BIGGEST SELLER

[Note:  This posting is a continuation of a report on the development of a civics unit of study.  This unit is directing students to formulate informed positions on the opioid epidemic.  Presently, this development, in real time, is reporting a set of factoids on a particular drug which is part of this epidemic.]

The next class of opioids this development will address is Oxycodone, including a derivative of this drug, OxyContin.  When it comes to recreational use of opioids among Americans, these two forms constitute the most used.  According to the US Department of Health and Human Services report, circa 11 million Americans consume an oxycodone drug for recreational or non-medical reasons.  As such, Oxycodone accounts for a large portion of this epidemic.[1]

          Oxycodone has its own history in the US.  It starts in 1939 when it was first made available on these shores.  But it took until 1970s before US authorities, in the Food and Drug Administration, to deem this drug as having a high probability of being abused and potentially causing addiction.  This government agency did this by classifying it as a Schedule II drug.  As the short history – provided in previous postings – indicates, the drug company, Purdue Pharma, began an active campaign to popularize a form of the drug in 1996.  To get around the addictive quality of the drug, this company introduced OxyContin. 

This “controlled release” formulation of the drug was meant to make the resulting product less apt to be addictive and the FDA approved it.  Unfortunately, it did not take a long time before consumers learned how to derive a purer oxycodone drug by simply crushing the controlled release tablets.  They then could consume the derived drug by various ways:  swallowing, inhaling, or injecting it.  Any of these modes renders a very powerful opioid.[2]

The derived drug, when consumed, results in an upgraded “high” that is described as being “morphine-like.”  Purdue’s eventual testing in 1995 demonstrated how users, by crushing their product, could extract a 68% oxycodone.[3]  All these developments cost Purdue dearly.  Eventually, in 2007, the company paid a $600 million fine for making false claims about their product specifically regarding its risks.[4]  Then, in 2010, the company issued a newer version.

In that year, Purdue introduced a reformulated OxyContin.  By using a polymer, they made their pills very difficult to crush or dissolve.  In turn, this made the product significantly less apt of being abused.  Predictably, documented use of the drug declined slightly.[5]

Despite this development, in 2012, Canada’s government decided to strip OxyContin from its approved drug list.  In 2017, the FDA requested the producers of oxymorphone, an injectable form of the opioid, to remove it from the domestic market.  The agency determined that the risk of the drug is greater than its benefits.  This marked a turning point for the FDA since it was the first time it issued such a request due to fears of abuse.

The next posting will look at fentanyl.

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[1] “Opioid Crisis Fast Facts,” CNN Library, June 16, 2018, accessed June 25, 2018, https://www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html .

[2] Art Van Zee, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy,” American Journal of Public Health, vol. 99, no. 2, (February 2009), 221-2273.

[3] Ibid.

[4] Barry Meier, “In Guilty Plea, OxyContin Maker to Pay $600 Million,” The New York Times, May 10, 2007, accessed June 29, 2018, https://www.nytimes.com/2007/05/10/business/11drug-web.html?mtrref=www.google.com&gwh=5EB54309CD06FBA620248E850CC5CC0B&gwt=pay .

[5] Catherine S Hwang; Hsien-Yen Chang; Caleb G Alexander, "Impact of Abuse-Deterrent OxyContin on Prescription Opioid Utilization," Pharmacoepidemiology and Drug Safety, 24, no. 2, 2015, 197–204.

AN OLD ENEMY

[Note:  This posting is a continuation of a report on the development of a civics unit of study.  This unit is directing students to formulate informed positions on the opioid epidemic.  Presently, this development, in real time, is reporting a set of factoids on a particular drug as a part of this epidemic.]

The class of drugs considered to be opioids include various drugs.  They include prescription pain relievers, heroin, and synthetic opioids.  Of special concern, fentanyl has caused heightened effect on the health of tens of thousands of Americans.  This effect can be measured in terms of deaths and economic costs.  Generally, the economic cost of misused prescription opioids is estimated to be $78.5 billion a year.  That includes healthcare, lower productivity, treatment, and criminal activity.[1]

          The last posting shared a set of statistics that gives one a sense of how extensive the problem of opioids is in the nation.  Here is another that reflects how centered the problem is in certain areas of the nation:  in 2016, West Virginia, the most affected state, had an overdose death rate of 52 per 100,000 population.  West Virginia was followed by New Hampshire and Ohio with each reporting 39 deaths per 100,000.[2]

          This posting begins the next phase of developing a unit of study suitable for an American government course.  That phase, after providing a short history over the last several postings, provides a set of factoids that can function to develop individual lessons.  These factoids will be organized around the various drugs that make up this crisis.  This posting will highlight heroin.

          Heroin is chosen as the first drug to be looked at because in the minds of most Americans, heroin has the longest history.  As the short history in the previous postings indicates, awareness by many Americans stretches back to the 1950s when it was known that there were groups of Americans addicted to this drug.  Those groups were inhabiting large urban centers.  As such, the problem for most Americans was troubling, but not imminent.

          While heroin has this longer history, in terms of understanding the opioids problem, it is more a result than a cause of the problem.  Two facts reflect this relation to opioids:  of those who misuse prescribed opioids, 4 to 6 percent “graduate” to heroin and 80 percent of those, who use heroin, previously misused prescription opioids.[3]  This latter development is because heroin is cheaper then prescribed opioids and can be readily obtained through black market outlets – without a prescription.[4]

          Other facts regarding heroin are: 

·        men are significantly more likely to use heroin;[5]

·        between 2012 and 2015, deaths due to heroin-use were more numerous than deaths due to other opioids even though among women, deaths were higher due to opioid medications;[6]

·        while the problem of cocaine deaths is a greater problem among black population, all types of opioids (including heroin) are responsible for more deaths among all races;[7]

·        an overlooked fact, due to the concern over opioids, there has been a shift of attention from other drug addiction problems to the opioid problem.  For example, attention to cocaine-use has suffered from this shift – along with a lack of effective medication to treat cocaine addiction.[8]

·        The last decade or so has seen significant increases in heroin use.  Those numbers include an increase from an estimated 374,000 Americans using heroin in the years 2002-2005 to 607,000 in the years 2009-2011.[9]  By 2014, as a reflection of a leveling-off progression, the number was estimated to still be over half a million.[10]

The next posting will highlight Oxycodone.

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[1] “Opioid Overdose Crisis,” National Institute on Drug Abuse, March 2018, accessed June 25, 2018, https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis .

[2] Christopher Caldwell, “American Carnage:  The Landscape of Opioid Addiction,” First Things, April 2017, accessed June 18, 2018, https://www.firstthings.com/article/2017/04/american-carnage .

[3] Deborah Dowell, Rita K. Noonan, and Debra Houry, “Underlying Factors in Drug Overdose Deaths,” JAMA, vol. 318, no. 23, 2295-2296. 

[4] Andrew Kolodny, David T. Courtwright, Catherine S. Hwang, Peter Kreiner, John L. Eadie, Thomas W. Clark, and G. Caleb Alexander, "The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction," Annual Review of Public Health, vol. 36, 2015, 559–574.  Accessed June 25, 2018, see https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031914-122957 .

[5] Austin Frakt, “Overshadowed by the Opioid Crisis:  A Comeback by Cocaine,” The New York Times, March 5, 2018, accessed June 25, 2018, https://www.nytimes.com/2018/03/05/upshot/overshadowed-by-the-opioid-crisis-a-comeback-by-cocaine.html .

[6] Ibid.

[7] Ibid.

[8] Ibid.

[9] Leigh Anderson, “Heroin,” Drugs.com, May 18,2014, accessed June 25, 2018, https://www.drugs.com/illicit/heroin.html .

[10] "What Science Tells Us about Opioid Abuse and Addiction," Abuse, National Institute on Drug, January 27, 2016, Drugabuse.gov. This site no longer posted.  See “Opioid Epidemic,” Wikipedia, https://en.wikipedia.org/wiki/Opioid_epidemic#cite_note-38 , footnote #43.