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The Opioid Crisis - Where Did it Come From?


 On October 26, 2017, the President of the United States declared a state of emergency regarding opioid drug use, which grants the Department of Health and Human Services (HHS) the means to address it. HHS can now provide $485 million in prevention and treatment grants. But what are opioids exactly? The first class of opioid drugs are known as opiates, which are all made from a type of poppy. The very first opiate was opium, which was used as a narcotic (a non-medicinal drug meant to affect moods and behaviors), as opposed to the current purpose of pain management. After opium came drugs like morphine, heroin, and the medicines we commonly refer to as “painkillers,” such as Vicodin, Percocet, and Oxycontin. After those came a second class of opioids, which are all synthetic. These drugs are not made from plants but are instead manufactured, such as drugs like fentanyl. Many of these drugs are still widely prescribed and used (sometimes illegally).

However, for many who use illicit drugs like heroin and fentanyl, it was their prescription opioids that first caused the addiction. Because there have been so many forms of opioids in history, it’s unsurprising that we are in this current state of emergency. We tend to think of this epidemic as a recent issue, however, it has been around since the 1990s, when healthcare providers started heavily prescribing the powerful painkillers. Before 1980, providers had been wary to prescribe them and used them only sparingly for severe injuries. There has since been evidence to support this mentality, as numerous clinical trials show that opioids are more beneficial in short-term doses. [4] However, at the time, pharmaceutical companies claimed the drugs were safe to use and that they wouldn’t get people addicted, so doctors started to prescribe them more frequently. [1] In the mid ‘90s, the pharmaceutical industry started to aggressively market opiates such as Oxycontin. This push came with the support of physicians, medical societies, and government agencies like the FDA, all of whom believed that the drugs were safe to use. [4] Around the same time, the price of heroin went down, and when patients ran out of their opioid prescriptions, they would turn to heroin. [2]


Over the next two decades, the government sought to raise awareness about drug use such as through the Drug Abuse Resistance Education program, also known as D.A.R.E., while the health industry focused on understanding pain and adding it as a vital sign. However, these efforts only increased opioid use, and the epidemic has worsened. Between 1999 and 2014, all opioid drug poisoning deaths increased from 610,000 to 1.47 million; heroin drug poisoning deaths alone increased from 70,000 to 340,000; and analgesic drug poisoning deaths increased from 140,000 to 590,000. [5] Then, in 2014, the synthetic opioid fentanyl started to appear in the illicit drug supply in large quantities, and it has since been found to be more addictive than heroin. Since then, opioid overdose rates have steadily increased. Between 2014 and 2015, opioid-related drug overdoses across the country increased 3%, accounting for 63% of all overdoses. [6] From 2016 to 2017, emergency department visits for opioid overdoses increased 30% nationwide and 70% in the Midwest. [7]


According to the National Institute of Drug Abuse (NIDA), more than 115 Americans die from opioid overdoses every day. [1] Despite the data, people who are addicted to opioids are not receiving or can’t receive the treatment they need, which accounts for 90% of opioid addicts. [3] And even if a patient is diagnosed with a substance abuse or addiction disorder, insurance and healthcare policies often prevent them from receiving treatment. According to the Chief of Addiction Medicine at Stanford University, most insurance companies won’t pay for emergent inpatient treatment for someone in acute opioid withdrawal. [4] The Chief also claims that while electronic health records (EHRs) are becoming more normative in healthcare, most healthcare providers do not always use them to indicate if a patient has an addiction or substance use disorder. More often, providers use EHRs for billing insurance companies rather than for documenting illnesses. Fortunately, however, some states, agencies, and medical facilities are already imposing laws and offering alternative treatments that could change the future of pain management and substance abuse.





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