing a limit on how many prescriptions each practice could write. The idea was to force doctors and healthcare providers to be more selective about how and when they write prescriptions for painkillers.
These strategies were, in fact, effective at mitigating the prescription drug problem. However, they also inadvertently created a new issue.
The Rise of Heroin
From 2010 to 2013, overdose deaths from pharmaceutical opioids actually declined; whereas there were 5.4 deaths from prescription painkillers per 100,000 people in 2010, there were 5.1 overdose deaths per 100,000 people in 2013. This represented the first year-to-year decline since OxyContin was released.
This would prove to be only a temporary reprieve as many of those who had become addicted to prescription painkillers turned to heroin as an alternative. After all, heroin is cheaper than painkillers, more potent than most painkillers, and was suddenly much easier to get. For these reasons, heroin use increased even faster than prescription painkillers with an average annual increase of 37 percent until 2017. Meanwhile, we saw the first decline in life expectancy in over 100 years, which was widely believed to be because of the opioid crisis.
During this time, the government changed its position regarding many of its policies. Originally, the belief was that harsher punishment for drug-offenses would discourage participation in the illicit drug trade. However, given how quickly the opioid problem worsened, the Global Commission on Drug Policy came to refer to the War on Drugs as a spectacular failure.
Today, most agree that the best strategies for counting the opioid crisis are those that focus on educating people about the dangers of substance abuse and that provide access to rehabilitative resources. And it would seem that these kinds of approaches have been successful since 2018 was the first year in which opioid overdose deaths were lower than the previous year. Of course, there’s still so much work to be done, but it’s reassuring that we’re finally headed in the right direction.
Now that you’ve gotten the full history of the opioid epidemic, you’re ready to begin exploring your recovery options. For more information about how we can help you (or your loved one), contact Sea Change Recovery today.