A closer look at the chronology and science behind the worst drug epidemic in American history
In the United States, opioid misuse kills over 190 people every day—a rate of roughly 21.7 deaths per 100,000 people in 2017. Here in Canada, the numbers are slightly less dire: since January 2016, an estimate of over 9,000 deaths related to heroin, fentanyl, and other opioid drugs have been reported—a rate of 10.9 per 100,000 people in 2017.
A bit of history
The painkilling properties of opium (the natural form of opioids) have been well-known since ancient times. In fact, the famous Greek physician Hippocrates documented the useful medicinal properties of opium, which is derived from poppy flowers. Since the late 18th century, opium has been prescribed as a painkiller by physicians in North America under the medical label “morphine,” mainly for treating wounded soldiers or terminally-ill patients. But how did the use of these painkillers come to escalate into daily tragedies related to heroin and street drugs laced with fentanyl?
The roots of the current opioid crisis in North America can be traced back to the 1990s: data published by pharmaceutical companies falsely convinced the medical community that using opioids for pain management would not lead to addiction. Consequently, the number of opioid prescriptions rose sharply. The easy access to opioids and their liberal prescription soon led to its use for recreational purposes, causing many cases of drug abuse and misuse: 80 percent of heroin addiction cases started with the misuse of legal prescription opioids.
More recently, synthetic forms of opioids have emerged (mainly from illegal labs), such as heroin or fentanyl. The latter is 100 times more potent than traditionally prescribed morphine. In 2017 alone, fentanyl overdoses killed nearly 30,000 people in the United States, earning it the grim title of “Deadliest drug in American history,” according to the Centers for Disease Control and Prevention (CDC).
A bit of science
Why does heroin or fentanyl trap so many young people in a bottomless spiral of addiction? What makes opioid dependence excruciatingly difficult to overcome is the fact that these drugs literally rewire the human brain—slowly, but permanently.
At first, “it’s like being hugged by Jesus,” a 24-year-old woman with an addiction to heroin reports. Others who have experienced heroin addiction cite intense relief, ecstasy, and an unparalleled sensation of wellbeing.
This intoxicating euphoria is due to heroin’s ability to stimulate the brain’s reward centres. The structure of opioid molecules resembles that of an endorphin, which is the body’s own natural narcotic, usually released following physical exercise—which is why a good workout helps relieve stress! By binding neuronal receptors, endorphins signal the release of “feel-good” hormones such as dopamine, which is also released in large amounts when eating chocolate or having sex. By hijacking these brain receptors, opioid molecules are able to arouse similar yet even more powerful sensations of pleasure.
However, this effect soon wears off, bringing the user back to a basal state which, in comparison to the “high,” suddenly appears much duller than before. Problems and worries re-emerge. Even worse, things that were previously enjoyable, like having an ice cream or watching a good movie, might now seem bland compared to the euphoria that only drugs can procure.
Little by little, the repeated use of opioids tilts the brain’s delicate biochemical balance and progressively leads to drug tolerance. In other words, brain receptors become less and less sensitive to the presence of opioid molecules, requiring a higher dose to create the same feeling of satisfaction.
So why can’t one simply quit opioids cold-turkey before things get out of hand? For someone whose body has become used to these drugs, sudden withdrawal not only leads to psychological symptoms, but also manifests itself physically: pain, spasms, vomiting, and diarrhoea add to debilitating anxiety and depression. The misery of withdrawal often feels so unbearable that the only solution can seem like getting another fix—and quickly. Thus, the vicious cycle of dependence continues until doses become so large that the body cannot handle them anymore.
It comes without surprise that an opioid overdose can be fatal: the drug’s property as a depressant slows down respiration and lowers blood pressure. This can lead to coma, permanent brain damage, cardiac or respiratory arrest, or death.
Of course, above is but an oversimplified plotline of opioid dependence—all is not hopeless for those who do experience heroin addiction. With proper help in treatment centres, a supportive group of peers, and a huge amount of willpower, recovery is certainly possible, but the process may take years.
So, what next?
In an effort to address this national health crisis, the United States Congress has passed the Opioid Crisis Response Act of 2018, which allocates a portion of the federal budget to improving access to addiction treatment or therapy, raising public awareness as a preventive measure, and boosting cutting-edge research to develop new non-opioid pain medication.
Similar measures on a smaller scale have been taken in Canada, with an emphasis on public education. Also, naloxone kits can now be obtained without a prescription at most pharmacies and are even available for free at certain locations. If administered in time, naloxone can temporarily reverse the symptoms of opioid overdose and save a life, without any risk of creating dependence.
It is crucial to acknowledge the complex and often invisible social issues fuelling the ongoing crisis; isolation or socioeconomic disadvantage are factors that put people at a greater risk of drug abuse. Furthermore, the overall aging population in the Western world means that end-of-life palliative care (including pain management) will become an increasing concern in medicine.
Perhaps treating the glaring symptoms won’t be enough. For the opioid crisis to be eradicated, root causes like economic inequality and other social disadvantages must be addressed.
Comments are closed.