The Portrayal of Addiction

In 4th grade I stayed after school once a week. I usually called my mom with the school’s phone afterwards. But one day, I thought to myself, “It’s the same time everyday, I bet that she’ll remember.” So I stood eagerly on the curb at my school. And I waited for my mom… By the time I realized she wasn’t coming, the school was locked, my teacher had left, and there was no one in sight. I was there for almost an hour. Luckily a stranger asked if I needed his phone. I was on the verge of tears and I said “Mommy? Are you coming to get me?” She frantically apologized. She said she thought I was already home. She forgot me. Little did I know, my mom was struggling to remember anything because of one little pill: Vicodin. a painkiller prescribed to treat moderate to severe pain, like my mom’s severe migraines. Unfortunately, Vicodin is an opioid, one of the most addictive drugs in the world. This is just one of many stories that explain why America is facing the highest number of opioid addictions we have ever seen. Today nearly two million Americans have a substance abuse disorder relating to prescription painkillers. We are in a national opioid crisis, and around 143 Americans die everyday due to opioid overdose. Please join me as we learn about the history of opioids in America, explore the neurological causes of addiction, and finally discuss the possible solutions to this crisis.

First let’s explore the origin of opioids. Opioids are a class of drug that can be naturally created — like morphine and codeine — or synthetically made — like fentanyl and heroin. Natural opioids are derived from the poppy plant while synthetic opioids are made of chemicals. Surprisingly, there are accounts of natural opioid usage that date back to ancient Mesopotamia. The Sumerians (one of the very first civilizations) cultivated the poppy and called it Hul Gil, or the Joy Plant in 3,400 BC. As the name suggests, the painkilling properties of the plant were well-known by these ancient people, and for thousands of years folks around the world used opium for this purpose. By the early 19th century, it became clear that opium was very addictive, and imperial Britain used this knowledge to exploit the Chinese. The Brits deliberately sold India-grown opium there in order to make the Chinese drug-dependent so they could force the Qing Dynasty to trade with them. Within a year, there were millions of opioid addicts in China. The Qing Dynasty was understandably mad, and their crackdown on opium and refusal to trade with the British literally sparked — not one — but two Opium Wars between 1839–1860.

Opioids appeared in America in 1775 and were originally seen as useful painkillers, or, in the case of Thomas Jefferson, pretty plants. The founding father actually planted poppy seeds in his gardens at Monticello entirely because he thought they looked nice. And there they stayed until 1991, when the federal Drug Enforcement Administration forced the museum to remove the plants. For over two hundred years, opioids were widely available in pharmacies across the country and were used to treat a variety of things. In fact. in the 1830s opium was used to calm cranky babies, and treat asthma. The drug was also administered as a painkiller during the Civil War.

It wasn’t until the early nineteenth century that things began to change. In 1914, the United States Congress passed the Harrison Narcotics Act, which regulated the production and distribution of opium- related products. The intention was to curb the growing number of addicts in the US, anyone buying or selling opioid related-products had to register and pay taxes on it. In addition, it became illegal for doctors to prescribe opioids to treat withdrawal symptoms. By 1923, sales of all narcotics became illegal. This was a significant change in the United States: a drug that used to be available in many over-the-counter products, was now illegal to possess. These laws had major social effects as well. When narcotics became criminalized, the American public came to see addiction is a criminal activity rather than a public health concern. Regardless, narcotics continued to be illegally used in America and, within the century, the CDC declared that America was afflicted with an opium epidemic.

Beginning in the 1980s, doctors and pharmacists were aware of the addictiveness of opioids and were reluctant to prescribe them. Yet, by the late 1990s, the CDC acknowledged the crisis, so what changed? Corporate America put profits over people. Purdue Pharma continually downplayed the addictiveness of opioids when marketing OxyContin. In 2012 Wall Street Journalist Thomas Caitan wrote, “In 2007, Purdue Pharma and three executives pleaded guilty to “misbranding” of the drug as less addictive and less subject to abuse than other pain medicines and paid $635 million in fines.” Pharmaceutical companies were not the only culprits, influential doctors in the field misled the general public. For example in the 1990s Dr. Portenoy, a pain specialist, wrote that less than 1% of opioid users become addicted, when in reality almost 25% of users are at risk. As many of us have heard, money is the root of all evil, and this is a prime example. Some physicians are known as “pill mill” doctors, who write prescriptions for any real or fake ailment then accept cash as the only payment. On top of that, in 2019, Dr. Thomas Mckneese Keller was charged with murder of four patients. He constantly over prescribed opioids and other drugs that may have lethal side effects. Now, because of misleading doctors and money hungry companies, America is facing an all time high of opioid addictions.

To fully understand the epidemic, we must understand addiction. There are three levels of substance abuse: Tolerance, Dependence and Addiction. Once somebody becomes addicted, their need for a substance renders them incapable of controlling their actions despite the consequences. So how is it possible that this drug can control every aspect of someone’s personality? Our brain cells communicate through hormonal signals known as neurotransmitters. Neurotransmitters relay messages by attaching themselves to a specific receptor on a neuron. Many drugs mimic the structure of neurotransmitters, activate those neurons, then send abnormal messages throughout the body. Furthermore, your brain is wired to reward you with happy chemicals when you complete a positive activity. Many people refer to this as their ‘natural high’ , an activity that makes you feel good because it produces an increased amount of dopamine in the brain. Riding your bike, spending time with your family, or even public speaking can be examples of natural highs. In addition, these neurotransmitters are natural pain inhibitors. Therefore, opioids are just beefed up neurotransmitters. This is why they are extremely addictive; they have the ability to bind to receptors and produce extremely amplified effects. The brain gets used to the presence of opioids and stops producing as many neurotransmitters as before. Now your brain relies on opioids to carry out the processes that dopamine and other neurotransmitters used to. However, Addiction can not be blamed on one factor, even genetics can play a role, scientists are learning that certain genes make someone more or less susceptible to drug addiction.

So now that we have a thorough understanding of what is causing the opioid epidemic, how can we help. First of all, we should make rehab facilities more accessible to the average American. In 2016, only 18% of all drug abuse patients were able to access proper treatment. Furthermore, studies are finding that providing rehab for addicts rather than incarcerating them is more cost efficient. In Brooklyn, a program known as Drug Treatment Alternative to Prison (DTAP) cost $32,974 for a 24 month treatment, while incarceration costs for the average sentence are almost twice that, $64,338 for 25 months. Another solution is increasing the availability of Suboxone. Suboxone works to curb withdrawal symptoms and cravings by managing the amount of opioids in the brain. Suboxone binds to opioid receptors but can not stimulate the brain as greatly. In addition, it creates a ‘ceiling effect’, which means that there’s a threshold that suboxone can not exceed. If patients attempt to take more to achieve a high, it causes withdrawal symptoms which prevents abuse. This drug is the leading solution in solving the opioid epidemic. Studies show that during a one year treatment program, 75% of patients stopped abusing opioids. Yet, patients get denied prescriptions everyday. The FDA requires doctors to be certified in order to prescribe suboxone. This is meant to prevent this drug from reaching the streets, because it can be deadly when used in combination with other drugs. In addition, people without opioid dependencies may use this drug to obtain a high, although it won’t be as extreme as a regular opioid.

America’s Opioid epidemic is not getting any better. Our drug overdose rate was 4 times higher in 2018, than in 1999. Since opioids were advertised as a ‘safe’ drug, many people used them without knowing the consequences. Now, due to the absence of resources, many Americans go untreated everyday. After my mom spent $30,000 in a rehab center, she was finally able to get a prescription for suboxone. It took two years to wean off of the medicine, but now she’s been clean for 7.5 years. Not everyone gets to tell as happy of a story as me, and hopefully, we can change future outcomes.