The Origin Of The Opioid Crisis
By Micheal Kurth
August 31 was International Overdose Awareness Day. Events were held around the world to raise awareness of drug-related deaths.
The United States has the highest drug-related mortality rate in the world. The problem is getting worse — much worse — and that includes in Southwest Louisiana. Calcasieu Parish had nine drug-overdose deaths in August; late in the month, 45 people had to be rushed to the hospital in Lake Charles — unconscious or vomiting uncontrollably after smoking synthetic marijuana.
This stuff killing people today is not the “pot” smoked by hippies in the sixties or the crack cocaine that ravaged inner cities in the eighties and nineties as a cheap substitute for powdered cocaine. These new drugs are far more powerful; much more addictive; and have unknown and long-lasting effects on the way the brain functions.
The brain has receptors that tell the body what is happening to it and how to respond. Opioids attach themselves to these receptors and cause the brain to send out false information. For example, opioids can tell the brain to ignore pain. For someone suffering from intense or chronic pain, this can be a good thing. But pain also serves an important function by telling us to stop doing what we are doing: it’s like a flashing red light at a railroad crossing warning us that a freight train is coming down the tracks. Turning off that red light can have catastrophic consequences.
Opioids can also trick the brain by sending out false signals of pleasure that create a feeling of euphoria and cause one to crave more of it.
People have used naturally occurring opioids for thousands of years. In the 1800s, they were legal in the United States, and cocaine and opium were frequently used — and abused — in medicinal concoctions and “miracle cures.” In 1906, Congress passed the Pure Food and Drug Act, requiring substances containing alcohol, cocaine, heroin, morphine and cannabis be accurately labeled with contents and dosage. But these substances were still legally available without a prescription as long as they were properly labeled.
Then in 1914, the Harrison Narcotic Act was passed. It regulated the production and distribution of substances containing opiates under the commerce clause of the Constitution. But it was primarily used to prosecute quack doctors who prescribed opiates to addicts.
In 1919, the Constitution was amended to prohibit alcohol everywhere in the nation. The results were disastrous: crime syndicates quickly moved in and took over the black market for alcohol that developed; “speakeasy” clubs flourished; and people died from “bathtub” gin and bootleg whiskey made with unknown ingredients. In 1933, the prohibition on alcohol was repealed, but the sale and distribution of narcotics and opioids was never a federal crime. When the federal government did get involved with drug trafficking, it was in the guise of prosecuting the sellers for tax evasion.
During World War II, American soldiers were encouraged to smoke cigarettes and use amphetamines to steady their nerves and increase their stamina. The Pentagon issued between 250–500 million Benzedrine tablets to U.S. troops during the war, and morphine was used liberally to treat the wounded. Many soldiers returned home with drug addictions. But it was generally treated as a dirty little secret and not talked about. One exception was the 1957 movie Monkey on my Back based on the struggles of Barney Ross, a world champion boxer and World War II hero, to overcome a morphine addiction he acquired as a soldier.
The Vietnam War certainly played a role in introducing marijuana and other opioids to a new generation of soldiers while anti-war protestors and hippies built a culture around drugs that was glamorized and normalized in songs and movies of the 1960s and ‘70s. In 1971 President Nixon declared a “War on Drugs,” citing drug use as “public enemy number one in the United States.” The Drug Enforcement Agency (DEA) was created to combat illicit drugs.
Whether you think drugs are cool and hip or the tool of the devil, you have to admit the DEA’s strategy of reducing the supply of drugs has not been effective in decreasing drug use; on the contrary, drug use has increased the price of drugs and made drug lords as rich as Arab sheiks.
Most experts who have studied the current drug epidemic say it began in the 1990s with the over-prescription of opioids for pain relief. Pharmaceutical companies claimed the risk of addiction to prescription opioids was very low and encouraged doctors to use them for more than just cancer patients. By 1999, 86 percent of patients using opioids were using them for non-cancer pain. Evidence to support this is that communities where opioids were readily available and prescribed liberally were the first places to experience increased opioid abuse and diversion (that is, the transfer of opioids from the individual for whom they were prescribed to others).
When the over-prescription of opioids became apparent around 2010, steps were taken to restrict their use. But this had an unintended consequence: there was a rapid increase in deaths from heroin as opioid addicts turned to it as a cheap, potent and widely available — albeit illegal — alternative. Deaths due to heroin-related overdose increased by 286 percent from 2002 to 2013; and 80 percent of heroin users admit to misusing prescription opioids before turning to heroin.
The latest chapter in this story began in 2013 as deaths related to synthetic opioids like fentanyl began to skyrocket. The sharpest rise in drug-related deaths occurred in 2016, with more than 20,000 deaths from drugs laced with fentanyl and synthetic opioids.
One problem encountered by members of law enforcement is that they can only go after and prosecute the distribution of substances that are on the government’s list of controlled substances. Back in 1970, when Congress passed the Comprehensive Drug Abuse Prevention and Control Act, it had to define exactly what substances it could control or prohibit. Five schedules were created; they listed the various controlled substances and their degrees of criminality. If a substance is not on that list, it’s not illegal to make or distribute it in the United States.
Many of the synthetic opioids we are seeing are concocted in pharmaceutical laboratories in Asia, where a chemical formula can be tweaked to create a substance that mimics an opioid but is not on the DEA’s list of controlled substances. They are then mass-produced and shipped legally to the United States.
These synthetic opioids are used by black market dealers to enhance the power of heroin and other street drugs and make them more addictive. Much of what is peddled as “synthetic marijuana” with all natural ingredients is simply crushed leaves sprayed with a highly potent synthetic opioid that has unknown side effects by people with little knowledge of what they are creating. One of the challenges for physicians and law enforcement when someone ODs on this stuff is trying to figure out what was in it.
As things stand, opioid chemists are going to be able to stay one step ahead of the DEA bureaucracy. But this is not a problem we can arrest our way out of anyway. As long as “safe” drugs are expensive and hard to obtain, there will be a market for unsafe drugs. And for every pusher we put behind bars, another pusher is waiting to take his or her place.
Part 2 of this series will cover the opioid crises in Southwest Louisiana. Look for it in the next issue of Lagniappe.