The Opiate Epidemic
Video Courtesy of Washington Post
The child tugs at her mother’s hand but cannot wake her. This tragic display was filmed by bystanders and went viral on YouTube in mid 2016. For some it was their first encounter with the horrific opioid crisis crippling America, but for many, news stories like this are something that we as Americans observe in our society. The opiate problem has affected us for centuries, but it wasn’t until recently we started to do something about it in a serious way.
I first noticed this problem when someone close to me became addicted to heroin. I became interested in solving this problem after I realized thousands of other families were affected by this problem. I chose this topic because I wanted to be able to craft and share a possible solution to this crisis.
Opiate use is a long standing problem in the United States. In fact, opiate use can be traced back to the Mayflower voyage in 1620, when the physician Samuel Fuller began overprescribing laudanum, which is fermented opium water (“Johns Hopkins Hospital Bulletin”). From the Colonial Era of America all the way up to the Progressive Era we see opiates being used in excess, whether it is for recreational or medical use. Despite many studies conducted throughout the late 19th century, it wasn’t until the early 20th century that the government began to take action against the heavy use of opiates (Institute of Medicine Committee on Opportunities in Drug Abuse Research). Around this time, in the 1890s, we also see a wave in opiate use throughout the country. Previously, there were two other spikes in use after doctors had once again, overprescribed opioids in the Revolutionary and Civil Wars. This third epidemic can be traced back to the creation and mass-distribution of heroin, by Bayer, a German pharmaceutical company (Stobbe). After the 1920s, there are two more notable spikes in opiate use. The first is the Vietnam War, which was the first time an epidemic had been started by recreational use from overexposure to opium throughout Vietnam (Stobbe). The second is the epidemic we are experiencing today. It started in the 1990s, shortly after the public release of OxyContin. In the early 1990s the number of painkiller prescriptions increased by 2 to 3 million per year. After the release of the painkiller OxyContin in 1995, the number increased to 8 million prescriptions per year (Moghe). While from 2012 to 2016 there was a drop of 46 million opiate prescriptions filled, there was still a substantial 236 million prescriptions filled in 2016 (“Opioid Crisis Fast Facts”). In addition to prescription opioids being abused, people also use opioids obtained from illegal sources. Along with stronger, synthetically produced opioids, there has also been an extreme increase in opium importation, especially from Afghanistan. In 2017, opium production increased 87%, to about 9000 tons. 47% to 55% of this 9000 tons is estimated to go towards heroin production (Woody). In 2016, the overuse of opium killed about 116 people across the country everyday, whether it is prescribed or bought illegally (“Opioid Data Analysis”). Though often under discussed, the opioid epidemic is just as serious as any of the other issues facing America today.
The Causes of the Problem
The Medical Industry’s Part
As mentioned above, pharmaceutical companies are responsible for many of the mentioned epidemics. Throughout history, there is a trend of doctors overprescribing opium to their patients. The doctors claimed that opium was the miracle drug: it fixed any problem, from trouble sleeping to having a mild headache! So naturally, doctors began excessively giving it out to society, unknowingly creating a whole generation of opium addicts. Its uses were extensive, it was in sleep medicine for babies and was used to help our Founding Fathers with everyday health problems. Not until the late 19th century, when research about addiction was conducted, did doctors first start to get regulated. An abundance of medical essays were written to spread the news that opioids form crushing addictions, cause health complications, and that the heavy, nonchalant use of them should end (Kane). Since these essays began to rise to prominence, physicians began releasing papers in opposition to these essays that stated opiates were not addiction forming. After heavy debate, many people accepted the fact that opioids were extremely addictive, and with almost perfect timing, Bayer released the new, non-addictive opium replacement, heroin. Heroin became Bayer’s best selling product and thanks to later research upon the drug it was declared extremely more addictive than opium. In fact, it started so many problems, that one the US’s first laws towards drug regulation was made specifically to declare heroin illegal with the Heroin Act of 1924 (“The National Alliance of Advocates for Buprenorphine Treatment”). Flash forward 70 years, we see that once again, the pharmaceutical industry introduces another epidemic. Purdue Pharma, a pharmaceutical company in Connecticut manufactured OxyContin which, similar to heroin, was praised as a medical breakthrough. Instead of having to take several painkillers in one day, you only have to take OxyContin once every 12 hours. This longer lasting high also means greater draw backs. Not only is the drug dangerously addictive, but it is also easier to abuse. It is prescribed for mild to severe pain and is also manufactured in enormous quantities. Like many other pharmaceutical companies, Purdue Pharma has been accused of creating the drug solely for the sake of profit. In fact, so many fingers are being pointed at these large corporations that 41 states have decided to investigate these companies. Purdue Pharma is one of the accused companies (Noguchi).
The Stigma and Punishments Toward Addiction
Here is a video that I believe does a great job of explaining the problems with society’s view of addiction and how to deal with drug problems.
Video Courtesy of Ted Talks
In the video, Johann Hari, author of famous book Chasing the Scream, explains that almost every country in the world treats addicts as criminals. This especially holds true in America. Throughout our history of drug enforcement, we see, whether a dealer or addict, harsh punishment and often times imprisonment. While harsh punishment may be planned for a distributor, it is vital that it is the opposite for an addict. As seen in the video, he quotes a scientific experiment where rats are shown to drink the non-opiate laced water when they have healthy connections and relationships to others and are not isolated. By imprisoning an addict, all the Justice Department is doing is furthering the addict’s disconnection from the rest of society. Also when they are released, they will have a criminal record which only repels them further from society because they will always be seen as a degenerate. Scientific research has shown that addiction is a disease that requires treatment, not punishment.
The Problems with the Programs and Methods of Sobering Addicts
America has rehabilitation centers who aim to help addicts, but they are deeply flawed. The first major flaw is undertrained staff. The staff at these rehabilitation centers are often poorly educated, “In many states, they are not even required to have a college degree” (Szalavitz). There is also a problem with the availability of treatment. Many treatment centers only exists in densely populated areas leaving rural addicts in a difficult position with nowhere to go. Many addicts don’t have the means to drive to the nearest treatment place. For example, the state of Nevada has an extremely high rate of opioid overdose, yet very few treatment centers are located outside of major cities (“Drug Overdose Death Data”). Even if an addict can make it to a treatment center, they are still faced with the problem of isolation. As mentioned in the above video, living creatures thrive when they are part of a community, however treatment centers work to isolate the patient. Similar to the rats mentioned in the video, addicts would most likely become drawn to the drugs and fall back to their old habits. For treatment centers to be effective, they need to address these problems and evolve into a productive program to help opioid addicts. I believe my solution will ameliorate these issues.
The three maps below show the scarcity of rehabilitation centers throughout the country. The bottom two include the highly supported use of Medication-Assisted Treatment instead of quitting abruptly, which leads to extreme withdrawal symptoms. The key next to the map indicates the amount of the certain types of facilities per county.
All Substance Abuse Facilities
All Substance Abuse Facilities Offering Medication-Assisted Treatment
All Substance Abuse Facilities Offering All Three Forms Medication-Assisted Treatment (Methadone, Naltrexone, and Buprenorphine)
Photos Courtesy of Health Affairs
This is a graph of data obtained by an experiment conducted by Harvard University showing that Medication-Assisted Treatment is an effective method of rehabilitation.
Photo Courtesy of Harvard University
I have designed a plan that I believe would address these problems with current treatment facilities, which would lead to an overall decline in opiate use. Currently, there are many private and public rehabilitation centers. First of all, I believe that these rehabs need to take better precautions and approaches to getting addicts clean. These changes include, better financed, government supported facilities with better trained employees. Within these treatment centers there would also be a system that would reintegrate addicts into society. The system to integrate the addicts back into society is much like Delancey Street Foundation’s strategy, which pairs treatment with work programs. If these centers ran businesses such as restaurants, landscapers, and even a moving company, they can become almost self-sufficient. This strategy is also a great way to help bring isolated addicts back into the community, which would address rehabilitation.
The second part of this system is the placement of these centers. I believe if these centers were located in specific areas throughout the US, it could drastically help the addicts throughout America. If you look at a map of opiate use throughout the US, you see many of the more rural, midwestern, and southern states being greatly affected by this epidemic (“Drug Overdose Death Data”). I attribute these statistics to the poor medical treatment that they have and new, higher quality centers would help decrease opiate use in these areas. Additionally, in these rehabs there would be access to medication-assisted treatment, which is a prominent form of replacement therapy. Replacement therapy is when an addict takes a less severe form of the drug they are addicted to and slowly ween themselves off. This method prevents withdrawals, which can lead to severe symptoms such as vomiting, insomnia, anxiety, and even death (“Opiate and Opioid Withdrawal”). I believe my solution addresses the three major problems within current drug rehabilitation centers.