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The Opioid Epidemic

Why I Chose the Opioid Epidemic

I chose the topic of the opioid epidemic for my sophomore research project because it reveals and emphasizes just how prone people are to addiction and the way specific addictive substances can affect entire communities. Recently, opioid addiction has blown up all over the United States, and concern about it  is one of the main topics of discussion in the news, medical circles and politics. Even before the discussion of the research project came up I was already thinking of what I could write about. I then began thinking about how every single morning while driving me to school, my mom would put on the radio and I’d hear news about the opioid epidemic. For the past month I have heard the word “opioid” at least once a day. At first, I wasn’t sure about what exactly an opioid even was and decided to simply block out what I had been listening to about it. But after exploring just a little bit more about the issue, I discovered that the magnitude of this epidemic is bigger than I could have ever imagined.

What is the Opioid Epidemic?

It has taken over America, kills more 64,000 people each year, and although it has been acknowledged as a huge problem in the US, it continues to grow. The opioid epidemic kills more people than guns or AIDs, yet little has been done to prevent this crisis. According to the National Institute on Drug Abuse, opioids are a class of drugs that include pain relievers such as morphine and oxycodone as well as other drugs such as fentanyl and illegal heroin. Below is a series of pictures of the United States showing how rapidly the number of deaths due to opioids has grown from the 1999 to 2014, with the red blotches representing the areas with the most fatalities:

Growth of deaths due to opioids in the US over a period of 15 years.

Background of Opioids: 

According to New York Times’ Maya Salam, the rate at which these overdoses are killing people is faster than that of the H.I.V. epidemic at its peak. In 2017, 38,440 people were killed from guns, 40,200 died due to car accidents, but an astonishing 64,026 died because of painkiller overdoses (Salam)

When hearing the word “opioid,” many people may think of opium, the addictive, milky sap that is derived from the opium poppy. The cultivation of opium dates back all the way to around 3400 B.C. in Mesopotamia. This harvesting of the opium poppy spread to the ancient Greeks, Persians, and Egyptians, who used the sap from this flower to help people sleep, relieve pain, and even calm children (History). During this time, they were not aware of the addictive nature of the opium poppy (History). During the 6th or 7th century A.D., opium was introduced to China and East Asia along the Silk Road, which connected the Mediterranean cultures of Europe to central Asia, India and China (History). In 1803, German scientist Friedrich Sertürner first isolated morphine from opium  – in its purest form, it is 10 times stronger than opium (History). Morphine was used on US soldiers during the Civil War to relieve pain, and as a result, over 400,000 men became addicted to the opiate (History). In 1874, English chemist Alder Wright first refined heroin from a morphine base in search for a less addictive form of morphine. Heroin was then used in medicine until the early 1900s, when its addictive properties became known and addiction to the drug shot up (History) .

Below is a quick video discussing facts about the opioid epidemic: 

Why Are Opioids So Addicting? 

It is very easy to get addicted to opioids, therefore anyone who takes this drug for more than the prescribed amount of time is very prone to addiction. Ever since Sumerians discovered the opium poppy plant in 3,400 B.C., opiates have been used not only to treat coughs and induce sleep, but also abusively to get high. Traveling a bit into the future, doctors have manipulated these opiates to create opioids, which include common drugs such as morphine, codeine, oxycodone, and heroine. But what makes opioids so addicting?  

When the user takes opioids, a flood of artificial endorphins and dopamine is produced, causing the said user to feel happy and satisfied.  However, this wave of euphoria is not natural and so unlike any high that can be felt normally, that the person will want to take more opioids to once again achieve that feeling. But once opioids are taken again and again, the brain will not be able to produce endorphins and dopamine without the help of the drug. 

In addition to the high that opioid users experience when taking the drug, there is also a correlation between depression and opioid use. According to Kathleen Smith of PSYCOM, the relationship between depression and opioid abuse is bi-directional, meaning that suffering from one increases the risk of suffering from the other (Smith). However, the real question is whether those who use opioid go into their addiction are already burdened by depression, or if they fall into depression because of their addiction. Smith states, “In one study at St. Louis University, researchers found that 10% of over 100,000 patients prescribed opioids developed depression after using the medications for over a month. These patients were taking the medication for ailments such as back pain, headaches, arthritis, etc. and had not received a diagnosis of depression prior to treatment” (Smith). Due to this study, we can infer that it more likely the patient develops depression because of their use of opioids, rather than using opioids to get rid of their depression. 

Who is Affected Most by the Epidemic?

Although the opioid crisis has been known to affect the entire nation, there are certain communities in which the crisis hits hardest. According to Andrew Kolodny during his interview on NPR, the opioid epidemic has proven to be “overwhelmingly white”. When asked why the epidemic has spared blacks and Latinos, Kolodny answers, “Something that we do know is that doctors prescribe narcotics more cautiously to their non-white patients. It would seem that if the patient is black, the doctor is more concerned about the patient becoming addicted, or maybe they’re more concerned about the patient selling their pills, or maybe they are less concerned about pain in that population. But the black patient is less likely to be prescribed narcotics, and therefore less likely to wind up becoming addicted to the medication. So what I believe is happening is that racial stereotyping is having a protective effect on non-white populations” (Kolodny). In short, the reason why blacks and Latinos have been spared by this ever-growing crisis is due to racial discrimination. Kolodny goes on to say that this drug epidemic is way different than the cocaine outbreak that the US witnessed in the 80s and 90s. Kolodny states about the cocaine outbreak, “What we saw from policymakers, what we got from policymakers was a message that we could potentially arrest our way out of the problem” (Kolodny). Now that the opioid crisis is mostly white, policymakers say we can no longer arrest our way out of this problem (Kolodny).  

What Can We Do to End the Opioid Crisis? 

So, how can we solve this epidemic that has completely overtaken America in the past few decades? And if we do manage to suppress the issue, how can we make a dent large enough to deter future generations from addiction and overdoses? The answer does not come with ease, as we cannot simply cut off the supply of opioids to the public. This would mean, as stated in the previous paragraph, that those who are experiencing extreme pain and who are in real need of opioids would be without relief. The biggest problems with how the country is dealing with the crisis are, according to Keith Humphreys, a Stanford University drug policy expert, the issues of “stock” and “flow” (Lopez). Change needs to happen soon, because in a statistic produced by STAT news, if the opioid crisis goes unsolved, more than 650,000 people will die from overdosing – more than that of Baltimore’s entire population (Blau).

The first step would be to allow Medicaid to start paying for treatment at large institutions for mental disease (Cunningham). Currently, the “IMD exclusion” policy prohibits the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds (LAC). The main focus of the crisis is how to ease patients off of their addictions to opioids. But with the IMD exclusion policy still in order, there is no immediate solution to this problem. Therefore, the first step in pushing back the opioid epidemic is removing the IMD exclusion.

In addition, something would need to be done about the way doctors have been wrongly prescribing opioids to their patients. In a study by the National Safety Council, about 67% of doctors have been found to base their prescribing decisions solely on patient expectations, not what is medically correct (Teater). This means that doctors are deliberately prescribing opioids in opposition to the suggested amount of time that they should be prescribed, which is 3 days. In the same study it was also found that 74% of doctors incorrectly believe that opioids are the best and most effective way of treating pain (Teater). If this stigma can be proven wrong, doctors would have no need to feel obliged to give their patient opioids, and can instead offer a safer form of treatment. 

 

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Bibliography 

1. Benson, Thor. “The Surprising History of Why Opium Is Illegal.” ATTN: ATTN: 14

            June 2015, www.attn.com/stories/1934/why-is-opium-illegal.

2. Blau, Max. “STAT Forecast: Opioids Could Kill Nearly 500,000 in U.S. in next

           Decade.” STAT, 30 June 2017, www.statnews.com/2017/06/27/opioid-deaths-forecast/.

3. “Heroin Overview : Origin and History | Methoide.” MethOIDE – Methamphetamine

            and Other Illicit Drug Education, methoide.fcm.arizona.edu/infocenter/index.cfm?stid=174.

4. “Heroin.” Wikipedia, Wikimedia Foundation, 29 Jan. 2018, en.wikipedia.org/wiki/Heroin.

5. Johnson, Steven Ross. “CDC Opioid Prescribing Guidelines Unlikely to Affect

           Physicians’ Practices.” Modern Healthcare, 15 Mar. 2016,

           www.modernhealthcare.com/article/20160315/NEWS/160319936.

6. Kolodny, Andrew. “Why Is The Opioid Epidemic Overwhelmingly White?” NPR, NPR, 4 Nov. 2017,  

             www.npr.org/2017/11/04/562137082/why-is-the-opioid-epidemic-overwhelmingly-white.

7. “Opiate Addiction | What Are Opiates & Why So Addictive?” The Recovery Village, www.therecoveryvillage.com/opiate-     

              addiction/#gref.

8. Physicians’ Practices.” Modern Healthcare, 15 Mar. 2016, www.modernhealthcare.com/article/20160315/NEWS/160319936.

9. Lopez, German. “How to Stop the Deadliest Drug Overdose Crisis in American History.” Vox, Vox, 1 Aug. 2017,

           www.vox.com/science-and-health/2017/8/1/15746780/opioid-epidemic-end.

10. Salam, Maya. “The Opioid Epidemic: A Crisis Years in the Making.” The New York Times, The New York Times, 26 Oct. 2017,

11. Smith, Kathleen. “Depression and Opioid Abuse: How Painkillers Affect Your Mental Health.” PsyCom.net – Mental Health

           Treatment Resource Since 1986, www.psycom.net/depression.central.opioid.abuse.html.

12. Teater, Don. “Prescriber Attitudes and Behavior Related to Prescription Opioid Pain Medication.” National Safety Council,

           2016.

Photo Sources

1. “#Opioids.” Diaspora* Social Network, framasphere.org/tags/opioids.

2. Park, Haeyoun, and Matthew Bloch. “How the Epidemic of Drug Overdose Deaths Rippled Across America.” The New York  

            Times, The New York Times, 19 Jan. 2016, www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-

            us.html.

 3. “The-Opium-Poppy-Papaver-s-007.” Ancientfoods, 28 Jan. 2016, ancientfoods.wordpress.com/2016/01/28/philistines-    
             introduced-sycamore-cumin-and-opium-poppy-into-israel-during-the-iron-age/the-opium-poppy-papaver-s-007/.
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COMMENTS: 4
  1. April 27, 2018 by Jonathan.DeMiguel Reply

    Great job! Your visuals were really effective and your data is really interesting. I wonder how many people are using both prescription and illicit opioids.

  2. April 29, 2018 by Ellery Reply

    Wow! Your presentation was really powerful. The visuals were helpful. The racial ties and the contrast to the cocaine epidemic were fascinating.

  3. April 30, 2018 by Caroline.Herzfeld Reply

    You have so many great interactive things here! So many great pictures, videos, and even a survey. Nothing looks out of place and it all flows so perfectly! I’m jealous of how well you were able to put your page together. You also give such clear information and present it in such a way that the audience can easily stay engaged. This topic is also very intriguing.

  4. May 01, 2018 by Lauren San Martin Reply

    I really think this was a powerful presentation with the stats you mentioned and the visuals that really explained the epidemic. I think overall one of the most shocking things for me was the rate at which the overdoses are killing people, is faster than that of the H.I.V. epidemic at its peak. But I think ultimately this was a really good and impactful presentation!

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