History of opioid use in America

Summary

The 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

00:00

💊 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.

05:03

🚨 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.

10:08

📢 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.

Keywords

💡Opioids

Opioids are drugs derived from the opium poppy and have been used for millennia to treat pain, for spiritual purposes, and recreationally. In the video, they are central to the discussion, as they provide pain relief but also lead to euphoria, making them highly addictive. The video discusses how opioids, such as morphine and heroin, have been involved in multiple addiction crises throughout history.

💡Morphine

Morphine is a potent molecule isolated from opium by a German chemist around 200 years ago. It quickly became widely used in medical products for pain relief, but its overuse led to the first opioid addiction epidemic in the U.S. in the mid-1800s, particularly affecting soldiers and housewives. Morphine is highlighted in the video as one of the earliest opioids contributing to widespread addiction.

💡Heroin

Heroin is an opioid introduced by the Bayer Corporation as a supposed safer alternative to morphine in the late 1800s. However, it quickly became a drug of abuse, particularly in urban areas among young Americans. The video explains how heroin's introduction exacerbated the opioid crisis rather than mitigating it, as initially claimed by the manufacturer.

💡Opioid Crisis

The opioid crisis refers to the various waves of opioid addiction epidemics in the U.S., with major instances in the 1800s, post-World War II, and the current crisis starting in the 1990s. The video frames the opioid crisis as a recurring issue fueled by overprescription and misuse of opioids, leading to widespread addiction and overdose deaths.

💡OxyContin

OxyContin is a prescription opioid introduced in 1996 that played a pivotal role in the modern opioid crisis. The video discusses how its manufacturer marketed the drug aggressively, encouraging its use for chronic pain despite the medical community's prior caution about opioids' addictive potential. The overprescription of OxyContin is linked to the sharp rise in addiction and overdose deaths.

💡Addiction

Addiction is a core theme in the video, described as a major consequence of opioid overuse. Opioid addiction leads to physiological dependence and, in many cases, overdose. The video highlights various waves of opioid addiction in American history, showing how both medical and non-medical use of opioids like morphine, heroin, and OxyContin has led to widespread addiction.

💡Overdose Deaths

Overdose deaths refer to fatalities caused by excessive consumption of opioids, leading to respiratory failure or other fatal complications. The video stresses the increasing rates of overdose deaths throughout the history of opioid use, particularly in the modern crisis, where overdose deaths have reached unprecedented levels due to prescription opioids and heroin.

💡Bayer Corporation

The Bayer Corporation is the pharmaceutical company that introduced heroin to the market, promoting it as a safer alternative to morphine. The video highlights Bayer's role in exacerbating the opioid crisis by misleading the public and medical community about the safety of heroin, contributing to widespread addiction.

💡Overprescribing

Overprescribing is a key cause of the opioid crisis, as outlined in the video. It refers to doctors prescribing opioids, such as OxyContin, in excessive quantities, particularly for chronic non-cancer pain. This practice, heavily influenced by aggressive pharmaceutical marketing, has led to a dramatic rise in opioid addiction and overdose deaths.

💡CDC (Centers for Disease Control and Prevention)

The CDC is mentioned in the video as the organization that has tracked and identified the root causes of the opioid epidemic, attributing it to the overprescription of opioids starting in the 1990s. The CDC's research is cited to show the parallel rise in opioid prescriptions, addiction, and overdose deaths.

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.