Opioid Crisis: The Blame Game
During some recent info filtering, I found some folders from my graduate school days in the 70s. After getting my Masters in ‘72 I wrote a Qualifying Paper before being approved for the PhD program titled “An Experimental Analysis of Opiate Addiction” where I reviewed research literature on the topic and used Behavioral Principles of Learning in forming my analysis.
To begin lets make a distinction between Opiates and Opioids.
- Opiates are derived from the Opium Poppy, a plant grown mainly in Mid-Asia. Morphine, Delauded and Heroin all come from Opium
- Opioids are synthetic versions having similar effects to natural Opiates. Commonly included are Oxycontin, Hydrocodone, and deadly Fentanyl.
In my Literature review, I learned a lot about the history of Opiates. At that time (1970) noted that researchers had tried for over 50 years stemming from the 20s to separate the pain relieving effects of opiates from their addicting qualities,”with very limited success”. Now we understand that this reality is due to the nervous system receptors and pathways being the same.
Mid 90s Insanity
In the mid 90s with much fanfare BigPharma touted these new Opioids were safer and not nearly as addiction prone as the nasty old Opiates. While clearly untrue, MDs and other prescribers wanted to help their patients and perhaps get more trips to Cancun. Once providers began to prescribe for long tern pain relief, the cascade of over use and addiction began to spiral out of control.
Who to Blame?
- Simply stated every part of the Healthcare system involved with these drugs bares some blame for this crisis.
- While current lawsuits focus on manufacturers like Perdue Pharma, volume distributors like McKesson ignored large increases in orders particularly from rural areas in the Midwest
- MDs and other providers kept expanding the use of opioids dramatically.
- For example, kids were given 30 oxycontin tabs for post wisdom teeth extraction pain.
- FYI a long time ago in the 60s I had 4 impacted wisdom teeth surgically removed getting only aspirin with codeine for the first few days.
Worse yet, Opioids were then prescribed for long term use in addition to post surgical pain. No studies were done to validate the safety of this practice. Over time patients require larger and larger doses due to tolerance which increases the likelihood of an OD. Best case here is an quick admin of a narcotic antagonist like naloxone, but worse case is death.
Fentanyl Accelerates the Crisis
The addition of black market Fentanyl from China has raised the stakes ever higher. Once addicted, many seek to find drugs on the street. In the past most street Heroin was heavily cut. With cheap fentanyl flooding the zone dealers have a easy way to satisfy demand, but the downside is many, many more ODs and deaths from street drugs. Fentanyl is 500 times stronger than morphine and makes even handling it very dangerous.
Cannabis to the Rescue?
States with functional medical marijuana programs report over a 20% decrease in opioid OD ER admissions. In addition, other studies suggest that Cannabis and CBD help addicts by lessening their drug cravings after primary withdrawal. Thus, making relapse less likely. More research and more tolerance.
My twitter friend Peter Grinspoon, MD (@Peter_Grinspoon) a recovered addict. writes elegantly of the problems healthcare workers face in overcoming their own addictions. We must remember that MDs are human too!
So in conclusion, each and every part of the opioid prescription chain has some responsibility. Seeking to blame one part of the industry misses the main point. The lust for profit has contaminated the system giving patients the short end of the deal with inadequate and unsafe opioid solutions the sometimes lead to death. The silver lining is the efficacy of cannabis preparations to improve outcomes and lessen relapses among recovering addicts.