Opium Wars

When opioids are used to treat toothache and back pain without informing patients that it is actually just a chemically pure drug that is easy to sit on and can overdose, it does not end well. MedPortal tells about how the epidemic of drug addiction in the United States began and what it led to.

In most countries of the world, the use of opioid (narcotic) analgesics is strictly limited. They are used for emergency care (severe trauma, burns, surgery) and palliative cancer treatment. In the United States, such drugs in recent years have become available to almost every adult for almost any kind of pain. This led to a severe epidemic of opioid dependence. How could this happen in a country with such a high level of development of medical science?

More recently, in the United States, it was difficult to imagine such a massive use of drugs for pain of non-cancer origin. The most controversial opioid in use today, oxycodone (now marketed as the pain reliever OxyContin) was completely banned back in the 1960s. After the Vietnam War, during a surge in heroin addiction among soldiers, the drug legislation became even stricter. There, however, after a short time, doctors began to progressively convince them that they "do not heal" the pain, and that narcotic analgesics in skillful hands are not dangerous. Opioids are back on the market with unprecedented availability and aggressive marketing support.

Dry, but surprising numbers

By 2010, the US population (5% of the world's population) consumed 95% of the world's hydrocodone (Vicodin, well known to us from the House Doctor series), 85% of oxycodone and 65% of hydromorphone. The abuse of prescription opioids kills more Americans each year than heroin and cocaine combined, according to the Center for Disease Control and Prevention (CDC).

From 1999 to 2010, sales of prescription pain relievers quadrupled, and the number of overdose deaths increased by the same amount.

From 2006 to 2015, lobbyists for opioid manufacturers spent 8 times more than lobbyists for arms manufacturers, and 200 times more supporters of tighter drug control.

Glavdragdealer lobby

The development of the market for narcotic analgesics proceeded intensively, contrary to common sense. For example, the growth in sales of OxyContin since its inception in 1996 was driven solely by marketing and lobbying. Moreover, studies have not shown its advantages over other drugs of the same class.

In 1998, Purdue Pharma released the video I Got My Life Back, in which 6 people suffering from chronic pain were treated with OxyContin. 15,000 copies of it appeared in doctors' waiting rooms as a self-help guide. From 1996 to 2002, Purdue sponsored, directly or indirectly, 20,000 educational programs for health care workers, dramatically increasing opioid prescriptions. At the state level, the company's lobbyists also regularly addressed administrative barriers to sales. For example, in 2012, they were able to get the state of New Mexico not to pass legislation to reduce the duration of a prescription for narcotic analgesics to 7 days.

From time to time, the pharmaceutical company was symbolically punished - sometimes quite seriously. For example, in 2007 she had to pay a fine of 634 million for falsely reporting oxycodone addiction. However, in 2014, at the peak of the rise in deaths from opioids, the FDA (Food and Drug Administration) registers a new hydrocodone drug, Hysingla, from Purdue Pharma.

Doctors with pistols under their robes

A few years after OxyContin was launched on the market, many unscrupulous businessmen realized that selling narcotic painkillers was a gold mine. Hundreds of pain clinics were opened, where they could write a prescription and then sell drugs to everyone. The state of Florida became notorious for having up to 90% of opioid prescriptions at one time. The most notorious was the AmericanPain clinic with, in the words of The Guardian, "pharmacies run by former strippers and doctors with pistols under their robes." Its founders, brothers Christopher and Geoffrey George, were recognized as the largest illegal oxycodone distributors in the United States from 2008 to 2010. In an interview, Christopher, who is serving a 17.5-year sentence, said that not a single doctor refused to cooperate with them. The salary of a specialist could be up to 37,5 thousand dollars a week. Many doctors and providers have been convicted over time as accomplices after the network was “shut down” in 2010. “When I started my business, all I had to do was call the wholesaler, tell him I have a medical clinic, and fax the doctor’s medical license number,” says George. “Then I just told them what I needed and they sent me the medicine I needed. They didn't know who I was. They didn't speak to the doctor. I could just be the person who stole the data of some doctor. Nobody cared about it. "and fax the doctor's medical license number,”says George. “Then I just told them what I needed and they sent me the medicine I needed. They didn't know who I was. They didn't speak to the doctor. I could just be the person who stole the data of some doctor. Nobody cared about it. "and fax the doctor's medical license number,”says George. “Then I just told them what I needed and they sent me the medicine I needed. They didn't know who I was. They didn't speak to the doctor. I could just be the person who stole the data of some doctor. Nobody cared about it."

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Residents of other states (Kentucky, West Virginia) also frequently visited Florida to purchase “country heroin,” as they called OxyContin and its generics. The path to the south, which they made, was popularly called the Oxy Express. Writer Dee Davis, who was born in the poorest region of Kentucky, testifies: “You cannot visit a doctor and not see a merchant in him. Synthetic opioids, which are good for palliative care, are marketed as regular pain relievers in the knowledge that they are addictive. […] Everyone gets their share: doctors, pharmacists, lawyers."

From prescription analgesics to heroin

Robert Eaton from Florida began receiving opioids for a spinal hernia in 2009 when he was 24 years old. After two months of low-dose treatment, the doctor said there was nothing else he could do and referred him to a pain management clinic, where the doctor instantly increased the doses of the drug and made monthly visits.

“By that time, I already felt that the pills were holding me tight. But I had no idea how far it could go,”says Eaton. Oxycodone addicts usually say that the big problem is not the craving for the drug, but the fear of losing it and the pain that becomes more acute again. Soon, Eaton realized that the doctor was not trying to treat him, but rather was trying to escort him out the door after writing the prescription in order to see the next patient.

“The doctor never asked me if the pain got better within a month. You come in and you are prescribed the maximum dose. If you don't have insurance, pay in cash. " Over time, the cost of drugs and doctors has reached hundreds of dollars a day.

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Later, the fight against illegal sales of prescription opioids began. Pain clinics were closed, drugs became hard to come by, and their prices on the black market soared. “As soon as prices jumped, I realized that I would just switch to heroin,” says another pain reliever addict. Heroin was more readily available and cost eight times less.

“I found myself in a world where I no longer wanted to live. Am I responsible for this? Yes, I'm an addict. I visited a doctor who just took my money and did not try to help me. I have many friends who have already died while receiving the same prescriptions from doctors,”Eaton concluded.

A common abuse of oxycodone has been injecting it after crushing and dissolving tablets, an incredibly harmful practice that injures blood vessels and increases the risk of overdose. The release in 2010 of a new form of OxyContin, protected from such use, did not solve the problem. The New England Journal of Medicine published a 2012 study that showed drug abuse fell from 35.6% to 12.8%. But the same study found that 66% simply switched to other opioids. “Most of my acquaintances no longer take OxyContin to get high. They switched to heroin, which is easier to use, cheaper and more accessible,”said one of the study participants.

It is characteristic that even those who are protected from all bad habits are not protected from opioid dependence. For example, in Utah, a third of the adult population, 65% of whom are Mormons, had prescriptions for narcotic analgesics. Members of this church do not abuse alcohol, drugs, tobacco or even coffee. However, many of them could not “evade” the prescription issued by the doctor.

“Before I knew, my father, brother and sister had already taken the same pills. They thought it was okay because the medication was prescribed by a doctor,”says the sister of a deceased woman who attended a Mormon church.

The US authorities and regulators are currently taking action to tackle the opioid abuse epidemic. This is not an easy task, we have mentioned how the fight against trafficking in oxycodone has led to a surge in heroin addiction. A groundbreaking step forward is the CDC's 2016 release of guidelines for the use of opioids for chronic pain. This document explicitly states that with long-term use of narcotic analgesics, the risks outweigh the benefits. Of course, lobbyists are on the alert and say that opioid opponents do not understand the problem of pain. Given the multifaceted and neglected problem, it is difficult to say how long it will take to fix it. It also remains to be hoped that the American experience will be useful to the whole world and will not be repeated.