The White House just recently declared the opioid crisis a national public health emergency toward the end of 2017. However, the rising rates of overdoses are not a recent development in America, as most people seem to believe. The history surrounding the rise of the opioid crisis is pretty extensive. In fact, opioid abuse and addiction in the United States dates as far back as the 1860s. It was just never publicized as an epidemic until the 2000s.
Opioid Use Throughout American History
The Roots of the Nation’s Greatest Drug Epidemic
During the whole of the Civil War from 1861 to 1865, medics on the battlefield sidelines used morphine as an anesthetic for wounded soldiers. Morphine is a potent opioid with some of the most addictive properties of any drug. Its extensive use in medicine caused many American soldiers to become physically dependent on it. Morphine addiction went on to become a problem even after the Civil War ended.
The Bayer Company began to produce and market heroin as an alternative to morphine for chronic pain management. At the time, physicians believed heroin was less habit-forming and less harmful than morphine. Professionals even used it in commercially distributed medicine.
Cocaine was also used in medicine around this time. In fact, between the two, hospitals and surgical centers sometimes use liquid cocaine in medicine today. The Controlled Substances Act classifies cocaine as a Schedule II drug.
Prescriptions for these kinds of drugs weren’t in effect until Congress passed the Harrison Narcotics Act in 1914. This industry-changing act required practicing doctors to write prescriptions for narcotics like opioids and cocaine. This act also required drug distributors and manufacturers to register with the Treasury Department and pay taxes for their products. It wasn’t until a full decade later that the Anti-Heroin Act banned the production and sale of heroin in America.
The Beginning of Mass Opioid Consumerism
During this time, America’s pharmaceutical market began implementing combination opioid drugs. These particular drugs were short-acting painkillers that utilized other ingredients like acetaminophen and hydrocodone. Combination opioids include Vicodin and Percocet, which provide pain relief for between four and six hours.
In Boston, a physician created a database that recorded the effects of different drugs prescribed to hospitalized patients. This database reported that a small percentage of those treated with opioids developed an addiction. Later, the New England Journal of Medicine published a one-paragraph letter summarizing the findings of this database. The authoring physician titled this now infamous letter “Addiction Rare in Patients Treated with Narcotics.”
However, these findings were not an accurate representation of opioid addiction. The study only examined hospitalized patients who were closely monitored by medical staff. As a result, the pharmaceutical industry mistook the letter as proof that opioid drugs were non-addictive and safe for commercial consumption outside of hospitals.
By this time, most medical professionals recognized the addictiveness of the drug oxycodone. Still, the Food and Drug Administration (FDA) approved OxyContin, a painkiller with oxycodone as its active ingredient, for prescription use. After the FDA’s approval, the pharmaceutical company Purdue Pharma began marketing OxyContin as a safe alternative to combination opioids like Vicodin and Percocet.
In 1998, the FDA approved the medication Actiq for chronic pain management in cancer patients. Before this, the active ingredient of this medication, fentanyl, was highly restricted. This was because fentanyl is a synthetic opioid with a high potential for overdose, even with prescription use. In fact, fentanyl is 50 times stronger than heroin.
According to the Department of Mental Health & Substance Abuse Services of Tennessee, by the 2000s, prescription opioids were overprescribed to the point where they became the top substance abused by people receiving treatment at detox facilities and halfway houses. Additionally, opioid overdose deaths, both from prescriptions and illicit drugs like heroin, had quadrupled since 1999.
As medical practitioners began to recognize the addictive properties of opioids, they also began to warn pharmaceutical companies to change their marketing strategies. Before this point, most of them did not advertise the risks associated with opioid use. One such company was Purdue Pharma, the same company that contributed heavily to the OxyContin over-prescription trend from 1995 onward.
The FDA sent a letter of warning to Purdue Pharma regarding their misleading advertisements for OxyContin, stating that promoting the drug without disclosing [its] potential for abuse [or its] potentially fatal risks “is especially egregious and alarming in its potential impact on the public health.”
Purdue Pharma responded to the letter in a public statement saying that they [did] not believe that the ads [midled] physicians about the safety risks of OxyContin. This issue later became a federal case that brought the full extent of the opioid crisis to light.
Four years after responding to the FDA’s letter, several state governments sued Purdue Pharma for their misleading OxyContin advertisements. The company had been promoting the drug as a non-addictive alternative to other medical opioids without disclosing any risks. This federal lawsuit charged the company and three of its executives with criminally “misleading and defrauding physicians and consumers.”
Purdue Pharma and the executives all pleaded guilty to the charges and paid a collective $634.5 million in fines. Even today, this is one of the most substantial pharmaceutical payouts in history.
Months later, Purdue Pharma faced another court case in Kentucky. The company paid another $24 million in compensation for damages caused by the widespread OxyContin abuse in Appalachia.
Opioid Overdose Deaths Rise and State Lawmakers Demand Justice
During this time, the FDA approved an “abuse-deterrent” form of OxyContin and other opioid prescriptions. These drugs could not be crushed, making snorting or injection impossible. In time, the reformulation of OxyContin decreased its misuse by 36%. However, the new uncrushable OxyContin likely triggered the concurrent 42% increase in heroin use. Overall, abuse-deterrent opioids proved to be of little value since people were still able to find ways to abuse opioids and perpetuate the increasing number of addiction cases.
Operation Pilluted, a sting operation that lasted 15 months, came to a close when the Drug Enforcement Administration (DEA) arrested a total of 280 people across the states of Arkansas, Alabama, Louisiana, and Mississippi. These arrests included 22 doctors and pharmacists.
The DEA created this operation in response to the increased trafficking and abuse of pharmaceutical drugs in the area. The investigation focused largely on health care providers who were distributing suspiciously large amounts of opioids. Operation Pilluted turned out to be the largest-ever prescription drug bust in DEA history.
The First Signs of (Potential) Progress
After Operation Pilluted, the Centers for Disease Control and Prevention (CDC) published a set of strict guidelines for prescribing opioids for chronic pain management. These guidelines encouraged healthcare professionals to prescribe acetaminophen, ibuprofen, and over-the-counter painkillers instead of opioids.
In March, President Donald J. Trump signed an executive order to establish the President’s Commission on Combating Drug Addiction and the Opioid Crisis. A few months later, in July, the White House panel responsible for examining the opioid epidemic released a report and implored Trump to declare the crisis a national public health emergency. He officially did so until October, claiming “we can be the generation that ends the opioid epidemic.”
Make 2018 a Productive Year in the Fight Against Opioids with TTC
A significant part of combating the opioid crisis is helping those who have already been affected by it. At The Treatment Center by The Recovery Village, our staff of trained medical professionals and counselors can help sufferers of opioid addiction become sober and rebuild their lives. If you or someone you know has developed an addiction to prescription or illicit opioids, please call us at (866) 295-6003. All calls are confidential.