Opioids are drugs formulated to replicate the pain-educing properties of opium. They include both legal painkillers like morphine, oxycodone, or hydrocodone prescribed by doctors for acute or chronic pain, as well as illegal drugs like heroin or illicitly made fentanyl. The word “opioid” is derived from the word “opium.”
During 2017, there were more than 70,200 overdose deaths
in the United States and 47,600 of those
overdose deaths involved opioids. More than 130 people died every day
from opioid-related drug overdoses in 2016 and 2017, according to the US Department of Health & Human Services (HHS).
Prescription opioid volumes peaked in 2011, with the equivalent of 240 billion milligrams of morphine prescribed, according to the market research firm, IQVIA Institute for Human Data Science.
The volume declined to about 171 million milligrams of morphine in 2017, a 29% drop.
Common opioids:Opioids bind to receptors in the brain and spinal cord, disrupting pain signals.
They also activate the reward areas of the brain by releasing the hormone dopamine, creating a feeling of euphoria or a “high.”
Hydrocodone and oxycodone are semi-synthetic opioids, manufactured in labs with natural and synthetic ingredients. Between 2007 and 2016, the most widely prescribed opioid was hydrocodone (Vicodin). In 2016, 6.2 billion hydrocodone pills were distributed nationwide. The second most prevalent opioid was oxycodone (Percocet). In 2016, 5 billion oxycodone tablets were distributed in the United States, according to IQVIA..
According to two national surveys conducted by the National Center for Health Statistics,
covering 78,000 visits to emergency rooms and outpatient clinics by teens and young adults between 2005 and 2015, 15% of ER visits and three percent of outpatient visits resulted in an opioid prescription.
The International Narcotics Control Board reported that in 2015, Americans represented about 99.7% of the world’s hydrocodone consumption.
Fentanyl is a fully synthetic opioid, originally developed as a powerful anesthetic for surgery.
It is also administered to alleviate severe pain associated with terminal illnesses like cancer. The drug is up to 100 times more powerful than morphine.
Just a small dose can be deadly. Illicitly produced fentanyl has been a driving factor in the number of overdose deaths in recent years.
Methadone is another fully synthetic opioid. It is commonly dispensed to recovering heroin addicts to relieve the symptoms of withdrawal.
People who become dependent on opioids
may experience withdrawal symptoms when they stop taking the pills. Dependence is often coupled with tolerance,
meaning that opioid users need to take increasingly larger doses of the medication for the same effect.
About 11.4 million Americans misused opioids in 2017,
including 11.1 prescription misuers and and 886,000 heroin users.
In August 2017, Attorney General Jeff Sessions announced the launch of an Opioid Fraud and Abuse Detection Unit within the Department of Justice.
The unit’s mission is to prosecute individuals who commit opioid-related health care fraud. The DOJ is also appointing US attorneys who will specialize in opioid health care fraud cases as part of a three-year pilot program in 12 jurisdictions nationwide.
On October 24, 2018, President Donald Trump
signed opioid legislation
into law. The SUPPORT for Patients and Communities Act
includes provisions aimed at promoting research to find new drugs for pain management that will not be addictive. It also expands access to treatment for substance use disorders for Medicaid patients.
are also introducing measures to regulate pain clinics and limit the quantity of opioids that doctors can dispense.
Emergence of a crisis:1861-1865 –
During the Civil War, medics use morphine as a battlefield anesthetic. Many soldiers become dependent on morphine after the war.
1898 – Heroin is first produced commercially by the Bayer Company.
At the time, heroin is believed to be less habit-forming than morphine, so it is dispensed to individuals who are addicted to morphine.
1924 – The Anti-Heroin Act bans the production and sale of heroin in the United States.
1970 – The Controlled Substances Act becomes law.
It creates groupings (or schedules) of drugs based on the potential for abuse. Heroin is a Schedule I drug while morphine, fentanyl, oxycodone (Percocet, OxyContin) and methadone are Schedule II. Vicodin – a hydrocodone-acetaminophen combination – was originally a Schedule III medication but wasn’t recategorized as a Schedule II drug until October 2014.
January 10, 1980 – A letter titled “Addiction Rare in Patients Treated with Narcotics” is published in the New England Journal of Medicine.
It was not a study and looked at incidences of addiction in a very specific population of hospitalized patients who were closely monitored. However, it would become widely cited as proof that narcotics were a safe treatment for chronic pain.
1995 – OxyContin, a long acting version of oxycodone, which slowly releases the drug over 12 hours, is introduced and aggressively marketed as a safer pain pill by manufacturer, Purdue Pharma.
May 10, 2007 –
The federal government brings criminal charges against Purdue Pharma for misleadingly advertising OxyContin as safer and less addictive than other opioids. The company and three executives are charged with “misleading and defrauding physicians and consumers.” Purdue Pharma and the executives plead guilty, agreeing to pay a $634.5 million in criminal and civil fines.
The three executives plead guilty on criminal misdemeanor charges and are later sentenced to probation.
2010 – FDA approves an “abuse-deterrent” formulation of OxyContin, to help curb abuse. However, people still find ways to abuse it.
May 20, 2015 –
The DEA announces that it has arrested 280 people, including 22 doctors and pharmacists, after a 15-month sting operation centered on health care providers who dispense large amounts of opioids. The sting, dubbed Operation Pilluted, is the largest prescription drug bust in the history of the DEA.
March 18, 2016 – The CDC publishes guidelines for prescribing opioids for patients with chronic pain.
Recommendations include prescribing over-the-counter pain relievers like acetaminophen and ibuprofen in lieu of opioids. Doctors are encouraged to promote exercise and behavioral treatments to help patients cope with pain.
March 29, 2017 –
Trump signs an executive order calling for the establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. New Jersey Governor Chris Christie
is selected as the chairman of the group, with Trump’s son-in-law, Jared Kushner, as an adviser.
July 31, 2017 –
After a delay, the White House panel examining the nation’s opioid epidemic releases its interim report,
asking rump to declare a national public health emergency to combat the ongoing crisis
February 27, 2018 – Attorney General Jeff Sessions
announces a new opioid initiative: the Prescription Interdiction & Litigation (PIL) Task Force.
The mission of the task force is to support local jurisdictions that have filed lawsuits against prescription drugmakers and distributors.
March 19, 2018 – The Trump administration outlines
an initiative to stop opioid abuse. The three areas of concentration
are law enforcement and interdiction; prevention and education via an ad campaign; and job-seeking assistance for individuals fighting addiction.
April 9, 2018 – The US surgeon general issues an advisory recommending that Americans carry the opioid overdose-reversing drug, naloxone.
A surgeon general advisory is a rarely used tool to convey an urgent message. The last advisory issued by the surgeon general, more than a decade ago, focused on drinking during pregnancy.
May 1, 2018 – The Journal of the American Medical Association publishes a study that finds synthetic opioids like fentanyl caused about 46% of opioid deaths in 2016.
That’s a three-fold increase compared with 2010, when synthetic opioids were involved in about 14% of opioid overdose deaths. It’s the first time that synthetic opioids surpassed prescription opioids and heroin as the primary cause of overdose fatalities.
June 7, 2018 – White House announces a new multimillion dollar public awareness advertising campaign to combat opioid addiction.
The first four ads of the campaign are all based on true stories illustrating the extreme lengths young adults have gone to get a hold of the powerful drugs.
December 12, 2018 –
According to the latest numbers
from the CDC’s National Center for Health Statistics, fentanyl is now the most commonly used drug involved in drug overdoses
. The rate of drug overdoses involving the synthetic opioid skyrocketed by about 113% each year from 2013 through 2016.
January 15, 2019 –
A court filing in a Massachusetts lawsuit reveals that members of the Sackler family, who own Purdue Pharma, misled doctors and patients about the dangers of OxyContin.
March 18, 2019 –
More than 600 cities, counties and Native American tribes from 28 states file a federal lawsuit against eight members of the Sackler family.
The suit says the family increased sales by creating a “new ‘health care’ narrative, one in which opioids are considered safe and effective for long-term use, and pain is aggressively treated at all costs.”
March 28, 2019 –
The New York Attorney General’s office announces the filing of a comprehensive lawsuit
against six opioid manufacturers, as well as the Sackler family and opioid distributors.
April 22, 2019 – Connecticut’s attorney general files an amended lawsuit against Purdue Pharma,
alleging deceptive business practices and fraudulent transfer.
May 2, 2019 – Five executives from Insys Therapeutics,
maker of a version of fentanyl called Subsys, are found guilty Thursday on federal racketeering charges for bribing doctors to prescribe the painkiller to people who didn’t need it.
May 14, 2019 – Pennsylvania’s attorney general announces that the state is suing Purdue Pharma,
alleging that the company misrepresented its opioid products as nonaddictive and appropriate for chronic pain.
May 21, 2019 – Vermont’s attorney general announces
that the state is suing members of the Sackler family for deceptive marketing of opioid painkillers.
May 26, 2019 –
The drugmaker Teva Pharmaceuticals reaches an $85 million settlemen
t to resolve a lawsuit filed by the attorney general in Oklahoma.
May 28, 2019 – A major opioid trial, the first of its kind, begins in Oklahoma.
The trial is expected to determine whether states and municipalities can hold drug companies accountable for the opioid crisis. The defendant in the case is Johnson & Johnson.
May 30, 2019 – The state of New Jersey files a lawsuit against members of the Sackler family,
alleging Purdue Pharma’s marketing strategies overstated the benefits of their opioid drugs while also minimizing the health risks and downplaying their potential for addiction.