Opioid use and addiction is a growing epidemic in America. The National Institute of Drug Abuse reports that in 2015, more than 33,000 Americans died as a result of an opioid overdose, with 42,000 deaths in 2016. That’s a 27% single year increase, and 2017 numbers are expected to show another increase. That’s a higher death toll than from guns or car crashes that year, and a higher amount than the deaths per year from HIV/AIDS at the peak of that crisis. Just that two-year total alone, greatly surpasses the number of U.S. military casualties in the Vietnam and Iraq wars combined.

What are Opioids?

Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. Opioids can also make people feel very relaxed and “high” – which is why they are sometimes used for non-medical reasons.

Popular slang terms for opioids include Oxy, Percs, and Vikes.

Common prescription opioids include:

• hydrocodone (Vicodin®)

• oxycodone (OxyContin®, Percocet®)

• oxymorphone (Opana®)

morphine (Kadian®, Avinza®)

• codeine

• fentanyl

heroin is a non-prescription opioid.

How Did We Get Here?

The crisis dates back to the late 1990s with pressure being put on doctors to recognize pain as a serious medical issue and it is. About 100 million U.S. adults suffer from chronic pain, according to a 2011 report from the Institute of Medicine.

Pharmaceutical companies took advantage of this concern, launching a big marketing campaign, to get doctors to prescribe products like OxyContin and Percocet. While the products have proven effective for short-term, acute pain, there was little evidence about the safety and efficacy of the drugs for treating long-term pain. In fact, many of the pharmaceutical companies have been sued for misleading marketing about the safety of the drugs.

However at the time, doctors, many exhausted by dealing with difficult-to-treat pain patients, took to the products, prescribing them in droves. The drugs proliferated, and as a result, America has by far become the world’s leader in opioid prescriptions.

The powerful opioid painkiller OxyContin, a time-release version of oxycodone, was hailed as a breakthrough treatment for chronic pain when it was approved by the FDA in 1995. It worked over 12 hours to maintain a steady level of oxycodone in patients suffering from a wide range of pain ailments.

Unfortunately, it could be easily abused to achieve a heroin-like high by crushing the pills and snorting or injecting the entire dose at once. The drug’s maker, Purdue Pharma, reformulated OxyContin in 2010 to make it harder to crush and stopped selling the original form of the drug.

Keeps Getting Worse

The opioid crisis just keeps getting worse, in part because more and stronger forms of the drug keep finding their way onto the streets. Fentanyl, a powerful synthetic opioid, is legally prescribed to manage pain after surgery. However, clandestine laboratories are producing the product and taking it straight to the street.

Fentanyl is deadly because it’s so much stronger than heroin, as shown by the photograph above, which was taken at the New Hampshire State Police Forensic Laboratory. On the left is a lethal dose of heroin, equivalent to about 30 milligrams; on the right is a 3-milligram dose of fentanyl, enough to kill an average-sized adult male.

Fentanyl, according to the Centers for Disease Control and Prevention, is up to 100 times more potent than morphine and many times that of heroin.

Heroin and fentanyl look identical, and with drugs purchased on the street, “you don’t know what you’re taking,” Tim Pifer, the director of the New Hampshire State Police Forensic Laboratory, told STAT, a health related website, in an interview. “You’re injecting yourself with a loaded gun.”

Mediocre Response

Unlike the Crack Cocaine epidemic, where America immediately got tough on crime, and moved to arrest addicts and strengthened the penalties for crack drug related offenses, America has been slow to respond to the opioid crisis, which has been brewing for nearly 20 years.

First the drug “pushers” were big pharmaceutical companies instead of Pookie and his boys on the corner. Then the drugs were being prescribed by doctors and legally, as allowed and licensed by the Federal Drug Administration. However, as the demand for the opioids grew, so did the illegal market and criminal related activity.

The Drug Enforcement Administration finally began to crack down on doctors operating “pill mills.” Of the 42,000 Americans who died from opioid overdoses in 2016, 40% were attributed to prescriptions.

In February 2016, Dr. Hsiu-Ying “Lisa” Tseng of Los Angeles became the first doctor in the U.S. to be convicted of murder for overprescribing opioids to multiple patients. Tseng was sentenced to 30 years to life for the deaths of three patients, including selling Xanax and oxycodone to a college student who later died after mixing the substances with alcohol.

While the DEA chronicles the arrests of physicians illegally dispensing substances, these aren’t the only means in which opioids make their way into communities.

The DEA also keeps tabs on drugs that are either lost or stolen. In 2016, there were nearly 19,800 cases of drug theft or loss from pharmacies and almost 5,700 incidents in hospitals, with 68% of all incidents identified as “lost in transit.”

In one instance, a pharmacist stole over 35,000 pills (including oxycodone) over a three-year period from the Pennsylvania hospital where she was employed. The hospital was later ordered to pay $510,000 to settle the allegations that they enabled this staff member to steal the drugs. After pleading guilty to 25 counts of possession, the pharmacist was sentenced to six years in prison and three years of supervised release.

In the case of government-run hospitals (like those affiliated with the U.S. Department of Veterans Affairs), the rate of drugs reported missing is more than double the rate reported by private-sector facilities. In response, the VA argued many drugs were lost in transit, although the DEA argues those cases may have been wrongly classified. Studies have shown veterans are more than twice as likely as nonveterans to die from accidental opioid overdoses, particularly among those who experience chronic pain as a result of their service or deployment.

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