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Opioids

The opioid crisis in the U.S. dramatically illustrates how the central nervous system can be abused and what the consequences of doing so can be. CNN reports that in 2017, approximately 1.7 million Americans suffered from the effects of prescribed opioids and 652,000 people became addicted to heroin.2 Approximately 70,200 people died from substance overdoses, of which 47,600 were opioid overdoses. In 2016 and 2017, more than 130 people died each day from an opiate overdose (U.S. Department of Health & Human Services). In 2011, 240 billion milligrams of morphine were prescribed, then in 2017 it was “only” 171 billion milligrams.3 Globally, illicit drug sales, fueled in part by prescription drug abuse, are estimated at approximately $320 billion per year.

The mode of action of opioids is mediated by receptors found in the spinal cord and brain—our central nervous system. The transmission of pain is stopped, and dopamine is also released in the brain, which can trigger a feeling of well-being, sometimes even euphoria—a high. Opiates are obtained from the opium plant (poppy family) and belong to the narcotics family. Heroin is a synthetic derivative of morphine and is considered a highly addictive drug. Opium has played a role in various societies for centuries. Particularly well known are the Opium Wars in China (First Opium War 1839–1842, Second Opium War 1856–1860). Currently, the largest producing countries are Mexico, Colombia, Afghanistan, Iran, Pakistan, Burma, Thailand, Laos and Vietnam. Hydrocodone and oxycodone are semi-synthetic opiates produced in laboratories with natural and synthetic ingredients. In 2016, 6.2 billion oxycodone tablets were prescribed to patients in the U.S. alone (IQVIA). Between 2005 and 2015, 15% of emergency department patient visits and 3% of office-based appointments resulted in an opioid prescription. In 2015, it was reported by the International Narcotics Control Board that 99.7% of global hydrocodone use was represented by American patients.4 In 2016, the National Institute on Drug Abuse estimated that approximately half of the people addicted to heroin had previously developed an addiction to prescribed opiates, and that people who develop an addiction to prescribed opiates are 40 times more likely to become addicted to heroin.5