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Candace George
Professor Hellmers
English 1201
02 Dec. 2016

Helping or Hurting: The Opioid Epidemic


Scientists develop new medications in laboratories that are most often
based on substances found in nature. New drugs are repeatedly tested
before they are made available to the public to make sure they are effective
and the benefits of the drug are greater than any known risks. Prescription
opioids to manage pain but they also produce euphoric feelings. In an effort
to further reduce pain and enhance the euphoria experienced, patients begin
abusing opiates by taking more than what was prescribed. Over time the
body builds up a tolerance to the drug, requiring more and more to produce
the initial effect. When doctors prescribe opioids there is a risk of addiction.
In an attempt to help patients, doctors are unintentionally creating addicts
that could potentially go on to become heroin addicts.
According to the Center for Disease Control and Prevention, from 19992010 there were enough opioids prescribed to medicate every American
adult with a standard pain treatment dose, one every four hours, for a
month. In 2014 alone doctors wrote 240 million prescriptions for opioids
(The Opioid Epidemic). Opioids are a host of painkillers derived from the

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opium poppy (Gaidos). These medicines act on receptors in the spinal cord
and brain to reduce the intensity of pain (Misuse of Prescription Drugs).
Frequent use of opiates over time builds the bodies tolerance, requiring a
larger dose to reduce pain. Seeking relief, patients begin abusing these
prescriptions by taking medication prescribed for someone else, taking a
larger dose than prescribed or using the medicine to get high (Prescription
Drug Abuse). The increase in prescriptions caused an increase in availability
and by 2014, 4.3 million Americans were taking prescription painkillers
without medical a prescription. Over 2 million of these people were new
users and had never abused prescription medications until now (Misuse of
Prescription Drugs). Pain doctor Lynn Webster, doctors have defaulted to
using opioids as quick, easy, cheap fixes that are wrong in many cases
(Katel).
People succeed in changing a situation when they are willing to fight
for it, progressing only when all involved are fully dedicated. The United
States government recognized the need for intervention and became
involved in the prevention of opioid abuse and addiction. Secretary of the
Department of Health and Human Services Sylvia M. Burwell announced the
Secretary's Opioid Initiative in March 2015. The initiative aims to reduce
addiction and death caused by opioid abuse, reform opioid prescribing
practices, expand access to the overdose reversal drug Naloxone and
provide more access to medication-assisted treatment (MAT) for opioid use
disorder (Prescription Opioids and Heroin). The following year, the Center for

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Disease Control and Prevention (CDC) published its guideline for prescribing
opioid pain medication in a primary care setting. Establishing clinical
standards for balancing the benefits and risks of chronic opioid treatment
this guideline is known as the CDC Guideline for Prescribing Opioids for
Chronic Pain (Misuse of Prescription Drugs). Addressed in the guideline was
the initiation and continuance of opioids for chronic pain (pain lasting longer
than three months past normal healing time) outside of active treatment,
palliative care, and end-of-life care. The guideline covered recommendations
for opioid selection, dosage, duration, follow-up and discontinuation, while
assessing risk and harms of opioid use (Injury Prevention and Control).
Realizing first contact providers (primary care) as a major source of opioid
epidemic, the Department of Health and Human Services along with the
Center for Disease Control and Prevention are using their instructions to curb
the epidemic. Will this be enough?
Specialist in opioid addiction history David Courtwright says those
calling for cautious opioid prescribing are knocking on an open door. "I think
it's already the case that the medical profession has collectively awakened to
the fact that we have a problem," he says. Excessive prescribing is only one
engine of the epidemic. "We have massive importation of heroin from Mexico
and more recently, heroin spiked with fentanyl," he says. The amounts of
heroin entering the United States are so high Courtwright is pessimistic the
epidemic can be reduced (Katel).

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Doctors have unintentionally prescribed highly addictive substances to


their patients for almost a century. Marijuana, opium, amphetamine, cocaine,
LSD and heroin are all illegal substances that were introduced as legal overthe-counter and prescription medications. Opiates have been popular in the
United States since the 19th century when they were prescribed to women to
treat "female problems". Derived from the opium poppy, morphine was used
during the American Civil War as an injectable pain reliever, causing the first
wave of morphine addiction (Casa Palmera Staff). Processed from morphine,
heroin was first marketed as a cough suppressant in 1898 (Katel). Heroin was
once thought to be a potential cure for morphine addiction. As part of a
campaign against morphine addiction samples were mailed out to morphine
addicts, resulting in the beginning of the heroin addiction. The next major
outbreak of heroin addiction was in the 1930s and 1940s during the Harlem
jazz scene, and the Beatniks of the 1950s. During Vietnam, U.S. serviceman
stationed abroad became addicted to heroin. Users began snorting and
smoking heroin in the 1980s and 1990s when the purity of heroin increased,
causing a significant rise in the number of users in the 1990s (Casa Palmera
Staff).
During the resurgence of heroin in the 1990s, the American Pain
Society introduced pain as the 5th vital sign saying clinicians need to take
action when patients report pain (National Pharmaceutical Council). After the
establishment of these new standards, pharmaceutical company Purdue
Pharma told doctors they had developed a new drug that could be safely

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prescribed without becoming addictive. Oxycontin was supposed to pose


little risk due to its time release formula that would limit the amount entering
the bloodstream at a time. Oxycontin, like other opioids, was highly
addictive. People began abusing this drug by crushing it into a powder,
eliminating its time release safety feature, and snorting or injecting it. Heroin
was entering the United States from Mexico during this time. Dealers were
expanding their operations and deliberately began setting up in areas with
high rates of Oxycontin addiction. The heroin coming into the United States
was cheap, highly available and easily injectable. When people addicted to
prescription opioids couldn't find any painkillers they opted to try heroin
since it produced a similar effect(Katel).
On an average day in the United States 650,000 opioid prescriptions
are dispensed, 3,900 people initiate nonmedical use of prescription opioids,
580 begin using heroin and 78 people die from an opioid related overdose
(The Opioid Epidemic). One of the reasons opioid overdose deaths are on the
rise is herion is now laced with fentanyl and carfentanil (elephant
tranquilizer). Fentanyl is a synthetic opioid approved for treating advanced
cancer it is 50 times more powerful than heroin and 100 times more powerful
than morphine (Injury Prevention and Control). Carfentanil, the chemical
cousin to fentanyl, is 10,000 times more powerful than morphine and 100
times more powerful than fentanyl (Katel). Heroin related deaths tripled
between 2010 and 2014 with 10, 574 deaths in 2014 (Injury Prevention and
Control). Overdose deaths involving synthetic opioids, including fentanyl

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increase by 80% from 2013-2014 (The Opioid Epidemic). When overdose


deaths surpassed deaths from motor vehicle accidents in a 2014 report from
the CDC, Nora Volkow, director of the U.S. National Institute on Drug Abuse
said, "The opioid epidemic is devastating and the number of people dying
demands an urgent intervention." (Gaidos).

Fig. 1 Overdose Deaths by Age in 2014 per 100,000 people (Nolan,


Dan)

The statistics involving drug overdose deaths are alarming. Why would
an individual risk their life to take these drugs? When a person frequently
uses opioids (such as their own prescription) they become dependent on the
effects that are produced from these drugs often resulting in drug
abuse(Prescription Opioids and Heroin). Abusing drugs interacts with cells in
the brain governing reward, including pleasure circuits. Painkillers attach to
opioid receptors inhibiting the release of a chemical known as GABA. This

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chemical controls the release of dopamine, when GABA isn't released


dopamine floods the brain creating the euphoric high. Dopamine fuels the
high that people feel from taking and addictive drug (Misuse of Prescription
Drugs). Overtime drug abuse changes signaling in the number of brain
circuits. The addicted brain experiences decreased sensitivity and a
disruption in self-control. Dopamine receptors decline requiring more
stimulation to produce feelings of pleasure. Individuals no longer find the
same things enjoyable and the brain learns the only thing that is going to
stimulate the pleasure is the drug. Nora Volkow says this is one of the
components that drives the drug-seeking behavior of addiction (Gaidos).
Dr. Matt Rohrbach M.D. and member of the West Virginia House of
Delegates describes addiction as a medical problem just like diabetes and
heart disease, some answers are medical and some are social (Miller). There
are treatment options available to treat opioid abuse disorder. Behavioral
therapy helps change the way patients think and includes strategies for
managing cravings and avoiding situations that could lead to relapse.
Medication-assisted therapy uses drugs that counter the effects of opioids on
the brain n combination with psychosocial supports (Prescription Opioids and
Heroin). Psychiatry professor Johnson from SUNY Upstate Medical University
says medical treatments alone are inadequate, "People use drugs for a
reason. It's not random-people have emotional issues and opioids get rid of
them."(Katel). Emphasis needs to be placed on both prevention and
treatment.

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Doctors prescribe medications to help people feel better based on the


symptoms the patient is experiencing. Narcotic painkillers are routinely
prescribed after major surgeries and to manage chronic pain. People assume
these drugs are safe since they are prescribed by a doctor but that isn't the
case. Doctors have been unknowingly prescribing highly addictive
medications to patients for almost a century. Now doctors know the side
effects of these drugs and how addictive they are and still prescribe them.
Regulations from government agencies require doctors to weigh the risks
with the benefits before prescribing opiates for chronic pain. Do doctors
consider the risks? Every time a doctor writes a prescription they are
creating a person who will become dependent upon opioids. Dependence
after prolonged use is often accompanied by tolerance, requiring higher
doses of medication to get the same effect. As people use more and more
they abuse their prescription, becoming addicted. Many addicts result to
using heroin since it is cheaper and highly available. Doctors are potentially
creating an addict every time they write a prescription.

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Works Cited
Casa Palmera Staff. "History of Illegal Drugs." Casa Palmera Treatment
Center. October 03,2012. https://casapalmera.com/the-history-ofillegal-drugs-in-america/. Web. 02 Dec. 2016.
Gaidos, Susan. "Addiction Protection." Science News. 190.1 (2016):22
MasterFILE Premier. Web. 20 Nov. 2016.
"Injury Prevention and Control: Opioid Overdose". Centers for Disease
Control and Prevention. National Injury Center for Prevention and
Control. Division of Unintentional Injury Prevention. Oct. 17, 2016.
http://www.cdc.gov/drugoverdose/index.html. Web. 12 Nov. 2016.
Katel, Peter. "Opioid Crisis." CQ Researcher. 7 Oct. 2016: 817-40
Http://library.cqpress.com.sinclair.ohionet.org/cqresearcher/cqresrre201
6100700. Web. 13 Nov. 2016.
Miller Debra. "Attacking the Opioid Crisis with Policies, Education." Capitol
Ideas. 59.4 (2016): 14 MasterFILE Premier. Web 20 Nov. 2016.
"Misuse of Prescription Drugs." National Institute on Drug Abuse. August
2016. https://www.drugabuse.gov/publications/researchreports/misuse-prescription-drugs/summary. Accessed 16 Nov. 2016.
Nolan, Dan. Overdose Deaths by Age in 2014 per 100,000. Digital image.
How Bad Is the Opioid Epidemic. PBS, 23 Feb. 2016. Web. 29 Nov.
2016.

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National Pharmaceutical Council. "Section II: Assessment of Pain."


http://americanpainsociety.org/uploads/education/section_2.pdf .Web.
02 Dec. 2016.
"Prescription Drug Abuse." Medline Plus. September 18, 2014. <
https://medlineplus.gov/prescriptiondrugabuse.html>. Web. 16 Nov.
2016.
"Prescription Opioids and Heroin." National Institute on Drug Abuse.
December 2015. https://www.drugabuse.gov/publications/researchreports/relationship-between-prescription-drug-abuse-heroinuse/introduction. Web. 16 Nov. 2016.
"The Opioid Epidemic: By the Numbers." U.S. Department of Health and
Human Services. June 2016. Pp. 1-2.
http://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf.
Web. 16 Nov. 2016.