History of opioid use in America
Summary
TLDRThe video script discusses the history of opioid use, from ancient times to the present crisis. It details the 19th-century morphine epidemic, the introduction of heroin as a 'safer' alternative, and subsequent addiction issues. The script emphasizes the current opioid crisis, linked to overprescription by the medical community, particularly since the 1990s with OxyContin. It outlines how aggressive marketing and a shift in medical attitudes towards pain management have contributed to the escalating addiction and overdose rates.
Takeaways
- 🌿 Opioids have been used for thousands of years for various purposes, including pain relief, spiritual, and recreational use.
- 🔬 In the 1800s, a German chemist isolated morphine from opium, leading to its widespread use in medical products.
- 🏥 The mid-1800s saw the first opioid crisis in the United States due to overexposure and addiction, affecting both Civil War soldiers and middle-class housewives.
- 💊 By the late 1800s, morphine addiction and overdose deaths were rampant, prompting health officials to recognize the dangers of opioid products.
- 🏭 During the morphine epidemic, Bayer Corporation introduced heroin as a 'safer' alternative, despite lacking evidence for its safety.
- 🚫 After the introduction of heroin, a new wave of opioid addiction emerged, particularly among young, urban Americans.
- 📉 Federal intervention in the early 20th century through regulatory laws helped reduce opioid addiction rates.
- 🌐 Post-World War II, a new opioid epidemic arose, affecting inner-city, nonwhite populations with illicitly manufactured heroin.
- 📈 The current opioid crisis, which began in 1996, is the worst the U.S. has faced, with significant impacts on communities and healthcare.
- 🏥 The CDC attributes the current epidemic to the medical community's overprescribing of opioids, starting in the 1990s, which led to increased addiction and overdose deaths.
- 💊 The aggressive marketing of OxyContin in 1996 reframed cautious opioid prescribing as a barrier to compassionate pain care, influencing doctors to prescribe more opioids.
Q & A
What are opioids and what are their primary uses?
-Opioids are drugs derived from opium, primarily used for pain treatment, but also for spiritual and recreational purposes due to their ability to produce euphoria.
Who was the German chemist that isolated morphine from opium?
-The script does not specify the name of the German chemist who isolated morphine from opium.
When did the United States first experience an opioid crisis?
-The United States first experienced an opioid crisis in the mid-1800s, characterized by an epidemic of opioid addiction due to overexposure to opioids.
Which groups were particularly affected by the first opioid crisis in the US?
-Civil War soldiers, middle-aged housewives, and doctors who prescribed morphine heavily were particularly affected by the first opioid crisis.
How did the Bayer Corporation market heroin when it was introduced?
-The Bayer Corporation marketed heroin as a safer alternative to morphine, promoting it as having a lower risk of overdose death.
What was the outcome of heroin's introduction during the morphine epidemic?
-Heroin's introduction led to a new type of opioid addiction, particularly among young Americans in urban areas who began using it non-medically.
When did the federal government step in to regulate the sale and prescribing of narcotics?
-The federal government stepped in and began passing laws to regulate the sale and prescribing of narcotics by 1914, in response to the severe opioid addiction problem.
What was the nature of the opioid epidemic after World War II in the United States?
-After World War II, the opioid epidemic disproportionately affected inner-city, nonwhite populations, with a focus on the use of illicitly manufactured heroin.
When did the current opioid addiction epidemic begin, as described in the script?
-The current opioid addiction epidemic began in 1996, which is considered worse than any previous drug addiction epidemic in the United States.
What role did the marketing of OxyContin play in the current opioid crisis?
-The marketing of OxyContin, which began in 1996, reframed cautious use of opioids as barriers to compassionate pain care, leading to more aggressive prescribing and contributing to the current crisis.
What has the CDC identified as the cause of the current opioid addiction epidemic?
-The CDC has identified the cause of the current opioid addiction epidemic as the medical community inadvertently overprescribing opioids.
Outlines
💊 Opioid History and Early Crises
The paragraph discusses the long-standing use of opioids for various purposes, including pain relief and recreation, due to their euphoric effects. It recounts the historical development of morphine, which was isolated from opium by a German chemist around 200 years ago and quickly integrated into medical products. The mid-1800s marked the U.S.'s first opioid crisis, with overexposure leading to addiction among Civil War soldiers and the middle class. The crisis escalated to include high overdose death rates, prompting health officials to recognize the dangers of morphine. During this time, Bayer Corporation introduced heroin as a safer alternative to morphine, based on studies in mice suggesting lower overdose risks. However, this claim was dubious, and heroin soon led to a new wave of addiction, particularly among young urban Americans who began using it non-medically. The federal government's intervention in the early 20th century through regulatory laws helped reduce opioid addiction.
🚨 The Current Opioid Crisis
This paragraph delves into the most recent opioid epidemic, which is considered more severe than any previous drug crisis in the U.S., characterized by high overdose death rates and widespread addiction. The root cause is identified as an increase in opioid prescriptions since the 1990s, which inadvertently led to a surge in addiction and overdose deaths. The CDC has linked this increase to overprescribing by the medical community. The paragraph highlights how the introduction of OxyContin in 1996 and aggressive marketing campaigns by the pharmaceutical industry contributed to the crisis. These campaigns reframed caution about opioid addiction as barriers to compassionate pain care, encouraging more liberal opioid prescriptions. This shift in medical practice, influenced by pharmaceutical marketing and endorsement from medical authorities, has resulted in the current epidemic, affecting a large number of Americans and causing significant health and social issues.
📢 Influence of Pharmaceutical Marketing on Opioid Prescribing
The final paragraph examines the influence of pharmaceutical marketing on opioid prescription practices. It describes how doctors were persuaded by educational programs, national societies, hospitals, and state medical boards to view opioids as a compassionate treatment for pain, diverging from previous cautious approaches. This change in perception, driven by marketing and industry-sponsored education, led to increased opioid prescriptions and consequently, the current opioid epidemic. The paragraph emphasizes the role of pharmaceutical companies in reshaping medical opinion and practice, which has had profound and detrimental effects on public health.
Mindmap
Keywords
💡Opioids
💡Morphine
💡Heroin
💡Opioid Crisis
💡OxyContin
💡Addiction
💡Overdose Deaths
💡Bayer Corporation
💡Overprescribing
💡CDC (Centers for Disease Control and Prevention)
Highlights
Opioids have been used for millennia for pain treatment, spiritual, and recreational purposes.
A German chemist isolated morphine from opium about 200 years ago.
The mid-1800s saw the first opioid crisis in the United States due to overexposure.
Civil War soldiers and middle-class housewives were among those addicted to morphine.
Doctors prescribed morphine liberally, contributing to the addiction crisis.
The late 1800s experienced a severe morphine addiction epidemic with high overdose deaths.
Bayer Corporation introduced heroin as a safer alternative to morphine during the morphine epidemic.
Heroin was marketed with studies in mice suggesting a lower risk of overdose.
Heroin use among young Americans in urban areas led to a new type of opioid addiction.
The federal government passed laws to regulate the sale and prescribing of narcotics, reducing addiction.
Post-World War II saw an opioid epidemic affecting inner-city, nonwhite populations with illicit heroin.
The 1996 introduction of OxyContin marked the beginning of the current opioid addiction epidemic.
The CDC attributes the current opioid crisis to overprescribing by the medical community.
OxyContin's manufacturer launched campaigns to encourage opioid prescribing for common conditions.
The medical community was encouraged to be more liberal with opioid prescriptions for chronic pain.
The opioid crisis has been inadvertently caused by the medical community's aggressive prescribing practices.
Transcripts
ANDREW KOLODNY: Opioids are drugs that have been used for millennia.
They've been used for the treatment of pain.
They've been used for spiritual purposes and for recreational purposes,
because opioids can provide effective pain relief.
They can also produce an euphoria.
Opioids are drugs that come from opium, and it
was about 200 years ago that a German chemist figured out
how to isolate one of the more potent molecules in opium, the sap
from the opium poppy.
What this chemist figured out how to do was to isolate morphine.
And it didn't take very long for morphine
to begin to make its way into many different medical products, products
that were either prescribed or in some cases sold over the counter.
It was in the mid-1800s that the United States began
to experience its first opioid crisis.
This was an epidemic of opioid addiction that
was developing because the population in the US
was becoming overexposed to opioids.
You had Civil War soldiers who were becoming addicted
to morphine that was prescribed to them, but you also
had many middle class, middle-aged housewives
who were becoming addicted to morphine.
You had many doctors who had as the business
model for their medical practice prescribing lots of morphine.
These were doctors who might have patients visiting their office multiple
times a day to receive a morphine injection.
By the late 1800s, the opioid addiction epidemic had grown severe.
Overdose deaths involving morphine had risen to very high levels,
and there was an awareness among health officials across the United States
about the risks and dangers of products containing morphine.
It was in the midst of that morphine epidemic
but the Bayer Corporation introduced a new opioid called heroin.
And when the Bayer Corporation introduced heroin,
it actually promoted heroin as a safer alternative to morphine.
There was lots of concern about overdose risk with morphine.
And so heroin was promoted as having a lower risk of overdose death.
Then the Bayer Corporation pointed to studies
that they had done in mice to try and show
that there was less risk of overdose death from decreased breathing.
We'll probably never know whether or not those studies were
done correctly or whether it was all made up
as part of a marketing strategy, but we do know
that heroin is not safer than morphine.
Shortly after heroin was released onto the market
we began seeing a new type of opioid addiction problem.
We began seeing young Americans, particularly in urban areas,
begin using heroin non-medically.
These were young, white street toughs in New York City.
They were the children of immigrants.
They were Italian, Irish, Jewish.
They were purchasing pharmaceutical-grade heroin tablets,
crushing them and snorting them.
And so we began to see this overlapping epidemic of opioid addiction
in non-medical users of prescription opioids by 1914.
The problem had grown so severe that the federal government stepped in and began
passing laws to better regulate the sale and prescribing of narcotics.
After these laws were passed, we began to see a decline in opioid addiction.
It wasn't until after World War II that the United States faced
its next opioid addiction epidemic.
This time, it's an epidemic that's disproportionately
affecting inner city, nonwhite populations,
and the opioid is black market, illicitly manufactured heroin.
And because the heroin that's coming into inner city communities
has been cut so many times before it reaches a user,
it's heroin that can really only have an effect in people who inject it.
So this becomes an injection heroin use epidemic
that hits low-income nonwhite communities very hard.
And that's in the 1970s.
It wasn't until 1996 that the next opioid addiction epidemic begins,
and that next epidemic is the one that we're dealing with today.
And the epidemic we're dealing with today
is far worse than any drug addiction epidemic
the United States has faced previously, when
we look at the number of people affected and the number of overdose deaths
that we're experiencing.
When we talk about our opioid problem or when we talk about the opioid crisis,
it's important to frame the problem in the right way.
Our opioid problem, I believe, is an epidemic of opioid addiction,
meaning that the reason that we're experiencing
record high levels of overdose deaths involving opioids and the reason
that we're seeing heroin flood into communities where it wasn't previously
available, and the reason we're seeing soaring rates of infants
born opioid-dependent and all of the different health and social problems,
that the driver has been a sharp increase in the number
of Americans suffering from opioid addiction.
The CDC has been very clear about the cause of our current opioid addiction
epidemic, but the CDC has shown is that as prescriptions for opioids
began to increase rapidly beginning in the 1990s, as the prescribing went up,
it led to parallel increases in rates of addiction and overdose deaths.
What the CDC has really been saying is that this
is an epidemic that has been caused inadvertently
by the medical community overprescribing opioids.
As the prescribing went up, it led to an epidemic of addiction and overdose
deaths.
Now, the reason that the medical community
began to prescribe opioids much more aggressively, starting in the 1990s,
has a lot to do with the way in which opioids were marketed.
It was in 1996 that OxyContin was introduced,
and the drug company that manufactures OxyContin
when it put the medication on the market that launched a campaign
to encourage opioid prescribing the manufacture of OxyContin
wanted to see the drug used for common conditions.
But they had a problem.
Back in the early '90s many doctors understood
that opioids are highly addictive, and we
understood that there are limitations to using them for chronic non-cancer pain.
We knew that if you put a patient on opioid chronically,
that the risk of addiction would go up if patients
taking the opioid long term.
We knew that patients would very quickly develop a tolerance to the pain
relieving effect, meaning that they would need higher and higher doses
in order to get pain relief.
And we knew that even if a patient didn't clearly get addicted,
the physiological dependence that would set in
would make it hard for many patients to ever come off of opioid.
So in the early '90s, the medical community
understood that opioids should be prescribed cautiously for chronic pain.
We knew these are essential medicines for end-of-life care,
and essential medicines to be used short term for severe pain,
for example, after major surgery.
But we knew better than to use them aggressively
for conditions like low back pain, chronic headache, fibromyalgia.
But when OxyContin was introduced, the manufacturer
reframed these very good reasons for being cautious with opioids as barriers
to compassionate pain care.
In educational programs that were sponsored by the drug company--
20,000 educational programs in the first six years of the release of OxyContin--
doctors began to hear that the risk of addiction
had been overblown, that we've been allowing patients to suffer needlessly,
that we can be much more compassionate if we prescribe opioids more liberally.
And we didn't just hear this in educational programs
that were sponsored by drug companies.
We heard these messages from our national societies, from our hospitals,
from our state medical boards.
So from every direction, primary care doctors
begin hearing that if you're an enlightened
physician and a concerned, compassionate physician,
you'll be different from those stingy puritanical doctors of the past that
were allowing patients to suffer needlessly.
And so as we responded to this brilliant campaign
and as the prescribing increased, that led to the epidemic
that we're dealing with today.
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