Throughout its history, the United States has suffered through several drug epidemics. The most recent of these is the Opioid Epidemic, which is receiving increasing attention by the public as the epidemic grows.  Of the approximately 64,070 fatal overdoses in 2016, three-fourths of these were due to opioid use — that’s ~48,000 people who died from opioid abuse. Therefore, it came as no surprise when President Donald Trump declared the Opioid Epidemic a national public health crisis in October 2017. However, the question remains: why did it take until 2017 to recognize the dangers of opioids?

     The introduction of opiates in America dates back to the Civil War. Military physicians treated injured soldiers and veterans with morphine, without understanding its addictive effects. A short 23 years later, in 1898, the Bayer Co., began commercially producing heroin. At a time when little was known about the effects of opiates, the pharmaceutical giant considered heroin a “wonder drug,” as it was extremely effective in eliminating symptoms of pain. The addictive nature of the drug led users to discover that direct injection into the bloodstream would enhance its effects, which in turn increased their vulnerability to abuse and overdose. In 1924, the dangerous effects of heroin became fully understood and the drug became illegal in the United States. Despite the new laws, the demand for heroin among addicts in the United States was high, and opium continued to pour into the US illegally.

     Illicit drug trade is highly focused in port cities, where drug traffickers find ease in smuggling on large cargo ships. Elizabeth, New Jersey, for example is a hot spot for heroin and cocaine trafficking, thus making the surrounding area vulnerable to drug exposure. During the 60’s, illicit shipments of opiates and other Class A substances to urban port cities in conjunction with “White Flight” — the social diaspora of whites from urban cities to the suburbs — exposed urban, primarily African-American communities to heroin and other illicit drugs through ease of access. These simultaneous events caused heroin and other drug use to surge among urban communities, which was ultimately blamed on crime that was associated with the inner-cities. The result – Nixon’s “War on Drugs”. Various laws enacted by states under the Nixon Administration’s “War on Drugs”, such as New York’s “Rockefeller Laws”, made African American communities targets of strict policies that punished for drug use, possession and distribution. There was little incentive for rehabilitative services and programs for opiate addicts, resulting in increased incarceration rates among African Americans.

     Today’s Opioid Epidemic has seen a dramatic shift from incarceration to rehabilitation, but why? By the mid- and late-1970’s, Percocet and Vicodin, two opioids manufactured by pharmaceutical companies to ease symptoms of pain, became readily available on the market. Prior to their release, there was a common perception among medical providers that prescribing opiate-based pain medications caused risk and vulnerability to addiction for a patient suffering from pain symptoms. Thus, opiate prescriptions had been highly avoided. However, in January 1980, The New England Journal of Medicine published a letter aimed at proving fallacious the belief among doctors that prescription opioids led to addiction. This letter, in conjunction with the desire of care providers to treat symptoms of pain more efficiently, once again put opioids into the hands of Americans, legally. This reversal in attitude towards prescription opiates continued throughout the 80’s and 90’s, making all Americans vulnerable to the dangerous, addictive effects of opioids, including transition to heroin use – a drug from which the suburbs had been largely shielded.

     In 1996, considered to be the starting point for the contemporary Opioid Epidemic, Purdue Pharma released OxyContin, a more highly addictive prescription opiate that was now being prescribed to Americans. Additionally, under the Clinton Administration in 1997, the FDA relaxed its policies on specific-drug for specific-ailment claims making the prescription of opiates a seemingly less harmful decision for care providers. This perception proved wrong, however. OxyContin is actually so dangerous that in 2007, Purdue Pharma was ordered to pay more than $600 million in legal fines to settle a suit where they were convicted of falsely advertising the mental and physical health risks of OxyContin. However, by 2007 it was too late for many Americans – the Opioid Epidemic was underway. The epidemic not only affected white Americans, but primarily white Americans.  In fact, approximately 90% of those who tried heroin for the first time in the past decade are white.  

     Opioid addiction seldom begins with heroin. Powerful prescription opiates like OxyContin are gateway sedatives for heroin use. Once a prescription runs out, or the effects are no longer effective enough in easing addictive tendencies, an addict may turn to heroin — which is in seemingly endless, illegal supply.  Thus, by 2007 many Americans found themselves with a heroin addiction that had begun with an opioid prescription to treat post-op or some other pain. Today, OxyContin not only is still prescribed, but it is often accompanied by several other prescription opiates, such as Codeine and Fentanyl.

     As the 90’s brought about a surge in opioid use across all demographics, but primarily white Americans living in suburbs, there was a shift in mentality from an approach based on prosecution to one based on rehabilitation. President Trump seems more inclined than past administrations since to tackle the opioid issue. As he has publicly stated, his plans for tackling the opioid epidemic are aimed more at aiding those who are “so seriously addicted,” as opposed to meting out debilitating punishment.

     With the President’s new budget proposal, the Trump Administration plans to add $13 billion over the next two years for the US Department of Health and Human Services (HHS) to tackle the opioid epidemic. HHS has announced a five-point plan aimed at decreasing opioid use, abuse, and distribution: improved prevention, treatment and recovery services; ease of availability to overdose reversing drugs; better public health data and reporting; more research on pain and drug addiction; and improved practices and services for pain management.

     With opioid use now spanning all different ages, demographics, and socioeconomic groups, there is no doubt that a more serious and holistic response is needed to tackle this issue. However, such an issue could have been handled from the moment the dangers of opiates were known in the early 1900’s or during the opioid surge amongst inner-city communities in the 60’s. Instead, our leadership was only awakened to the effects of crippling opioid addictions when they reached primarily-white communities, including youth.

     One would be naive to assume opioid use has not reached our high schools through illegal distribution and confiscation of prescriptions. Opiates have become increasingly popular among a younger crowd through their presence in media and pop culture that is recognized and more readily accepted by today’s high school students. After speaking with an old high school teacher, I was saddened, yet not surprised, to hear that students at my alma mater are bearing the effects of the Opioid Epidemic. As she pointed out, there are some students she has noticed who have “gone beyond the occasional pot smoking,” and onto more serious substance abuse, to which she believes rehab is the only solution. Thus, it is important that our government is now tackling this issue in a more systematic and rehabilitative way, but it should never have gotten this far.

     As Americans, we can no longer stand by and watch members of our society fall victim to the damaging and sometimes fatal effects that accompany opioid use, which is most often induced by Big Pharma and care providers who resort to prescribing addicting opiates — ironically, the people who are supposed to keep our health and welfare in their best interest. As Americans, we must champion the idea of ending the Opioid Epidemic, despite such action being overdue. To be a Democratic Republic, there needs to be a symbiotic relationship between our elected officials and We, the People. Lets move past past our right-leaning or left-leaning ideology and take some responsibility for Americans, who might be sitting next to us at work or in class, suffering from addiction. To progress together, one thing we can and must do is restore all members of our society to a drug-independent state.    


References

  1. Randolph, S. (2017). The Opioid Epidemic. Workplace Health & Safety, 65(12), 624.
    http://journals.sagepub.com.proxy.bc.edu/doi/pdf/10.1177/2165079917733753
  2. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
  3. http://www.drugfreeworld.org/drugfacts/crackcocaine/a-short-history.html
  4. http://statelaws.findlaw.com/massachusetts-law/massachusetts-heroin-laws.html
  5. https://www.theatlantic.com/politics/archive/2015/08/crack-heroin-and-race/401015/
  6. http://www.phillytrib.com/news/health/the-forgotten-opioid-epidemic-african-americans-and-heroin/article_7903ffc9-9f8c-5d2c-88a7-26b36952dc6d.html
  7. https://www.cnn.com/2017/10/26/politics/donald-trump-opioid-epidemic/index.html
  8. https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html
  9. https://www.cbsnews.com/news/opioids-drug-overdose-killed-more-americans-last-year-than-the-vietnam-war/
  10. https://www.cnn.com/2016/05/12/health/opioid-addiction-history/index.html

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