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RUNNING HEAD: The History of the Increase in Opiate Addiction Final Research Paper: The History of the Increase in Opiate Addiction Veronica C. Correll Grand Canyon University PCN: 527 Psychopharmacology and Addictions November 22, 2023

RUNNING HEAD: The History of the Increase in Opiate Addiction Numerous inquiries have been made regarding the causes of the opioid crisis's consistent escalation. The detrimental effects that this medication has had on patients and their families are supported by a plethora of statistics, and the prevalence of opioid addiction is rising as more people investigate new drugs. Studies on this epidemic have shown how pharmaceutical companies and physicians have fueled its continued growth. This paper will address the history of opioids in addition to providing background information on the rise in opioid prescriptions. We will discuss the history of opioids, psychopharmacology, new developments in pharmaceuticals, societal issues, and the connection between treatment and opioid dependence. A Synopsis of Opioid History Prescriptions for Sumerian clay tablets, according to Bandyopadhyay (2019), attest to an 8,000-year history of opioid use (para. 4). Morphine was introduced to the United States in the 1860s to treat injured Civil War soldiers; approximately 400,000 of these soldiers became addicted. Opium was first introduced in the country in 1775. Opioid addiction escalated in the 1800s, as evidenced by the figure in the article History of the Opioid Epidemic. This was mainly due to the accessibility of Bayer products over the counter: Foundation Recovery Network, 2021). The Foundation Recovery Network (2021) figure states that to get a stronger high, people began crushing and inhaling opioid medications later in 1910. This resulted in the Harrison Narcotics Act, which was signed into law in 1914 and mandated that only prescriptions be obtained for opioid medications. Between 1976 and 1986, the FDA approved Vicodin and Percocet after discovering that opioids could be used to treat pain caused by cancer. The Foundation Recovery Network (2021) figure illustrates the World Health Organization's 1986 recommendation to use opioids as a last resort. Regretfully, the rise in prescriptions written in the

RUNNING HEAD: The History of the Increase in Opiate Addiction 1990s marked the start of the first wave of opioid-related deaths, which persist to this day (CDC, 2020, para. 3). Psychopharmacology of Opioids Tolerance to opioids is typically the first step toward the development of an addiction, according to Juergen (2020) (para. 4). When someone starts taking larger-than-recommended dosages due to tolerance, they become physically dependent and start to crave the drug. In 2013, the National Survey on Drug Use and Health found that more than half of people abusing prescription painkillers did so with assistance from a friend or family member (Juergen, 2020, para. 31). By attaching to opioid receptor proteins on brain and spinal cord nerve cells, opioids prevent pain signals from the spinal cord from reaching the body (ASA, 2021, para. 2). Opioids have significant side effects and have the potential to become very addictive, even though they can reduce pain. Opioid use can have potentially fatal side effects such as unconsciousness and insomnia when abruptly stopped (ASA, 2021, para. 3). Juergen (2020) defines opioids as agonists that amplify opioid receptors. This category includes both illegal and prescribed opioids. Antagonists "interact with specific receptor sites in the brain" (para.9), according to Juergen (2020), to replicate the opiate-producing effects of endorphins that are found naturally in the body. Both opiates and opioids function by activating the brain's Mu receptors while inhibiting the central nervous system (Juergen, 2021, para. 12). Issues and Trends of Today To treat severe or persistent pain, such as pain following surgery or chronic pain from cancer, doctors prescribe prescription opioids such as OxyContin, Percocet, or Vicodin (American Society of Anesthesiologists, 2021) (para. 1). In addition, opioid prescriptions may be used to treat injuries sustained in sports, auto accidents, falls, and other mishaps (ASA, 2021,

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RUNNING HEAD: The History of the Increase in Opiate Addiction para.1). Despite the high risks and lack of information regarding the long-term efficacy of these drugs, the Centers for Disease Control and Prevention (2017) report that the number of prescriptions for opioids for patients with chronic pain and non-cancer patients has increased recently (para. 1). Codeine, loperamide, and dihydrocodeine are examples of opioid-like drugs that are frequently abused, according to Sobczak and Gorynski (2020). The abuse of over-the- counter opioids has supplanted the use of illegal or prescription opioids. According to Sobczak and Gorynski's (2020) research, OTC opioid-based medications—much like the drugs we discussed earlier—are frequently abused when taken for purposes other than medical ones (para. 3). Sobczak and Gorynski (2020) state recommended dosage for over-the-counter codeine tablets is 15 mg every 4-6 hours; however, abuse starts at a starting dose of 30–60 mg and can increase to 100–250 mg to produce euphoria (para.13). Public Issues or Concerns A 2016 Hagemeier (2018) report states that more than 60 million patients were prescribed opioids at least once in 2016. In 2012, there were 259 million prescriptions written for opioid painkillers in the United States alone. The CDC estimates that roughly 70% of drug-related deaths in 2020 involved opioids (para.1). There have been four times as many drug-related deaths since 1999. Almost 450,000 people, both legal and illicit opioid users, overdosed on opioids between 1999 and 2018 (CDC, 2020, para. 2). As per the CDC (2020, para. 3), there has been a rise in the number of deaths resulting from opioid overdoses since 1999. The outbreak of the epidemic coincided with a rise in the prescription of opioids during the 1990s. The beginning of the second wave of overdose deaths in 2010 was characterized by a sharp rise in deaths related to heroin use. Starting in 2013, an extra rise in overdose deaths associated with synthetic opioids set apart the third wave (CDC, 2020, para. 3). Government taxes were intended to be used as a

RUNNING HEAD: The History of the Increase in Opiate Addiction means of controlling drug use, according to Levinthal (2023)'s analysis of the 1914 Harrison Act (p. 61). Persons who manufacture, distribute, import, or dispense certain medications were required by this Act to register with the Treasury Department, pay a tax, and maintain transaction records. Courtwright (2015) stated that doctors found it challenging to consistently treat addicts due to the enforcement policies of the Harrison Act (para.1). The Act was successful in primary prevention and decreased the number of new addicts. Estimates from Levinthal (2023) indicated that 22% of US soldiers had at least tried heroin in 1971, and 11% had used it regularly. The 10% of returning Vietnam veterans who continued to abuse heroin sparked concerns, according to Levinthal (2023). Although they were aware of the consequences, which included having their departure delayed, U.S. soldiers in Vietnam were using drugs at epidemic levels, with an estimated 5% of positive urine tests (Robbins et al., 1974). The soldiers' continued use of heroin prompted Robbins et al. (1974) to raise concerns about the employability of returning soldiers and their prosocial behavior. A crackdown on trafficking, tainted dosages, unusually high prices, and a rise in criminal activity caused a shortage of heroin in the 1960s (Levinthal, 2023). Heroin prices rose quickly, tainting dosages and promoting an increase in crime, particularly in urban ghettos. According to Agar & Reisinger (2002), President Nixon's treatment policies and law enforcement's involvement contributed to a shift in the heroin epidemic that resulted in stronger supply chains and an ongoing rise in the number of addicts. Prescription painkillers were a source of concern for two million Americans aged 12 and up, while heroin was used by 20.5 million (Hedegaard, 2015, p. 1). The age-adjusted rate of heroin poisoning deaths increased almost fourfold from 0.7 per 100,000 deaths in 2000 to 2.7 per 100,000 deaths in 2013. Most of these deaths happened after 2010. Hedegaard and colleagues

RUNNING HEAD: The History of the Increase in Opiate Addiction (2015) reported this information. In 2013 there were nearly four times as many heroin-related deaths in the male population as in the female (Hedegaard et al., 2015, key findings-2). Hedengaard et al. (2015) highlighted three important findings, including the fact that Black non- Hispanics had the highest rate of heroin-related drug poisoning deaths in 2000. More than enough to provide every American with a bottle, 259 million prescriptions for opioids were written in 2012 (Hedegaard, 2015, p.1). With 20,101 deaths linked to prescription painkillers, opioid addiction is the primary cause of overdose deaths in the US (Hedegaard et al., 2015, p.1). Overdose rates, sales, and admissions to drug abuse treatment centers increased four to six times between 1999 and 2008. Furthermore, according to a 2014 survey, 94% of respondents stated that the price of prescription painkillers had an impact on their decision to use heroin (Hedegaard, 2015). Importance of Opioids in the Counseling Profession There are many ways to use opioids, regardless of their legality. Morphine and fentanyl are the most prescribed opioids with the most potent effects. Juergen (2021) pointed out that other commonly prescribed opioids with a high potential for abuse include buprenorphine, heroin, hydrocodone, and oxycodone (para.11). Opioids that are frequently used for extracurricular activities include methadone and morphine. These drugs are not only prescribed for pain relief, but they can also be used to treat several addictions and are the primary cause of unintentional deaths (Juergen, 2021, para. 12). The National Institute on Drug Abuse (2018) found that naloxone is an antagonist that can bind to and reverse the effects of other opioids, which is why it is being used more frequently to save people who have overdosed on opioids. When someone overdoses and their breathing stops or slows down, naloxone can be injected into their body to quickly reverse the effects and

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RUNNING HEAD: The History of the Increase in Opiate Addiction restore adequate breathing (NIDA, 2018, para.1). According to the Centers for Disease Control and Prevention (CDC, 2020), opioid addiction patients can recover; the most effective way to do so is to combine behavioral therapy and medication for opioid use disorder (para. 4). Potential Consequences All states make medication-assisted treatment, evidence-based prevention, and recovery support services easily accessible to counselors to combat the opioid epidemic (SAMHSA, 2017, para. 3). With initiatives about prevention, treatment, and recovery, the SAMHSA (2017) seeks to address the opioid crisis by expanding access to treatment, decreasing unmet treatment needs, and lowering the number of opioid overdose-related deaths. The FDA published the "Guidelines for Industry Assessment of Abuse Potential of Drugs," which contained details on how to use "abuse-dissuasive pharmaceutical dosage forms" to prevent drug abuse as well as information on the creation of new pharmaceutical technologies (Simon et al., 2015, para. 1). In response to the nation's fastest-growing drug problem, the pharmaceutical industry has been urged to establish ADFs by the White House Executive Office of the President and several federal agencies (Simon et al., 2015, para. 4). Conclusion In conclusion, there are a lot of strategies to stop opioid addiction without outlawing use. The legalization of illegal drugs or painkillers increases demand while loosening government regulations. This paper reviewed the pharmacology, history, current concerns and trends, societal issues surrounding opioids, the importance of opioids in the counseling profession, and any potential future reductions in opioid addiction.

RUNNING HEAD: The History of the Increase in Opiate Addiction References Agar, M., and Reisinger, H.S. (2002 Oct). A tale of two policies: the French connection, methadone, and heroin epidemics. Culture Medicine and Psychiatry, 26(3):371-96. doi: 10.1023/A:1021261820808 ASA (2021). What are opioids? American Society of Anesthesiologists. Retrieved from https://www.asahq.org/madeforthismoment/pain-management/opioid- treatment/what- are-opioids/ Bandyopadhyay, S. (2019 Apr 16). An 8,000-year history of use and abuse of opium and opioids: How that matters for successful control of the epidemic? American Academy of Neurology, 92(15):9-055. Retrieved from https://n.neurology.org/content/92/15_Supplement/P4.9-055 CDC (2020 Mar 19). Opioid overdose. Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html CDC (2020 Apr 12). Recovery is possible. Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/rxawareness/treatment/index.html Courtwright, D.T. (2015 Nov 26). Preventing and treating narcotic addiction century of federal drug control. The New England Journal of Medicine, 373:2095-2097. doi:10.1056/NEJMp1508818 Foundation Recovery Network (2021). History of the opioid epidemic. DualDiagnosis.org. Retrieved from https://dualdiagnosis.org/infographics/history-of-the-opioid-epidemic/ Hagemeier, N.E. (2018 May). Introduction to the opioid epidemic: the economic burden on the

RUNNING HEAD: The History of the Increase in Opiate Addiction healthcare system and impact on quality of life. Am J Manag Care, 24(10 Suppl): S200- S206. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29851449/ Hedegaard, H., Chen, L,H, Warner, M. (2015). Drug, poisoning deaths involving heroin. National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db190.htm Juergens, J. (2020 September 18). Opiate addiction and abuse. Addiction Center. Retrieved from https://www.addictioncenter.com/opiates/ Levinthal, C. F. (2023). Drugs, behavior, and modern society (9th ed.). Pearson Publishing ISBN-13: 9780135385340 Robbins, L.N., Davis, D.H., and Nurco, D.N. (1974 Dec). How permanent was Vietnam's drug addiction? AJPH Supplement, 64. Retrieved from https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.64.12_Suppl.38 SAMSHA ((2017). State-targeted response to the opioid crisis grants. Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/sites/default/files/grants/pdf/other/ti-17-014-opioid-str abstracts.pdf Simon, K., Worthy, S.L., Barnes, M.C., and Tarbell, B. (2015 Apr). Abuse-deterrent formulations: transitioning the pharmaceutical market to improve public health and safety. Ther Adv Drug Saf., 6(2):67-79. doi:10.1177/2042098615569726 Sobczak, L. and Gorynski, K. (2020 Sep). Pharmacological aspects of over-the-counter opioid drugs misuse. Molecules, 25(17):3905. doi:10.3390/molecules25173905

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WEEK 7 FINAL PAPER

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