The Hard Truth Behind Prescription Opioids
Prescription Opioids History
The word “opioid” refers to any substance derived from the opium poppy that induces changes in someone using it. Opioids have a long history going back thousands of years, with archaeological evidence indicating that they were used for recreational purposes, as medicine, and for religious rituals by a variety of civilizations. In Ancient Greece, Hyppocrates, often known as the “Father of Medicine,” recommended it for medical purposes specifically, citing opioids for their usefulness in inducing sleep and the treatment of pain. Even in these ancient times, prescribing opium was considered controversial, with some early physicians like Avicenna discouraging the use of opium except when absolutely necessary.
By the middle ages, opium had become a staple crop in parts of India, China, and the Middle East. Its use rapidly spread, especially in the form of laudanum, a medicinal tincture composed of opium and alcohol. During the 17th and 18th centuries, the opium trade began in earnest. High demand made selling and managing the distribution of opium a highly profitable enterprise for colonial powers like Britain. In fact, the opium trade even led to wars. Britain smuggled opium into China illegally over a period of decades, despite warnings by the Chinese government, who wanted to curtail the practice due to the ubiquity of opium addiction among their population. By the mid 19th century, this led to two wars often termed “The Opium Wars.”
The development of the hypodermic needle and the development of morphine, an alkaloid derivative of opium, led to opioids’ breakthrough in modern medicine. In 1832, codeine, another derivative of opium, was discovered. Throughout the 19th century and much of the 20th, morphine and codeine were widely believed to be panaceas for all ills. In addition to pain, these supposed cure-alls were prescribed for lung problems, gastrointestinal problems, menstrual pain, nervousness, among other disorders. They were also widely perceived not to be addictive.
Scientists in the early 20th century worked tirelessly to derive forms of opium that would be less addictive. Instead, they created semisynthetic opioids that were significantly more potent — and far more addictive. Heroin emerged as a pain and lung illness treatment in the first decade of the 20th century, with oxycodone and hydrocodone coming shortly thereafter. In 1932, scientists invented the first fully synthetic opioid, meperidine, later marketed as Demerol. Synthetic opioids, which operate via the same chemical compounds as natural opioids, are distinct in that they are developed entirely in the lab via artificial means, and are significantly stronger.
Today over 150 synthetic opioids are known, including fentanyl, which is 50 times stronger than heroin. They are widely prescribed all over the world in the treatment of pain and major illnesses. Despite that, opioids are highly addictive and have wrought irreparable damage on communities, destroying both lives and livelihoods. While illegal opioids like heroin bear the brunt of the blame and associated stigma, the over-prescription of prescription opioids is in large part responsible for the 21st century’s “opioid epidemic.” Not only are many prescription opioids in and of themselves extremely dangerous and life-threatening, like fentanyl and oxycodone, but they often lead physically dependent users to illegal drugs such as heroin.
What Are Prescription Opioids?
Prescription opioids work by acting on opioid receptors in a user’s body. Opioid receptors are naturally occurring in most vertebrates, and humans have them throughout their brain, spinal cord, and digestive system. When prescription opiates bind to opioid receptors, the brain blocks pain being sent to the brain. The result is that any chronic or severe pain a user is experiencing is immediately dulled. For this reason, prescription opioids are known as analgesic drugs, substances used in the treatment of pain.
What Are Prescription Opioids Made of?
Historically opium, which comes from the opium poppy, a common flower, was prescribed by early physicians. While opium was known to be effective and ultimately recognized for being addictive as well, prescription opioids used by modern day physicians are incomparably more so. The vast majority of prescription opiates used today are synthetic, meaning they are developed in the laboratory rather than being derived directly from a plant. Meperidine, the first synthetic opioid, actually has a chemical structure completely unlike naturally occurring opioids — but it operates on opioid receptors in the same way. Some prescription opioids are semi-synthetic, however, meaning that the opium poppy is used very indirectly. Oxycodone, for instance, is made by synthesizing thebaine, an opioid alkaloid derived from opium poppies.
Prescription Opioids Street Names
While prescription opioids are often abused even by people holding legitimate prescriptions, they are also widely distributed through black market channels. These medications are often known by colloquial street names. While the following list is not exhaustive, these are just a few of the slang names that have emerged during the 21st century’s prescription opiate crisis:
Street Names for Codeine:
Street Names for Hydrocodone:
Street Names for Fentanyl:
Street Names for Morphine:
Street Names for Oxycodone:
Different Types of Prescription Opioids
There are hundreds of synthetic and semi-synthetic prescription opioids currently available. They are prescribed for many different purposes to meet the needs of individual patients whose cases differ. Some opioids are more potent than others, others last longer in the system, and some are quite short-acting. Naming can be confusing, given that some identical opioid medications are sold under a variety of brand names by different companies. The following survey is an attempt to cover some of the more common prescription opioid painkillers.
Used mainly in the treatment of pain, diarrhea, and coughing, codeine begins taking effect as it is broken down in the liver into morphine. A naturally occurring opioid, codeine has a presence of approximately 2% in opium.
Hydrocodone, which is derived from codeine, is also more potent. Like codeine, it is used as a cough suppressant but is also significantly effective for treating prolonged pain. Available in a variety of forms, from extended-release tablets to immediate-release tablets that include acetaminophen, such as Vicodin, Norco, and Lortab.
Oxycodone, which is often sold under the brand name OxyConton, is also frequently taken as Percocet when it is combined with acetaminophen. Effective for treating severe pain, oxycodone is approximately 1.5 times stronger than morphine. Oxycodone is also one of the more commonly abused prescription opiates. Even non-abusing users who have developed a physical dependence on oxycodone are at risk of rapidly entering acute withdrawal if they stop taking the medication.
Believed to be one of the first isolations derived from opium, morphine has a long history of use in pain relief. It is also used as a base ingredient in the production of heroin, hydromorphone, and oxymorphone. Morphine is listed on The World Health Organization’s List of Essential Medicines. Unfortunately, morphine and morphine-derived substances like heroin have also been shown to be more addictive than other opioids such as oxycodone.
Also known as pethidine, meperidine is commonly sold under the brand name Demerol. Meperidine is a synthetic opioid used mainly in the treatment of moderate to severe pain. Throughout the 20th century, meperidine was considered to be a safe, non-addictive alternative to opioids like morphine. As a result, by 1975 it was the drug of choice for physicians treating acute pain. This conception of meperidine as a safe non-addictive substance was later proven to be false, with abuse still continuing today despite a drop in prescriptions.
Most famously sold under the brand name Dilaudid, hydromorphone is used primary in the treatment of moderate to severe pain. Hydromorphone is derived from morphine and is typically taken by mouth but can also be injected into a muscle, vein, or directly under the skin. This semi-synthetic opioid is highly addictive and can cause acute withdrawal symptoms immediately upon ceasing use.
Fentanyl, which is approximately 50 times more potent than heroin, is a synthetic opioid. Fentanyl, which is often applied via a patch on the skin, is also available in pill form and as a rapid-onset “lollipop.” Fentanyl is usually prescribed only for severe cases of pain, often to manage suffering following a major surgery. Unfortunately, fentanyl is also currently playing a large and tragic role in the current opioid epidemic. Because it is so potent, fentanyl is an affordable and effective way for drug dealers to lace their products. Many users do not realize they are buying fentanyl when they purchase drugs off the street. As a result, unwitting fentanyl users are at an increased risk of overdose.
While it can be used in the treatment of pain, methadone is an opioid that is commonly prescribed by physicians treating a person for opioid use disorder. It effectively blocks the high from other opioids like heroin and oxycodone. It also reduces cravings and the severity of withdrawal symptoms. As such, methadone replacement therapy is often used as a harm reduction tool for individuals suffering from opioid addiction. Methadone can also be used effectively as a detoxification tool. People being treated with methadone can stay on it for several weeks to many years, depending on what kind of treatment the severity of their addiction requires.
Like methadone, buprenorphine is most frequently prescribed to treat opioid use disorder. Often sold under the brand name Subutex, buprenorphine treatment usually begins when an opioid addict enters withdrawal. While it has a similarly efficacy to methadone, buprenorphine can be abused by users who inject it. To that end, pharmaceutical companies developed Suboxone, a medication that combined buprenorphine and naloxone. Naloxone works by blocking the effects of opioids, meaning anyone trying to abuse Suboxone this way would enter acute withdrawal immediately.
Prescription Opioid Statistics
The prescription opioid crisis began in the 1990s, when medical professionals began doling out opioid prescriptions with increasing frequency until opioids became the number one most prescribed class of medications in the United States. Not only did prescriptions become more frequent, but so did the strength of the medications prescribed. While in 2002 only one in six prescription opiate users were prescribed drugs more potent than morphine, by 2012, that rate had increased to one in every three drug users, with the most frequently prescribed drugs being oxycodone and hydrocodone.
Between 2001 and 2010, physicians treating pain increased their use of opioid pain relievers, while their use of non-opioid pain medications like ibuprofen and aspirin decreased from 38% to 29%. Prescription opioids were the main cause of drug overdose in the 1990s, but in the early 2010s heroin made a comeback. Since 2013, however, synthetic opioids have again become the major factor in the death total, with fentanyl-laced substances posing a particular problem. In 2018 alone, an estimated 10.3 million Americans engaged in substance abuse with opioids, with 9.9 million of these involving prescription opioids. Of the 70,200 overdose deaths that occured in the United States in 2017, 47,600 (more than half) were opioid deaths. For Americans under 50, drug overdose is now the leading cause of death.
Why are Prescription Opioids so Addictive?
When opioid receptors are activated in the brain, not only are pain signals blocked, but endorphins and dopamine flood the brain, causing a feeling of euphoria. These short term effects are followed by withdrawal, during which individuals experience dysphoria and intense cravings. Seeking to renew the high or avoid the withdrawal are too of the strongest reasons people continue abusing opioid painkillers. Over time, however, the body acclimates and develops a tolerance to the medication. When users develop physical tolerance, achieving the high to which they are accustomed requires them to consume the drug in greater quantities or at a greater frequency. The result, unfortunately, is that withdrawal effects also intensify, making users even more averse to weaning off. This kind of physical dependence on prescription opioids can very quickly give rise to the phenomenon of addiction.
While some genetic factors have been found to increase the likelihood of a person developing an addiction, environmental factors play key roles. Individuals who have a prior history of substance abuse or who have family members with addictions are far more likely to develop an addiction to opioids. The presence of other mental health disorders also increases the likelihood of addiction, which can cause someone to be diagnosed as dual diagnosis. Early childhood trauma such as child abuse and neglect makes people more susceptible to addiction down the line. Poverty and socioeconomic circumstances can drive people to abuse drugs as well. In fact, many addiction experts consider opioid addiction to be a “disease of despair,” with the prescription opioid crisis arising from the increasing social inequality in the United States.
Tackling the prescription opioid crisis involves government interventions, some of which have already been working to develop an opioid task force. Reducing the over-prescribing of these medications would dramatically weaken the prescription opiate crisis. Increasing the availability of medications like naloxone, which can be sprayed into a person’s nose while they’re overdosing to prevent death, would lessen the number of opioid deaths in the United States. For individuals who are interested in getting help, opioid rehab is an effective treatment option. These are available from a wide range of facilities, from inpatient treatment programs to outpatient treatment programs. The prescription opiate crisis is currently destroying lives and communities, but if proper action is taken, these substances can be put in their proper place as essential pain medications rather than drugs of abuse.