The opioid epidemic has been front and center in the news for years and it does not seem to be getting any better. Opioid addiction often begins with an innocent prescription from a physician for pain. When that source runs out, users find other sources until they end up on the streets where a cheaper opioid, heroin, is readily available.
The earliest historical account of the use of opium appeared in 3400 BC in lower Mesopotamia, now Iraq, parts of Iran, Syria and Turkey. The Sumerians called it hul gil, the “joy plant,” and they shared the knowledge of opium’s properties with the Assyrians who then passed it on to the Egyptians. Cultivation of the poppy from which opium is derived spread along the Silk Road from the Mediterranean, through Asia and into China. Ancient texts recognize opium as a powerful pain reliever, a sleep inducer and a treatment for bowel disorders. Several drugs are made from opium, including the familiar morphine, codeine, oxycodone and heroin. Thanks to modern chemistry, opium and its derivatives can be synthesized in the lab, bypassing the poppy entirely.
Authorities are worried about the appearance of heroin that is mixed with other opioids such as fentanyl. Fentanyl is a synthetic opioid used to treat surgical pain and pain from cancer, and it is about 100 times more potent than morphine. Fentanyl creates a high but also depresses breathing and slows the heart. A lethal dose of fentanyl is only 2mg, the size of a few grains of salt. The intense high is attractive, but it has led to many deaths from overdoses. Deaths of famous people like Prince, who died of an overdose of fentanyl, have increased public awareness of this epidemic.
Until 2015, fentanyl was not a regulated drug in China and could be purchased and sent to the U.S., but that was changed. Now things have gotten worse. Underground labs make subtle alterations to the chemical structures of opioids like fentanyl, and those new drugs are not covered by current laws. These are sold on websites as “research chemicals” and shipped anywhere in the world. A new cousin of fentanyl called carfentanyl is 1,000 times stronger than fentanyl. After this new drug appeared, one county in the U.S. experienced 176 drug overdoses in six days. The potency appears to have frightened even drug dealers, as the use of carfentanyl has declined.
With all these new variations, heroin users have no idea what they are buying and they cannot adjust their dosage to prevent overdoses. China has recently added carfentanyl and several other relatives to its list of controlled substances, which will drive production further underground but may decrease availability in the US.
The US is responsible for the use of 85 percent of the world’s opiates. In 2015, there were over 33,000 opioid overdose deaths. The deaths from opioid overdoses have quadrupled since 1999. Opioids have long provided pain relief to alleviate human suffering, however, their misuse warrants a serious consideration of how they are distributed.