OPIOID CRISIS GRADUATES

[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 reviewing the history of this epidemic.]

As the twentieth century reached its latter years, there was an increasing demand for what is now called opioids.  In the 1970s two drugs particularly, and their names, started to become common and known by many if not most Americans.  Despite initial apprehension over prescribing Vicodin and Percocet, doctors began to regularly prescribe these drugs in the 1980s.  This despite the fact that there were warnings against readily prescribing these addictive drugs.[1] 

Unfortunately, in January 1980, a short letter appearing in the New England Journal of Medicine had a bit of influence and helped change the thinking regarding these opioids.  Apparently, the letter issued by a group of Canadian researchers indicated that these drugs were not as dangerous as initially thought.  Their findings determined that only a handful of people who took one of several opioids became addicted.[2]

Years later, a follow-up comment by this journal further explained that the Canadians were only reporting on research regarding hospitalized patients and not people out in the general public after hospital visits – an observation that seems obvious upon reading the letter.  An author of the initial letter claims that his intent was not to give a green light to prescribing these drugs.[3]

          As the 1980s progressed another drug took center stage.  Crystalized cocaine, a drug that became popular during the 1970s, has a history stretching back 3500 years in South America.  There the coca plant, from which cocaine is derived, has been grown over all those years and has been used for a variety of purposes such as fatigue, depression, and sexual dysfunction.

Eventually, a German chemist, Friedrich Gaedcke isolated and purified the drug from the plant back in 1855.  Further “improvements” found a way to better extract the drug and this was accomplished by a German grad student, Albert Niemann, who first used the name, cocaine, for this product.  His work was done in 1859.[4]

This cocaine chapter in the drug story is important because of the crack epidemic in the 1980s led to government policies that were in place to meet the opioid epidemic.  Crack consumption resulted in an almost 2 per 100,000 population death rate and, under the leadership of Vice President George H. W. Bush, led to CIA and US military interdiction policies.  This initiative was given the name, War on Drugs.[5]

Under that general governmental posture, the opioid crisis grew some years later and became central in the nation’s consciousness as it resulted in vast devastation to numerous American communities.  This development began to take hold in the late 1990s.  And central to that growth was a well-thought out marketing strategy (1996-2001) for the opioid, OxyContin.  That strategy was aimed at alleviating concerns over the addictive qualities of that drug.[6]

A private pharmaceutical company, Purdue Pharma, organized more than forty promotional meetings at three locations in both the southeast and southwest US.  They coined the term, “Partners Against Pain.”  This was a marketing strategy that offered bonus system to incentivize sales of OxyContin.  Part of the strategy was to downgrade beliefs in the addictive danger of the drug.  They claimed that addiction affected less than 1 percent of users.  Along with incentives, this claim encouraged doctors to liberalize prescribing the drug.[7]

Nationally, the uptake in prescribing and subsequent consumption led to the death of 10.3 per 100,000 population and, in New Hampshire death rate of 30 per 100,000 and West Virginia, a rate of 40 per 100,000.[8]  In a 2016 national survey, conducted by Substance Abuse and Mental Health Services Administration, it was reported that more than 11 million people in the US misused prescribed opioids.  In addition, one million used heroin and 2.1 million fell into addiction of either prescribed opioids or heroin.[9]

One final statistic to end this short history is the following:  from the year, 2010 to the present, overdoses of illicit opiates have tripled.  There are signs, as the dangers of this type of drugs have become more readily known, that upsurge has leveled off.[10]  This writer is beginning to see public service announcements informing viewers of the dangers involved.  This development of the unit of study will continue in the next posting with reports on the usage of various opioids.

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[1] Clare Waismann, “The Devastating Effect of Opioids on Our Society,” The Hill, August 26, 2016, accessed June 18, 2018, http://thehill.com/blogs/pundits-blog/healthcare/293473-the-devastating-effect-of-opioids-on-our-society .

[2] “Opioid Crisis:  The Letter That Started It All,” BBC, June 3, 2017, accessed June 21, 2018, https://www.bbc.com/news/world-us-canada-40136881 AND Jane Porter and Hershel Jick, M.D., “Addiction Rare in Patients Treated with Narcotics,” The New England Journal of Medicine, January 10, 1980, accessed June 21, 2018, https://www.nejm.org/doi/full/10.1056/NEJM198001103020221 .

[3] Pamela T. M. Leung, Erin M. MacDonald, Matthew B. Stanbrook, Irfan A. Dhalla, and David N. Juurlink, “A 1980 Letter on the Risk of Opioid Addiction,” New England Journal of Medicine, vol. 376, no. 22, 2194-2195, accessed June 21, 2018, https://www.nejm.org/doi/full/10.1056/NEJMc1700150 AND “Opioid Crisis:  The Letter That Started It All,” BBC.

[4] Erik MacLaren, “Cocaine History and Statistics,” DrugAbuse.com, no date (some of the statistics reported through the year 2014), accessed June 21, 2018, https://drugabuse.com/library/cocaine-history-and-statistics/ .

[5] Peter Dale Scott and Jonathan, Cocaine Politics: Drugs, Armies, and the CIA in Central America (Berkeley, CA: University of California Press, 1991.).

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

[7] Ibid.

[8] 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 .

[9] Neil Doherty, Scott Gottlieb, Elinore McCane-Katz, Anne Schuchat, and Nora Volkow, “Federal Efforts to Combat the Opioid Crisis:  A Status Update on CARA and Other Initiatives,” National Institute on Drug Abuse, October 25, 2017, accessed June 21, 2018, https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2017/federal-efforts-to-combat-opioid-crisis-status-update-cara-other-initiatives .

[10] Deborah Dowell, Rita K. Noonan, Debra Houry, “Underlying Factors in Drug Overdose Deaths,” JAMA, vol. 318, no. 23 (December 19, 2017), 2295-2296.

A DRUG PROBLEM INITIATED

This is the second posting reporting the development of a civics unit of study regarding the opioids epidemic.  This development is in real time and this posting will begin looking at the history of the epidemic.  In reviewing that history, it is useful to make a distinction; a distinction that is no longer observed.  Historically, people used the term opiates to indicate all drugs derived from opium.  Later, the term, opioids, was used to distinguish between opiates from synthetic opiates.  Today, the term, opioids, is generally used to include both categories.

          This posting makes this distinction because this history of “opioids” stretches back to the nineteenth century when opiates were introduced to the US.  During the Civil War, morphine, an opiate, was an effective pain reliever.  Afterwards, the famous company, Bayar (as in Bayar aspirin) sold heroin (1898 to 1910) as a cough-suppressant; claiming it was non-addictive.

Apparently, experience with it proved otherwise and in due time concern among doctors were expressed by their increased reluctance to prescribe opiates. Shortly after, the US Congress enacted the Harrison Narcotics Act in 1914 which imposed a tax on opiates and, still later, the Anti-Heroin Act of 1924.  In this latter legislation, Congress made the importation or manufacturing of heroin illegal.[1]

In terms of general awareness among Americans, it was, at that time, quite limited.  One can detect during the 1950s a belief that an addiction problem existed among jazz musicians but not a problem affecting typical Americans.  Instead, the mere presence of heroin in the country was considered a frightening condition but limited to small groups within the population.[2]  As a young person, this writer can remember this general aversion to illegal drugs.

Then, during the years of Vietnam protest, there seems to have been a shift in public opinion.  In the 1960s and 1970s, one could readily detect the popularization of drugs among certain segments of the population – such as, on college campuses.  Chief among the favored drugs was marijuana and hallucinatory drugs, aka psychedelics.  The consumption of these drugs became common and, in popular media, often referred to and depicted.  There was even a much-highlighted event in which drug taking was featured; i.e., the Woodstock music festival.[3]

The war in Vietnam became a contributing factor since soldiers, coming home, often came with addictions, such as on heroin.  In Vietnam, these drugs were easily acquired.  In addition, there were highly publicized events, including the overdose death of Janis Joplin, that furthered the general awareness of the problem.  How extensive was drug-use among returning soldiers?  A Congressional report stated that 10 to 15 percent of returning vets were addicted to heroin.

This drew the attention of the president; he, President Nixon, declared drug abuse as the nation’s number one enemy.[4]  And the noted statistics did not undermine the conclusion.  In 1973 the estimate was that 1.5 deaths per 100,000 population were due to overdoses.[5]  What was not known, at the time, was that this level of drug-taking was only an introduction to what was to follow.  The next posting will continue this history and how the emphasis shifted to prescribed opioids.

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[1] Sonia Moghe, “Opioid History:  From ‘Wonder Drug’ to Abuse Epidemic,” CNN, October 14, 2016, accessed June 18, 2018, https://www.cnn.com/2016/05/12/health/opioid-addiction-history/ .

[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] Ibid.

[4] “Interview:  Dr. Robert DuPont,” Frontline, 2014 (estimated), accessed June 18, 2018, https://www.pbs.org/wgbh/pages/frontline/shows/drugs/interviews/dupont.html .

[5] Christopher Caldwell, “American Carnage:  The Landscape of Opioid Addiction.”