The Nation is in the midst of an unprecedented
Opioid Epidemic. More than 130 people a day die from opioid-related drug overdoses.
The opioid epidemic,
also referred to as the opioid crisis,
is the rapid increase in the overuse,
misuse/abuse, and overdose deaths
attributed either in part or in whole to
the class of drugs opiates/opioids since
the 1990s. It includes the significant
medical, social, psychological, and
economic consequences of the medical,
non-medical, and recreational abuse of
these medications.
Opioids are a diverse class of
moderate to strong painkillers,
including oxycodone (commonly sold under
the trade names OxyContin and Percocet),
hydrocodone (Vicodin, Norco), and
fentanyl, which is a very strong
painkiller that is synthesized to
resemble other opiates such as
opium-derived morphine and heroin. The
potency and availability of these
substances, despite the potential risk
of addiction and overdose have made them
popular both as medical treatments and
as recreational drugs. Due to the
sedative effects of opioids on the
respiratory center of the medulla
oblongata, opioids in high doses present
the potential for respiratory depression
and may cause respiratory failure and
death.
Opioids are highly
effective for treating acute pain, but
there is strong debate over whether they
are effective in treating chronic or
high impact intractable pain, as the
risks may outweigh the benefits.
America's
War on Drugs
The term
"war on drugs" became popular after
President Richard Nixon held a press
conference on June 18, 1971 where he
categorized drug abuse as "public enemy
number one". Two years before this, he
had also formally stated that the war on
drugs would focus on interdiction,
eradication and incarceration, but in
1971, when the media picked up this
expression he was actually leaning
towards prevention and rehabilitation.
The campaign
proved to be a very expensive failure
and resulted in extremely high and
racially profiled arrest rates.
The strategy focused on curbing supply
and the focus on demand stopped at "Just
say no", which, much like the
prohibition on alcohol only made drug
trade more profitable and the industry
more violent and creative.
There
were several studies that showed how
these measures were counterproductive:
1986 - "Sealing the Borders: The
Effects of Increased Military
Participation in Drug Interdiction" -
175-page study done by RAND Corporation
with funding from the US Defense
Department showed how using military
power to curb drug trafficking was
actually raising the profits for
manufacturers and cartels.
Clinton
Administration - Same RAND Company was
commissioned with performing another
study and concluded that funds should be
switched from law enforcement to
treatment - one again, focus on demand
2000 - 2006 - The US spends $4.7 billion
on trying to eradicate coca production
in Colombia - result: cultivation
increases in Peru and Bolivia
Numerous economists have pointed out
that trying to curb supply without
reducing demand causes the price to rise
and therefore makes the trade more
profitable and more appealing.
It's estimated that between 2000 and
2010, Americans spent $100 billion per
year on illegal drugs. This is just on
illegal drugs, not counting prescription
drug misuse. It also shows that most of
the expenditure comes from heavy users -
yet another argument for offering more
treatment options and focusing efforts
and resources on reducing demand.
What Led
to the Opioid Crisis in United States?
The opioid crisis in the United States
basically had three phases:
Phase
1 - 1990-2010 - pharmaceutical companies
convince the medical community that
prescription opioids are safe as pain
relievers and increase advertising
campaigns. Companies such as Purdue
Pharma lobbied, funded medical education
courses and sent their representatives
to speak directly to individual doctors.
The lack of communication and
coordination between states allowed
users to gather numerous prescriptions
and fund their addiction by selling the
excess pills. This changed the supply
chain from what the U.S. was used to.
Phase 2 - 2010- 2013 - Deaths from
prescription opioids surpass cocaine,
heroin and motor accidents combined and
we see a rise in HIV and Hepatitis C
Phase 3 - 2013 - present - Illegally
manufacture synthetic opioids like
Fentanyl and Carfentanil appear on the
market and are frequently mixed with
other street drugs like heroin and
cocaine or added to counterfeit pills.
This led to higher rates of overdose
deaths - it's now 5 times higher than
what it was in 1999.
What
is Fentanyl?
Fentanyl is
a synthetic opioid analgesic - a
pain-killer- but it's 50 to 100 times
stronger than morphine and 50 times
stronger than heroin. To understand why
it reaches such a high level of potency,
you need to understand the chemistry
behind it. Much like other opioids,
Fentanyl binds to the opioid receptors
in the brain and changes the perception
of pain. It also increases dopamine
levels which induces a state of euphoria
and relaxation.
Opioids like
oxycodone and codeine are synthesized by
making simple modifications to morphine.
Fentanyl, on the other hand is derived
from meperidine (Demerol) which is a
fully synthetic opioid, much more
addictive than morphine and only
recommended for treating severe post-op
pain in the short-term.
Fentanyl
also has a high lipid solubility so it
can reach the central nervous system
with greater ease, it binds more
efficiently and interacts with more
receptors. The effect is short - from 30
to 90 minutes but very intense.
The fact that it binds to more receptors
means it also attaches to those that
control breathing. An overdose typically
causes the person to stop breathing and
as the brain stops getting enough
oxygen, a condition called hypoxia sets
in which leads to brain damage, coma or
death.
The minimum lethal dosage
is about 250 micrograms but the
illicitly manufactured fentanyl or IMF
can be much stronger. Drug traffickers
mix it with heroin and cocaine because
it's cheaper and stronger so the users
have no way of knowing if they're taking
fentanyl and how much of it.
An
overdose can be reversed with naloxone (Narcan)
although it can require multiple doses
and they need to be supervised for two
hours afterwards.