Painkillers have been used in medicine for centuries, some believe dating all the way back to prehistoric times. Opium poppies were harvested and their pods were consumed, or the sap was smoked, but as science advanced specific substances were derived from the plant. At first morphine and codeine, two chemicals found naturally in the poppies, were isolated in 1804 and 1832 respectively. These two are classified as opiates, which are drugs derived directly from the poppy plants. Opioids, which were first introduced later in the 19th century and as recently as 1959, are chemicals similar to opiates despite not being derived from the poppy plant. These include, but are not limited to: hydrocodone, oxycodone, methadone, tramadol, oxymorphone, fentanyl and heroin. While killing pain was the biggest reason for prescribing them, they were previously used for diabetes, anxiety and depression until the 1950’s when better specialized drugs were introduced to the market.
Though these drugs were previously seen as miracle cures, today there's an opioid epidemic killing far more than any drug epidemic in U.S. history. While drugs as a whole, mainly marijuana and illicit prescription pills, have risen in the past decade, opioids have seen a far greater increase. For reference, two in 100,000 people died from the crack cocaine epidemic during the 1980’s, while opioids have killed ten for every 100,000 in 2016. So what exactly is causing the insane increase of use and deaths? While there isn't one specific cause for the entire epidemic, multiple factors from different regions of the country contributed to the current crisis.
The earliest factor was a large increase of prescriptions of painkillers during the 1990’s, due to 100 million (about a third) of citizens being diagnosed with chronic pain. This was a major problem in and near the Midwest, namely Kentucky and Ohio, and in Florida, which have all seen overdoses quadruple in the past fifteen years. When these patients gain a tolerance to these drugs, they will find their month-long prescription lasts only three weeks. Because they've been prescribed pain killers long enough to gain a tolerance, they're also physically addicted and begin to go through withdrawals. They vary from person to person and, more so, depend on the strength of the opiate, but it can be described like the flu; stomach problems, fever, cold sweats, fatigue, and loss of sleep are all common. Because of their tolerance, they'll either buy more pills on the street or, usually months into an addiction, turn to the cheaper alternative: heroin.
As you can see in the map above, southern states and the west coast became a huge problem for opioids. The increase in painkillers meant more people were turning to heroin, which meant a huge profit for Mexican cartels. During the mid 00’s, heroin trafficking and production increased from 8 tons in 2005 to 50 tons in 2009. The southern states, being near or on the border, proved less of a risk to smugglers and got hit hard. California is one of the major hubs for cartels, partly due to more relaxed laws on illegal immigrants compared to other border states. They might not have an epidemic when taking the deaths per person into account, but they have the most overall overdoses (considering they have the largest population). And since Oregon and Washington aren't far off, heroin is easily smuggled into any west coast state.
Through cartel hubs, the heroin is then moved from states like Texas up and into the Midwest and east coast. We know that the Midwest has a pill problem that started in the 90’s, but what makes it so popular in the east coast? The answer is the exact same. While their pill problem was smaller compared to the Midwest, heroin rose in popularity before it gained steam elsewhere. Instead of Mexican cartels though, African and Asian countries were supplying heroin that was far more pure. Due to this, the east coast was known to have a heroin problem since the late 90’s, with Baltimore, Maryland being called the heroin capital.Since the cartels saw this as a money making opportunity, they began producing comparably pure heroin along with the low quality version. In general, the higher quality goes to the east coast while the lower goes to the west.
The amount of heroin being brought into the U.S., along with the large amount of prescriptions, was alarming enough that the FDA attempted to restrict opioid usage by changing all painkillers, excluding tramadol and small amounts of codeine, from Schedule III to Schedule II. This meant that the drug had an accepted medical use, but the risk of addiction was high and a physical or psychological dependency took place. This means that doctors are less likely to prescribe them and patients must see their doctor for a refill, a burden for practitioners and patients in pain. Though they assumed this would lessen the amount of painkillers, the table and chart below show that the exact opposite happened. Please note that a 0 does not mean no one died from opioids that year, but that the data for that year was withheld.
|Year||Deaths||Population||Prescriptions by US Retailers (millions)||Death Per Person|
In conclusion, the rapid growth of overdoses has brought the issue to a national level. Though the data stops at 2014, the numbers keep rising every year. Addiction is slowly being seen as an illness rather than a fault, as clean needle exchanges and methadone clinics have increased. Naloxone, a drug used to kill opioid highs during an overdose by paramedics, has become more readily available over the counter. Though politicians and legal experts are looking for a way to combat the problem at the moment, it’s possible it may just worsen the problem. Hopefully we will see these numbers going down in the near future, but until then, stay away from opioids (and if you’re prescribed them, take them cautiously and as needed).