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How Did 100 Words Start the Opioid Epidemic?

Male addict holding syringe and spoon full of opioid

The number of drug overdoses and deaths involving opioids is steadily increasing across America. According to the CDC, approximately 60% of drug overdose deaths involve opioids. The number of deaths involving opioids has quadrupled since 1999, and there were over 500,000 deaths from overdoses in the period from 2000 to 2015. In 2014, the CDC reported that there were over 47,000 drug overdose deaths in the U.S. and that opioids were responsible for 61%. The big question is this: How did we get to this stage?

A Timeline of Addiction

The nation’s doctors receive the blame as the biggest cause of the opioid epidemic due to their inability to separate pain relief from addiction. The truth is, addiction is in our genetic makeup and began with the advent of the first medicine. The Sumerians discovered opium 6,000 years ago, and a doctor named Diagoras of Melos noticed that Greeks in the ancient world were addicted to the drug. He warned his contemporaries, but no one listened.

In 1803, Friedrich Serturner purified morphiumin a bid to separate pain relief from addiction. However, he became an addict and warned others about the new drug. Once again, no one listened, and Merck, a German pharmaceutical company, mass-produced morphine in 1827. In 1874, Charles Romley Alder Wright created a more powerful drug named diacetylmorphine, which made his dog very ill and hyperactive.

Doctors in the United States had an attitude towards opioids that was somewhere between wary and frightened. However, usage of opioids soared in the 1980s due to a couple of incidents. In 1967, a nurse in London, England used large amounts of painkillers to ease the suffering of terminally ill patients. The idea gained traction in the U.S.,and in 1984, the Compassionate Pain Relief Act came into effect. The act allowed medical staff to administer heroin to terminally ill patients.

The following year, a pain specialist named Russell Portenoy said that American doctors had to “get over” their fear of opioids. He suggested that large doses of painkillers should be available to everyone with a serious illness. According to Portenoy, opioids would not cause addiction if used correctly. His influence resulted in pain becoming the “fifth vital sign” along with heart rate, blood pressure, temperature, and respiratory rate.

The Fateful Letter

By the 1970s, the drug use problem in the United States prompted President Gerald Ford to create a task force to deal with the issue. By the time drugs such as Vicodin and Percocet were available later in the decade, doctors were extremely careful about prescribing opioids to patients. However, a letter totaling just over 100 words changed everything.

Jane Porter and Dr. Hershel Jick co-wrote a they published in the New England Journal of Medicine in January 1980. The duo had analyzed almost 12,000 patients who used narcotics and said,”The development of addiction is rare in medical patients with no history of addiction.” The headline stated,”Addiction Rare in Patients Treated with Narcotics.” Overall, they found only four cases where patients who had no previous history of addiction suddenly became addicts.

Later, Jick claimed that he was only referring to patients in a hospital setting and said the conclusion did not relate to the general population. At the time, the letter had little or no impact. It was only when companies started using the letter as a means of claiming their opioids were safe that Jick took notice. The manufacturers of new opioids used the letter to say their drugs were not addictive, but this is not what Jick intended.

As of the end of May 2017, there were over 600 citations of the letter in papers and articles written by physicians and researchers. Over 70% of these citations used the letter to”prove” that addiction is rare amongst patients with no prior history of addiction. Doctors who rally against the epidemic suggest it is clear that most of the people who cite the letter haven’t bothered to read it. It is obvious, as Jick did not offer any significant evidence nor did he ever claim opioids were safe for the general population.

The Consequences

It was the sale of OxyContin by Purdue Pharma in 1996 that really marked the start of the opioid epidemic. A study by the National Institute on Drug Abuse found that while the number of painkiller prescriptions increased by up to three million a year in the early 1990s, the figure rose to eight million by 1998.

By 1999, the number rose to 11 million. In 1997, prescriptions for OxyContin totaled 670,000. By 2002, the figure had skyrocketed to 6.2 million. Another disturbing trend followed; patients addicted to OxyContin switched to heroin, as it was cheaper and easier to use.

It is only in recent years that lawmakers have stepped in to stem the tide. On March 15, 2016, the CDC issued a series of guidelines to doctors. Now, they must follow these rules when prescribing opioids.

  1. They can’t issue them until physical therapies and non-prescription painkillers have failed.
  2. The amount can’t exceed seven days for chronic pain and three days for short-term pain.
  3. They can only issue them again if the drugs lead to a significant improvement.

On June 16, 2016, the American Medical Association (AMA) told doctors to eliminate pain as the fifth vital sign. Lawmakers in Pennsylvania made the CDC’s recommendations a legal requirement on January 1, 2017.

Final Words

Although the United States makes up approximately 5% of the world’s population, it uses 80% of its painkillers. The CDC recently stated that it knows of no other medication that kills patients so frequently. We have a major problem, because there are incredibly addictive drugs easily available on the marketplace that are also deadly.

While the letter written by Jick and Porter sometimes takes the blame for the widespread use of opioids, neither the doctor nor his assistant should take any responsibility for the epidemic. Given humankind’s propensity to destroy itself with addiction, it is inevitable that once a powerful drug takes hold, disaster is likely to follow. The federal government is finally taking steps to rectify the issue, but is it too late?