Introduction to the American Opioid Epidemic

Since the early 2000s, opioids have flooded into American communities killing hundreds of thousands and doing untold damage.

Introduction to the American Opioid Epidemic

A flood of dopamine to the brain induces an intense rush of pleasure followed by a few hours of drowsiness, where the user drifts aimlessly on a inner sea of warmth without any regard to the world around himself or the others who inhabit it. This is a reality that millions of Americans choose every year when they abuse prescription opioids or illicit ones like heroin. These compounds are a class of drugs which block pain signals while releasing dopamine in the reward system of the brain. This creates a positive feedback loop that reinforces the behavior and encourages the individual to seek out the drug experience again at some point in the future. However, the body responds to successive opioid use by building a tolerance, thus requiring higher doses to achieve the same high. Repeated use may lead to dependency, wherein the body develops withdrawal symptoms without regular opioid use. Dependency may eventually lead to addiction where the individual will do whatever it takes to seek out the drug experience, despite the heavy costs it may incur on their life and those around them. In this state, their rising tolerance requires higher and higher doses of opioids to achieve their high, thus further increasing the chance of a deadly overdose.

Not everyone who abuses opioids will become dependent, not everyone who develops a dependency will become addicted, and not every addict will overdose and die. However, every time someone pops an OxyContin pill or shoots up heroin, they are playing a game of Russian roulette where these are possible outcomes along with other dangers from the high-risk behaviors associated with the drug subculture. This is a gamble that millions of Americans partake in every year, and the staggering death count continues to grow annually.

The three most recent years for available data on drug overdose deaths shows a rising share of opioid-related casualties. The statistics provided from the Center for Disease Control’s Weekly Morbidity and Mortality Report for 2010-2015 and 2015-2016 are shown in the following table, and the demographics reveal the opioid deaths are approximately 80% non-Hispanic White. To put these numbers in perspectives, 6,906 US servicemen died in Iraq and 58,209 US servicemen died in Vietnam. The total opioid-related death count is 300,000 since 2000. In fact, these numbers are so large that the life expectancy of White men in America is being dragged down by these deaths.

 

Drug overdose deaths in the United States

Year  

Total drug overdoses in the US

Opioid drug overdoses in the US Percentage of overdose deaths from opioids
2014  

47,055

28,647 60.9 %
2015  

52,404

33,091 63.1 %
2016  

63,632

42,249 66.4 %

The Trump administration declared a public health emergency in October 2017 to address the opioid epidemic. In the statement, he provides a well summarized list of sobering facts about the crisis facing the country. For example, two million American’s currently have an opioid addiction, meaning the most important thing on their mind everyday is securing drugs and keeping the withdrawal symptoms at bay.

Sadly, the consequences of these addictions are not limited to the drug users. There has been a 500% increase since 2000 in babies born with opioid dependency. The most recent statistics show that 30,445 babies were born with this neonatal abstinence syndrome in 2014. A third of all child removals into foster care are now from parental drug abuse. Examples of these play out in heart-wrenching photos like the case in Ohio where both parents were overdosing on opioids while their child was in the back seat of the car.

The opioids that are ruining lives and killing Americans can be broadly classified into three different categories. First there are the pharmaceuticals, which are derived from natural sources and may be further modified via chemistry to create semi-synthetic compounds. The most notorious opioid in this group is oxycodone, which is produced by Purdue Pharma under the brand name OxyContin. It is an extremely potent compound that passed FDA approval in 1995 in a pill form that was easy to abuse. The approval of OxyContin is credited with initiating the opioid epidemic along with the advocacy push from groups like the American Pain Society, which urged doctors and hospitals to focus more on prescribing medication for pain.

Overprescribing opioid-based pain killers have reached a crescendo in the 21st century, where massive amounts of the drugs are legally prescribed in ludicrous numbers. For example, 258.9 million opioid prescriptions were written in the US in 2012. That more than one opioid prescription for every adult in the population. These statistics become even more clownish when looking a specific regions in the country with astronomical prescription rates. For example, one West Virginia town of 2,900 people had 20.8 million opioid pills shipped to its pharmacies over the last decade. It is important to note that these statistics are in reference to the distribution of pharmaceuticals within a regulated system. This deluge of painkillers that has occurred over the last two decades was signed off by medical professionals, pharmaceutical companies, and governmental regulators.

In response to greater scrutiny, Purdue Pharma redesigned the OxyContin pills in 2010, making them harder to abuse by switching to a more secure, time-release formulation. This shifted OxyContin abusers and addicts onto heroin in response. While most heroin users reported their first exposure to opioids from prescription drugs, this has shifted recently to more people trying heroin first. For example, 25% of people in the 2000s reported starting off with heroin and that number jumped to 35% for people in the 2010s.

Heroin is the second major category of opioid that is contributing to the epidemic. It is derived from the resin of poppy plants, and while the majority of heroin globally is produced in the poppy fields of Afghanistan, most of the heroin in the United States comes from poppy fields in Mexico. Heroin is commonly injected intravenously. This method of administering opioids opens up a whole host of complications. It allows for the easy transmission of bloodborne diseases, like HIV, when users share needles during an injection session.

This brings us to the final category of opioid, illicit synthetics. Unlike the pharmaceuticals and heroin, these drugs are produced via refined chemical precursors and require no natural materials, like the poppy plant resin. Similar to the synthetic marijuana that appeared in 2008, these drugs have a much greater binding affinity to receptors in the nervous system, thus making them far more powerful. The synthetic opioid fentanyl is 30-50 times more potent than heroin. This in turn makes the synthetic drugs far easier to overdose on, since a much smaller amount is required to achieve the same physiological effects of pharmaceuticals or heroin.

The production of synthetic opioids is far more difficult to regulate for a number of reasons. First, the chemical structures of the synthetic compound can be endlessly modified, with each iteration being technically a novel drug. Thus regulators can ban a large group of synthetic opioids, and new ones can be invented in a relatively short amount of time. Also, these drugs are not impossibly difficult to synthesize for anyone with advanced knowledge in chemistry. This information is freely obtainable through open access journals online. Stricter regulations could be applied to the precursors used in the production of these synthetic drugs, but then the producers simply need to develop a chemistry pathway for creating the synthetic precursors.

The discussion of regulating the production of synthetic opioids with American laws is irrelevant to the issue here. The majority of fentanyl and other synthetic opioids are being produced by labs in China and are smuggled across the southern border. The idea that easily-bribed Chinese authorities will be able to meaningfully crack down on the production of these dangerous compounds is laughable. Given the fact that hundreds of thousands of Chinese students are enrolled at American universities every year, it is entirely within the realm of possibilities that at least one of these clandestine labs operating within China has an American-trained chemist producing what is proving to be the deadliest category of opioids in the crisis.

Data from the Center for Disease Control shows that 2015 and 2016 experienced a massive spike in overdose deaths from synthetic opioids. They are now killing Americans at a higher rate than the other two categories of opioids.

Nevertheless, overdose deaths are continuing to rise for heroin and pharmaceutical painkillers too. These rising death rates are not expected to level off until sometime after 2020 with predictions that 500,000 Americans or more could die over then next decade from opioid overdoses. The opioid epidemic is currently raging on in the United States, and it deserves the full attention of our government, our medical institutions, and our leaders. It is an issue that is specifically affecting White Americans more than others, and it touches on important issues like national security and the ill effects of globalization. It is yet another reason why the southern border must be secured, and incompetent bureaucrats must be held accountable for what has been happening to this country over the last two decades.

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