How Did the Opioid Epidemic Start? What We Can Learn

The U.S. opioid epidemic started with a sharp rise in opioid prescribing in the 1990s and then moved through heroin to illicitly made fentanyl. It developed through overlapping changes in prescribing, drug supply and access to treatment, and no single medicine or group of people explains it.

It is one of the most serious ongoing health crises in America. It can affect anyone, of any age, whether they live in urban centers or rural communities. Addiction also knows no socioeconomic boundaries.

To address the problem, we need to understand its origins, the patterns of the last few decades, and educate the public about addiction recovery programs.

We've put together this opioid epidemic overview to help you or a loved one caught in the grips of addiction.

Opioids Throughout History

What are opioids anyway? Opioids are a class of drugs that originate from the opium poppy plant. Opium is certainly not a new drug. It has been used for thousands of years.

Some historians think it was used as far back as the Neolithic period. The ancient Greeks revered opium. There have even been "poppy goddess" figurines found in Crete.

Opium use spread throughout Asia, the Middle East, and Europe for centuries. However, perhaps the biggest influence was the introduction of laudanum in 1676. It was widely sold in apothecary shops as a treatment for a variety of ailments until after WWII.

The harms of opium, including dependence, have been recognized for well over a century.

Opioid Medications

Some opioid medications are made directly from the poppy plant. Others are created synthetically in a lab. All such drugs interact with opioid receptors that live on the nerve cells.

In turn, these nerve cells affect the body and brain. Common opioids include:

• Oxycodone (OxyContin®)
• Hydrocodone (Vicodin®)
• Codeine
• Morphine
• Fentanyl
• Methadone

Heroin is also classified as an opioid, but it is illegal, while a doctor usually prescribes the other drugs.

Medical Uses of Opioids

Opioids are often prescribed to relieve pain, and they can be effective in helping people recover after surgery or an accident, or in the management of chronic pain. However, they also carry risks of dependence, opioid use disorder and overdose.

The problem lies in the euphoria that accompanies pain relief. For some, the euphoria can become necessary. This often leads to misuse of the drug (taking more than necessary or without a doctor's prescription).

The misuse and increasing need for drugs can lead to tragic consequences, including accidental overdose and death.

Why Opioid Addiction Occurs So Readily?

You might wonder why opioids wreak such havoc. It comes down to the pleasurable feeling that accompanies the pain relief. Addiction is often described as something that started out as pleasurable that a person now can't live without.

People who use opioids can develop a strong craving for the drug, especially the high. Once the dose wears off, the person may want more in order to hold on to that feeling of pleasure.

Often, the person ends up needing the drug just to function normally. The compulsion to take opioids often leads to misuse, illegal means of acquiring the drug, and accidental overdoses.

How Bad Is the Opioid Epidemic?

The epidemic is still with us, and the figures change every year. Reports separate final data from provisional estimates, calendar years from rolling 12-month periods, and all-drug deaths from opioid-involved deaths, so two numbers can look different and both be right.

For updated numbers, use the CDC Overdose Prevention Data Channel and check the date and population before comparing figures.

It's easy to think that the opioid epidemic only affects those in big cities. It does not. Rural communities and small towns have been hit as hard as urban centers.

Opioid use doesn't only affect those who take the drugs. Babies exposed to opioids before birth can have withdrawal symptoms after they are born. Newborn withdrawal after prenatal opioid exposure is a medical condition, and if you are pregnant and taking opioids, talk to a clinician about treatment. SAMHSA TIP 63: Medications for opioid use disorder

History of the Opioid Epidemic

The CDC describes three major waves of increased opioid overdose deaths. CDC: Understanding the opioid overdose epidemic

Wave 1

The first wave began in the 1990s, when health officials noticed an increase in opioid-related overdoses and deaths. The uptick was no coincidence.

It was during this time that doctors began prescribing more opioid and opioid-combination medications to treat pain. Many had been given misleading assurances about the risk of addiction. There was also an increase in prescriptions for non-cancer-related pain, even though there wasn't much data concerning the risks or benefits of opioids.

Communities with the highest rates of prescriptions were also seeing higher rates of opioid misuse and illegal activity involving the way people were getting hold of these drugs.

Wave 2

The second wave began around 2010, with rising heroin-related overdose deaths. By this time, there was a concerted effort to limit the rates of opioid prescriptions. Some people turned to illegal sources. Enter heroin, which was cheap and easily available.

Heroin use increased, along with deaths. Injecting heroin also increased the risks of other infections and diseases, including HIV/AIDS, hepatitis B and C, skin infections, and even heart infections.

Not everyone who develops opioid use disorder starts with a prescription, and different pathways need different prevention and treatment responses.

Wave 3

The third wave began around 2013 and was driven largely by illicitly manufactured fentanyl and related substances. Fentanyl may appear in powders or counterfeit pills and can be present without the person's knowledge. CDC: Fentanyl

Exposure to more than one substance adds risk. An overdose may involve opioids along with stimulants, benzodiazepines, or other drugs. CDC: Polysubstance Use Facts

During this time, the CDC issued guidelines for doctors who were prescribing opioids for chronic pain. The guidelines suggested non-opioid treatments should be considered first.

Those in the medical community have not always followed the guidelines. There have also been noteworthy scandals tied to walk-in clinics (called pill mills) that sold vast amounts of opioids.

The HHS declared the opioid crisis a public health emergency in 2017. The Federal government also launched a Five-Point Strategy to Combat the Opioid Crisis.

How to Treat Opioid Addictions

Treating opioid addiction is not always easy. However, there are effective treatments.

One option involves medication therapy. Buprenorphine (Suboxone® or Subutex®) is considered an "essential medicine" by the World Health Organization (WHO). Other medications include methadone, and extended-release naltrexone (Vivitrol®).

Buprenorphine, methadone, and naltrexone are all options for opioid use disorder. They work differently and are not taken together as a routine. Naltrexone blocks opioid receptors and can precipitate withdrawal in someone physically dependent on opioids. A transition from buprenorphine or methadone requires clinical planning. Detoxification alone does not provide adequate ongoing treatment for opioid use disorder. CDC: Treating Opioid Use Disorder SAMHSA: Naltrexone

Most health and mental health experts recommend that medication therapy be used in conjunction with behavioral counseling and psychological therapy. This method is sometimes referred to as Medication-Assisted Therapy.

The NIH has also set research priorities to fight the opioid epidemic. They are looking for solutions to the opioid crisis by discovering better ways to prevent opioid misuse, treat opioid use disorders, and manage pain. In the summer of 2017, NIH met with pharmaceutical companies and academic research centers to discuss those priorities.

This includes:

• Non-addictive strategies to manage chronic pain
• New, innovative medications and technologies to treat opioid use disorders
• Improved overdose prevention and reversal interventions to save lives and support recovery

In April 2018 at the National Rx Drug Abuse and Heroin Summit, NIH Director Francis S. Collins, M.D., Ph.D., announced the launch of the HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis.

Free Yourself From Opioid Addiction

The opioid epidemic continues to affect the country. Recovery is possible, however. Treatment can help you or a loved one, and it can open the way to repaired relationships and a steadier life.

So what can we learn from this history? Each wave points to the same things. Opioids have real medical uses and real risks, so pain care needs individual decisions. The drug supply is unpredictable, so naloxone needs to be within reach. And treatment has to be easy to get to. Practical measures include access to naloxone, accurate medication information, timely treatment, secure storage, and nonjudgmental conversations.

If someone is hard to wake or is breathing slowly, call 911 and give naloxone if available. CDC: Responding to an Overdose

Recovery Delivered treats opioid use disorder online with Suboxone. Visits are by video, and new patients pick up their medication at a local pharmacy.

Start Suboxone treatment online. You can see one of our Suboxone doctors online, by video. The first visit is $89. Follow-up visits are $50 weekly, $75 every two weeks or $89 monthly. Visits are cash pay, and medication is priced separately.