ANDREW KOLODNY: Opioids are drugs that have been used for millennia.
They've been used for the treatment of pain.
They've been used for spiritual purposes and for recreational purposes,
because opioids can provide effective pain relief.
They can also produce an euphoria.
Opioids are drugs that come from opium, and it
was about 200 years ago that a German chemist figured out
how to isolate one of the more potent molecules in opium, the sap
from the opium poppy.
What this chemist figured out how to do was to isolate morphine.
And it didn't take very long for morphine
to begin to make its way into many different medical products, products
that were either prescribed or in some cases sold over the counter.
It was in the mid-1800s that the United States began
to experience its first opioid crisis.
This was an epidemic of opioid addiction that
was developing because the population in the US
was becoming overexposed to opioids.
You had Civil War soldiers who were becoming addicted
to morphine that was prescribed to them, but you also
had many middle class, middle-aged housewives
who were becoming addicted to morphine.
You had many doctors who had as the business
model for their medical practice prescribing lots of morphine.
These were doctors who might have patients visiting their office multiple
times a day to receive a morphine injection.
By the late 1800s, the opioid addiction epidemic had grown severe.
Overdose deaths involving morphine had risen to very high levels,
and there was an awareness among health officials across the United States
about the risks and dangers of products containing morphine.
It was in the midst of that morphine epidemic
but the Bayer Corporation introduced a new opioid called heroin.
And when the Bayer Corporation introduced heroin,
it actually promoted heroin as a safer alternative to morphine.
There was lots of concern about overdose risk with morphine.
And so heroin was promoted as having a lower risk of overdose death.
Then the Bayer Corporation pointed to studies
that they had done in mice to try and show
that there was less risk of overdose death from decreased breathing.
We'll probably never know whether or not those studies were
done correctly or whether it was all made up
as part of a marketing strategy, but we do know
that heroin is not safer than morphine.
Shortly after heroin was released onto the market
we began seeing a new type of opioid addiction problem.
We began seeing young Americans, particularly in urban areas,
begin using heroin non-medically.
These were young, white street toughs in New York City.
They were the children of immigrants.
They were Italian, Irish, Jewish.
They were purchasing pharmaceutical-grade heroin tablets,
crushing them and snorting them.
And so we began to see this overlapping epidemic of opioid addiction
in non-medical users of prescription opioids by 1914.
The problem had grown so severe that the federal government stepped in and began
passing laws to better regulate the sale and prescribing of narcotics.
After these laws were passed, we began to see a decline in opioid addiction.
It wasn't until after World War II that the United States faced
its next opioid addiction epidemic.
This time, it's an epidemic that's disproportionately
affecting inner city, nonwhite populations,
and the opioid is black market, illicitly manufactured heroin.
And because the heroin that's coming into inner city communities
has been cut so many times before it reaches a user,
it's heroin that can really only have an effect in people who inject it.
So this becomes an injection heroin use epidemic
that hits low-income nonwhite communities very hard.
And that's in the 1970s.
It wasn't until 1996 that the next opioid addiction epidemic begins,
and that next epidemic is the one that we're dealing with today.
And the epidemic we're dealing with today
is far worse than any drug addiction epidemic
the United States has faced previously, when
we look at the number of people affected and the number of overdose deaths
that we're experiencing.
When we talk about our opioid problem or when we talk about the opioid crisis,
it's important to frame the problem in the right way.
Our opioid problem, I believe, is an epidemic of opioid addiction,
meaning that the reason that we're experiencing
record high levels of overdose deaths involving opioids and the reason
that we're seeing heroin flood into communities where it wasn't previously
available, and the reason we're seeing soaring rates of infants
born opioid-dependent and all of the different health and social problems,
that the driver has been a sharp increase in the number
of Americans suffering from opioid addiction.
The CDC has been very clear about the cause of our current opioid addiction
epidemic, but the CDC has shown is that as prescriptions for opioids
began to increase rapidly beginning in the 1990s, as the prescribing went up,
it led to parallel increases in rates of addiction and overdose deaths.
What the CDC has really been saying is that this
is an epidemic that has been caused inadvertently
by the medical community overprescribing opioids.
As the prescribing went up, it led to an epidemic of addiction and overdose
deaths.
Now, the reason that the medical community
began to prescribe opioids much more aggressively, starting in the 1990s,
has a lot to do with the way in which opioids were marketed.
It was in 1996 that OxyContin was introduced,
and the drug company that manufactures OxyContin
when it put the medication on the market that launched a campaign
to encourage opioid prescribing the manufacture of OxyContin
wanted to see the drug used for common conditions.
But they had a problem.
Back in the early '90s many doctors understood
that opioids are highly addictive, and we
understood that there are limitations to using them for chronic non-cancer pain.
We knew that if you put a patient on opioid chronically,
that the risk of addiction would go up if patients
taking the opioid long term.
We knew that patients would very quickly develop a tolerance to the pain
relieving effect, meaning that they would need higher and higher doses
in order to get pain relief.
And we knew that even if a patient didn't clearly get addicted,
the physiological dependence that would set in
would make it hard for many patients to ever come off of opioid.
So in the early '90s, the medical community
understood that opioids should be prescribed cautiously for chronic pain.
We knew these are essential medicines for end-of-life care,
and essential medicines to be used short term for severe pain,
for example, after major surgery.
But we knew better than to use them aggressively
for conditions like low back pain, chronic headache, fibromyalgia.
But when OxyContin was introduced, the manufacturer
reframed these very good reasons for being cautious with opioids as barriers
to compassionate pain care.
In educational programs that were sponsored by the drug company--
20,000 educational programs in the first six years of the release of OxyContin--
doctors began to hear that the risk of addiction
had been overblown, that we've been allowing patients to suffer needlessly,
that we can be much more compassionate if we prescribe opioids more liberally.
And we didn't just hear this in educational programs
that were sponsored by drug companies.
We heard these messages from our national societies, from our hospitals,
from our state medical boards.
So from every direction, primary care doctors
begin hearing that if you're an enlightened
physician and a concerned, compassionate physician,
you'll be different from those stingy puritanical doctors of the past that
were allowing patients to suffer needlessly.
And so as we responded to this brilliant campaign
and as the prescribing increased, that led to the epidemic
that we're dealing with today.