How the quest for pain relief led to today's opioid crisis

 
By Arthur Lurigio and Sidney Weissman
Guest columnists
Posted5/3/2018 1:00 AM
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  • Arthur Lurigio

    Arthur Lurigio

  • Sidney Weissman

    Sidney Weissman

The opioid epidemic is currently the country's most serious public health problem. Opioids are responsible for more than 80 percent of U.S. drug overdoses, and annually, they take more lives than gun homicides and automobile accidents combined. In Chicago alone, in 2016, 741 people died from opioid overdose, nearly as many as those murdered in a year of record violence in the city.

That same year, 291 people died from opioid overdose in DuPage, Lake, Kane, McHenry, and Will counties in Illinois. DuPage County alone was home to 78 of them. The pervasive misuse of opioids, whether heroin, morphine, fentanyl, or other synthetic pills with well-known brand names, such as OxyContin, Percocet, Vicodin, Percodan, and Demerol, has contributed to a reduction in Americans' life expectancies for the last two years and has cost the country more than $600 billion to date.

Opioids effectively relieve pain and cause euphoria, but many users take them for their euphoric effect, rather than for pain relief.

Studies addressing the treatment of pain in the 1980s and 1990s concluded that pain was being undertreated. These studies called for the prescription of opioids to treat acute and chronic pain more effectively, but incorrectly presumed a minimal risk of addiction. During physician visits, pain evaluation became the fifth vital sign, in addition to blood pressure, temperature, pulse rate, and respiration. Physicians believed that the treatment of pain was essential and easy.

Not surprisingly, pharmaceutical companies took advantage of this shift in medical practices, seizing the opportunity to increase profits. They launched unrelenting campaigns urging doctors to treat every patient's complaint of pain, regardless of its cause. They promoted opioid drug prescriptions as safe while obscuring the dangers of opioid use, which include the risk of addiction arising from their euphoria-inducing effect.

Between 1998 and 2013, opioid prescription rates nearly doubled. Prescription opioids created a massive supply of drugs for potential misuse by patients and their friends and family members. Additionally a significant portion of legally prescribed opioids were deflected into criminal channels for illicit use. Some patients as well as family and friends and other illicit users developed opioid tolerance and resorted to taking increasingly larger doses to obtain the original pain-relieving or euphoric effects, which led to addiction.

Research suggests that eight out of 10 people who initially abuse opioid painkillers go on to ingest heroin and illicit fentanyl or its derivatives. Despite this, some opioid abusers begin with heroin, rather than prescription opioids, owing to its falling price in the face of increasing potency and availability.

In the 1990s, the enhanced marketing of opioids, which had already been available for many years, was accompanied by the introduction of fentanyl, a prescription pain medication 100 times more powerful than morphine and approved for use to treat pain in cancer patients.

In comparison, heroin is 12 times as powerful as morphine. Fentanyl and its derivatives, some of which are 50 times as powerful as Fentanyl, either obtained by prescription or illegally began to be used either alone to create euphoria or to enhance the effect of heroin. The use of fentanyl and its derivatives play a significant role in the rising number of opioid related overdose deaths. Every year, large quantities of illegal fentanyl enter the US by mail from China.

The opioid epidemic has emanated from the confluence of several factors. First was medicine's newfound focus on the adequate treatment of pain, accompanied by its failure to adequately train doctors in the effective use of opioids. Gradually, pharmaceutical manufacturers, rather than medical schools, became the educators of doctors in the use of opioids. Finally, the introduction of fentanyl and its derivatives, and the availability of cheap, pure heroin, created the conditions that enabled this public health crisis to take hold. These changes have had their most adverse impact on vulnerable, disaffected adolescents and young adults in rural and small-town America. West Virginia was once the epicenter of this epidemic, but it has now moved into urban and suburban areas throughout the country. As the No. 1 public health concern in America today, a multipronged effort will undoubtedly be necessary to address the opioid epidemic and reduce its impact on America's most vulnerable populations.

Arthur J. Lurigio is a professor of psychology and of criminal justice and criminology at Loyola University Chicago. Dr. Sidney Weissman is a clinical professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine.

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