Professor Susan Rockwell
English 102 - Lesson 11
16 September 2021
America Under Siege: Combatting the Opioid Epidemic
Opioid addiction does not differentiate between race, age, gender, or economic status and has ruined countless lives and to fight this enemy Americans need to band together to help those afflicted by addiction within our society to help end this deadly epidemic. It would be difficult to find someone who does not have any connections with addiction. Not necessarily direct exposure such as personal addiction or loved ones that have fought addiction. This includes every aspect of life. Everyone has come into some type of contact with someone who has had their life path altered because of addiction.
Opiates are drugs derived from opium which is well known for abuse and dependency and consist partially of morphine, codeine, heroin, thebaine, and papaverine. Opiates are used for the treatment of moderate to severe pain, usually prescribed after surgery or serious injuries. Common symptoms of opiate use are exhibiting euphoria, drowsiness, nausea, slurred speech, constricted pupils, and respiratory depression. Opiates create these symptoms by attaching to opioid receptors in the brain creating these feelings at a high level. Over time, users cannot achieve the same effects through natural means and need opioids to achieve this. Through continued use, the user develops a tolerance and requires more of the opioid to achieve the same effect. This causes the user to be dependent on opioids both mentally and physically. When the user attempts to stop using opioids they suffer withdrawal symptoms consisting of severe muscle aches, bone pain, tearing, runny nose, yawning, diarrhea, abdominal cramps, agitation, anxiety, and sweating. These symptoms are amplified depending on how long and how much the user has been using (Wang. 2019).
Opioids are and their history throughout the world to truly understand the grasp these substances have had on societies throughout time. Opium, which opioids are derived from is created from poppy plants. As early as 5000 B.C. in Sumerian there are references to the use of the poppy and is referenced as "it plants of happiness" (Aragon-Ponce, et all. 2002). In addition to Sumerians, the poppy and opium are referenced throughout history and in many different cultures. In Greece, around 300 B.C. was the first reference time that poppy was referenced as a narcotic. Roman poets wrote about the use of opium as many things to include a pain reliever before surgery. Interestingly, Islam used opium to primarily treat diarrhea after the fall of the Roman empire. During the renaissance period to the ninth century, opium was used as an analgesic during surgical procedures (Aragon-Ponce, et all. 2002). It is obvious that opium's benefits were widely known throughout a diverse group of civilizations, and it has been a part of society for at least 7,000 years.
So, what is the opioid epidemic? It began in the early 1990's through multiple physicians and pharmaceutical companies working to change physicians' views regarding the risk of addiction. Russell Portenoy was one of the most influential figures in this crusade. Portenoy was a well-respected neurologist who received the pseudonym of the "King of Pain" and campaigned that to not treat pain amounted to medical negligence. Because of people like Portenoy, by 2011 although the United States comprises only 5% of the worldwide population it accounted for 75% of the worldwide opioid prescriptions (Gale. 2016). This massive increase in prescriptions was fueled by people like Portenoy writing articles and speaking at lectures downplaying the addictive characteristics of opioids, reporting the risk of addiction low. This altered physicians' views regarding the risk of addiction which they previously held and opened the floodgates for the opioid epidemic to begin.
So, what would make a man condemn a society to opioid addiction? Most have heard the common phrase "everyone has their price", and it should come as no surprise that money was the drive that allowed Portenoy to put his humanity and scruples aside and doom generations of Americans to fight with addiction. Pharmaceutical companies invested millions of dollars into Portenoy's pain center, and he admitted to being financially compensated by dozens of pharmaceutical companies to push their products and convince the medical community that there was minimal risk of addiction and that opioids were safe to prescribe. Portenoy admitted that he misled the audience in his lectures by downplaying the addictive qualities of opioids. His greed was so deep he was quoted as saying "My viewpoint is that I can have these relationships [and] they would benefit my research mission and to some extent, they can benefit my own pocketbook, without producing in me any tendency to engage in undue influence or misinformation." (Gale. 2019). This greed led to an increase from opioid prescription-related deaths to approximately 165,000 from 1999 to 2014. A staggering price for society to pay for a few individual's greeds.
Of course, to suggest that one man was the cause of this epidemic is ridiculous and there are many others who through their actions doomed generations of Americans for the sake of a payday. Possibly the biggest contributor to this epidemic are the pharmaceutical companies themselves. After all, who is going to benefit the most from these opioids being prescribed in large amounts? Pharmaceutical companies have been fined millions of dollars for their unethical practices and the damage that they have caused to society. For example, the creator of a popularly abused opioid, Oxycontin has been fined over 600 million dollars in fines for its practices to entice physicians to prescribe their product through financial payments or misleading marketing. Purdue Pharma's misleading information of the addictive qualities of their products led to three of their chief executives being criminally charged. (Gale. 2016). Can you imagine the magnitude of the violations it took for a company with a seemingly endless supply of financial means to fight these allegations, to have three of their executives personally held liable?
Pharmaceutical companies routinely send representatives to physicians' offices throughout the country to promote their products, but these companies overstepped the rules of the promotion of opioids. This practice is referred to as "direct-to-physician marketing and has been associated with increased use and overdose deaths. In a recent study by Scott Hadland M.D., Hadland determined that pharmaceutical companies targeted 78,507 physicians across 2,208 counties and spent 39.7 million dollars on non-research-based marketing dollars. This is a staggering amount to spend on marketing without the expectation of a large return on the investment. In this study, Hadland determined that pharmaceutical companies focused their marketing campaign on counties with higher high school graduation rates, both lower and higher median household incomes, and greater unemployment rates. Marketing is big business and the demographics chosen for a particular campaign are developed through extensive research to reach the audience who is most likely to use this product. In this case, pharmaceutical companies were giving physicians money or goods to coerce them to push their product ("Direct-to-physician opioid marketing linked to overdose deaths."2019). As I mentioned earlier, these companies spend millions of dollars on marketing, and they would not do this without the expectation of substantial returns on their investments. Luckily the more studies and research that are completed on the causes of this epidemic will prevent it from expanding and stop future drug epidemics. If only this was true, but unfortunately, we don't always learn from our past mistakes. After all, this is not the first drug epidemic that America has dealt with.
Interestingly, this is not the first time America has encountered an epidemic with opioids and it is apparent that as a society we have not applied the lessons learned. An article titled "A Beautiful Opium Eater" from a newspaper in 1877 chronicled the death of a prominent 33-year-old Seattle socialite which was caused by her addiction to morphine, which is also a derivative of opium which is made from the poppy plant. The fact this article was published during this time presents evidence of how prominent of an issue the drug epidemic was during this time. Surprisingly the origins of the 1900's epidemic share the same many of the same characteristics of the current opioid epidemic. Then like now, physicians were directly marketed to, and this may have contributed to overprescribe these medications. Of course, then like now the physicians were compensated for their pushing of the product But, unlike today these drugs were not strictly regulated and physicians were able to prescribe these potent pharmaceuticals for minor injuries. During this period, morphine was routinely prescribed for just about anything. Prescribed uses ranged from severe pain to minor aches and pains to include anxiety and minor neurological or mood issues. This trend continued for some time, resulting in countless addicts being created throughout these communities, and with the introduction and ease of hypodermic injections of morphine, the epidemic grew exponentially basically dooming whole communities to lives of addiction. To fight this epidemic the government and states contained the epidemic through legislation.
These legislations consisted of the Pure Food & Drug Act of 1906, the Harrison Anti-Narcotic Act of 1914, and the Heroin Act of 1924. The Pure Food & Drug Act of 1906 is important because it combined with the American Medical Association, which was working toward drug reform, and with the powers of this legislation, this fight was easier. Although it took several years to incorporate, this legislation required a list of accurate ingredients to be included on all food & drug items. Many are aware that Coca-Cola previously used cocaine in its products, which continued until 1903 when the company exchanged cocaine for a large amount of caffeine which misrepresented the amount of caffeine in its products. This is important because it illustrates the power of this new legislation since it sued Coca-Cola which resulted in caffeine being listed as habit-forming and forcing the company to reduce caffeine levels (Babic. 2012).
Before the Harrison Anti-Narcotic Act of 1914 there were no federal laws regarding the commerce of narcotics, with exception of the Pure Food & Drug act of 1906 which required products to be properly labeled. This act was brought about due to the efforts of Hamilton Wright who was a member of the delegation that attended the Shanghai & Hague international conferences. Wright proposed new laws that would control the sales and purchase of drugs through taxation and require vendors to register with the government. These vendors and pharmaceutical companies were against this new legislation since it would place restrictions and complications in their distribution and ultimately their bottom line. These vendors were successful in their lobbying efforts and the bill was defeated. Wright did not concede and continued to amend and present his bill throughout congress until his hard work was rewarded, and Congressman Francis Harrison worked with his fellow legislators and pharmaceutical groups to shape the bill so that it would be accepted and pass. Although, there were many compromises the bill did pass and became law. The legislation restricted the sale of opium, cocaine, its derivatives, and salts. The new law required more accurate record-keeping and record retention so the federal government could inspect them to ensure compliance with the transfer of the named drugs. Prescriptions were required, mail order medications were restricted, a tax stamp was required, and anyone who sold these narcotics needed to be registered (Padwa & Cunningham. 2010).
As a result of the restrictions created by the Pure Food and Drug Act, the narcotics covered under this bill became expensive and opened the way for heroin which was a cheaper alternative to fill the void. The government recognized the potency, availability, and addictive qualities of heroin and determined that legislation was required to address this issue. This brought forth the Heroin Act of 1924, which made the manufacture, distribution, sale, and possession of heroin illegal. In the public eye, these legislations appeared to suppress the epidemic, but the actual result was addiction being moved to the underground.
The addiction continued in the shadows until the late 1950's through the 1970's when the epidemic made it's way back into society. Although not as severe as the previous epidemic, this still needed to be dealt with. Again, the Government and State legislature enacted new legislation which created more regulation regarding physicians, and the control and distribution of pharmaceuticals. Although this worked regarding the supply of prescription medication, it caused the illegal street sales of heroin, cocaine, morphine, and other illicit drugs. The government's response to this was to create more punitive legislation which led to more incarcerations and policing. An unforeseen result of these new policies was the public shaming and negative perceptions which were cast on our Asian, Jewish, and African American citizens (Lawson. 2018). It is truly astonishing that although America was given a perfect model to gauge a response and craft quality legislation to prevent another drug epidemic from taking hold in America, we ignored the past and repeated their same mistakes.
The United States recognizes the importance of addressing the opioid epidemic and although we may not have considered the history of drug use in America, we need to determine what solutions could reduce or prevent the future spread or deaths caused by opioids. Pharmaceutical companies and physicians need to be educated and held accountable for any actions that are not in the best interest of the public and more focused on generating revenue for their companies. Fines, such as the $600 million levied against Purdue Pharma are a start (Gale. 2016). But, to be a true deterrent these fines and punishments need to be substantial enough to have a large impact on these companies.
In addition to holding these companies responsible, we need to seek alternative solutions regarding those addicted to opiates. Although, there are many programs available the main source of detergent for addicts in prison. Prison does little to treat the root of the issue which is a dependency on opioids and does nothing but warehouse these addicts and causing a financial burden on society. One possible solution is the use of medications for opioid use disorder (MOUD) and psychosocial treatments to treat opioid dependence. A typical MOUD regimen consists of methadone, an opioid receptor agonist. Buprenorphine, a partial agonist. Extended-release naltrexone, an opioid antagonist. The purpose of the MOUD is to reduce withdrawal symptoms and opioid cravings in the hopes the biological response toward future drug use will be reduced. In addition to MOUD treatment, cognitive-behavioral therapies are used. Unfortunately, due to the need for daily MOUD dosing, this system is not used to its potential. There are advances with MOUD medications with extended-release injections that could increase the use of this method (Hoffman. 2019).
Of course, treatments such as these aren't possible without society's views of addicts can transition from a position of seeing addicts as someone who uses drugs by choice, to one that sees drug addicts as someone who is afflicted with a disease. This is a contested question within the medical community with both sides having valid arguments. One issue with viewing addiction as a choice is it makes addicts feel like they are undeserving of help and thus do not seek out help. This stigma does not benefit society or the addict, it only perpetuates the issue damaging both (Howard. 2021).
In contrast, if society views drug addiction as a disease this makes the addict eligible for long-term treatment covered under health insurance as if it were any mainstream disease. This also removes the stigma that could deter an addict from seeking help. In addition to treatment options, with a more positive public opinion legislatures are more likely to support legislation that will provide funding and opportunities for not only the addicts but those close to them who are directly affected by their disease. This mindset benefits both the addict and society since it is more likely to lead to more successful treatments.
By treating addicts poorly, reflects poorly on our human nature and society as a whole. We must help the weakest of us to create a stronger compassionate society. Although, we will never save every life we can change our perceptions and foster changes which will positively affect both the addicts and the communities around them.
Babic, Annessa A. "Pure Food and Drug Act of 1906." The Social History of Crime and Punishment in America: An Encyclopedia, edited by Wilbur R. Miller, vol. 3, SAGE Reference, 2012, pp. 1469-1471. Gale eBooks
"Direct-to-physician opioid marketing linked to overdose deaths." Adverse Event Reporting News, vol. 16, no. 3, 5 Feb. 2019, pp. 12+. Gale Academic OneFile
F Aragón-Poce, E Martı́nez-Fernández, C Márquez-Espinós, A Pérez, R Mora, L.M Torres (2002).History of opium,International Congress Series
Gale A. H. (2016). Drug Company Compensated Physicians Role in Causing America's Deadly Opioid Epidemic: When Will We Learn?. Missouri medicine
Hoffman, K. A., Ponce Terashima, J., & McCarty, D. (2019). Opioid use disorder and treatment
Lawson, C. (2018, May 20). America's 150-Year Opioid Epidemic. New York Times
Redford, Audrey, and Benjamin Powell. "Dynamics of Intervention in the War on Drugs: The Buildup to the Harrison Act of 1914." The Independent Review
Padwa, Howard, and Jacob Cunningham. "Harrison Narcotics Act." Addiction: A Reference Encyclopedia, ABC-CLIO, 2010, pp. 160-162. Gale eBooks
Wang, Shaocheng. "Historical Review: Opiate Addiction and Opioid Receptors." Cell transplantation vol. 28,3 (2019)
Categories which essay could be stronger
#1 Tone of voice
Throughout my essay I needed to be conscious of using to much of a passive voice. With earlier assignments I have had an issue with this and continue to work on correcting this.
Since I am passionate about my subject, I found myself going into tangents and had to go back and correct these areas, so the essay flowed better, and ideas transitioned effectively.
Although I cited my sources throughout the paper, I did not include enough direct quotes. Throughout the paper I only used one direct quote, and to effectively illustrate my topic more direct quotations will help.