Opioid Epidemic in the U.S.:
How Did We Get Here?
When the CDC published opioid-prescribing guidelines in 2016, it brought national attention to a problem plaguing Americans across the country. Overdose deaths related to prescription opioids and heroin addiction have reached epidemic proportions. In fact, opioid overdoses claimed the lives of almost 400,000 people from 1999 to 2017. These deaths were related to prescription opioids, heroin, and synthetic opioids.
Opium has been around since at least 3400 BC. Known as the "joy plant," it was cultivated by Sumerians in lower Mesopotamia, now current-day Iraq. Its use, both as a pain reliever and soporific, spread through the Middle East, India, Greece, China and Europe.
1700s
1800s-30s
1850s-60s
1870s-90s
1900s-10s
1920s
1930s-50s
1970s-80s
1990s-00s
2010s
1700s Colonial America
OPIUM AND LAUDANUM
Doctors prescribe opium to their patients to manage pain as well as help with dysentery, coughs, and other maladies. Also popular are laudanum, an opium compound in pill form, and later Sydenham’s Laudanum, a mixture of opium in wine and spices. Colonists cultivate opium in their gardens. Even founding father Thomas Jefferson grows opium poppies at Monticello.
1800s-30s
MORPHINE
Friedrich Wilhelm Sertürner of Germany isolates morphine from opium. He calls it morphine, after Morpheus, the Greek god of dreams.
1830s: INDUSTRIAL REVOLUTION
The U.S. begins manufacturing morphine.
1850s-60s
1855: HYPODERMIC NEEDLE
Alexander Wood of Scotland devises the first hypodermic needle to administer morphine to a patient suffering from neuralgia.
CIVIL WAR
Doctors administer morphine to injured American soldiers. Veterans who remain addicted after the war suffer from what is called the “Soldier’s Disease.”
1870s-90s
NARCOMANIA
Physicians raise concerns with morphine addiction, also known as “narcomania.”
Americans are now buying over-the-counter pills and elixirs that contain opiates to treat menstrual cramps, teething and other aches and pains.
1898: HEROIN
A German pharmaceutical company synthesizes heroin from morphine and introduces it as a cough and cold remedy. It is considered less addictive than morphine.
1900s-10s
1906: FOOD AND DRUGS ACT
Pharmaceutical companies must accurately label their products and list dangerous ingredients, such as alcohol, heroin and cocaine.
1914: NARCOTICS TAXED
The Harrison Narcotics Tax Act taxes those who import, manufacture, or prescribe narcotics.
FREE HEROIN
A philanthropic organization provides free heroin to morphine addicts to help them quit. Americans crush the pills and inhale the powder for a more intense high.
1920s
1920: HYDROCODONE
A German pharmaceutical company develops hydrocodone, another opiate painkiller.
1923: LEGAL NARCOTICS BANNED
All legal narcotics are banned under the U.S. Treasury Department's Narcotics Division.
1924: ANTI-HEROIN ACT
U.S. makes the manufacture and possession of heroin illegal.
1930s-50s
1938: FOOD, DRUG AND COSMETIC ACT
To ensure consumer safety, the U.S. government enacts the Food, Drug and Cosmetic Act. It also tightens controls over medical devices.
1955: ACETAMINOPHEN
Better known as Tylenol, acetaminophen is available via prescription (for children only). It is made available to adults a few years later.
1970s-80s
NEW PAIN KILLERS
Percocet (oxycodone and acetaminophen) and Vicodin (hydro-codone and acetaminophen) come on the market. Both are short-acting pain relievers.
1980s: OPIOIDS DEEMED ‘SAFE’
Two events indicate that opioids are safe to prescribe for chronic pain and not addictive.
One is a letter, “Addiction Rare in Patients Treated with Narcotics,” published in the New England Journal of Medicine in 1980. Another is a study, “Chronic Use of Opioid Analgesics in Non-Malignant Pain: Report of 38 Cases,” published in 1986 in Pain.
1980s: OPIOIDS DEEMED ‘SAFE’
Two events indicate that opioids are safe to prescribe for chronic pain and not addictive.
One is a letter, “Addiction Rare in Patients Treated with Narcotics,” published in the New England Journal of Medicine in 1980. Another is a study, “Chronic Use of Opioid Analgesics in Non-Malignant Pain: Report of 38 Cases,” published in 1986 in Pain.
1990s-00s
1996: OXYCONTIN DEBUTS
OxyContin, a long-acting painkiller, hits the market. In an aggressive marketing campaign, the drug’s manufacturer claims OxyContin is less addictive than its short-acting cousins, Percocet and Vicodin.
2002: OVERDOSE DEATHS
Overdose deaths from opioid drugs, including heroin, reach over 10,000.
2010s
2013: THE RISE OF SYNTHETIC OPIOIDS
Overdose deaths from synthetic opioids, like fentanyl, increase. Fentanyl is 50x stronger than heroin and 100x stronger than morphine.
2015: OPIOID DEATHS NEARLY TRIPLE
Overdose deaths from prescription opioids and heroin reach 33,000, almost triple the number of overdose deaths since 1999.
2012: 259 MILLION
In 2012, the number of prescriptions written for opioid pain medication reaches 259 million, enough for every adult in the United States to have a bottle of pills.
2016–2018: PRESIDENTS ACT
In 2016 Former President Obama asks Congress for over $1 billion to fight the opioid epidemic. And in 2017 President Trump signs an executive order to create the President’s Commission on Combating Drug Addiction and the Opioid Crisis. In 2018, President Trump signs the Support for Patients and Community Act to help combat the opioid crisis.
In 2017, overdoses claimed the lives of 72,000 people;
of drug overdose deaths in 2017 involved an opioid.
49,000 were related to opioids.
That means
almost 70%
On average,
from an opioid overdose.
130 Americans
die every day
1, 2 Frontier Medicine, (pg. 36)
3 Book: Thomas Jefferson's Flower Garden at Monticello, (pg. 59)
Book: Thomas Jefferson's Flower Garden at Monticello, (pg. 59)
Meldrum, A Capsule History of Pain Management
David J. Hart, Organic Synthesis Via Examination of Selected Natural Products. (pg. 405)
Elaine Casey, History of Drug Use and Drug Users in the United States, Facts About Drug Use, 1978.
Meldrum, A Capsule History of Pain Management
PBS Frontline
Meldrum, A Capsule History of Pain Management
PBS Frontline
FDA
Meldrum, A Capsule History of Pain Management
PBS Frontline
PBS Frontline
NY Magazine
History.com
NY Magazine
FDA
NY Magazine
california-drug-rehabs.com
NY Times
National Institute on Drug Abuse
National Institute on Drug Abuse
CDC, Dowell
CDC
NY Times
nbcnews.com
usatoday.com
National Institute on Drug Abuse
CDC, Dowell
CDC
NY Times
nbcnews.com
usatoday.com
CDC
Meldrum, A Capsule History of Pain Management
CDC
PBS
2016: CDC GUIDELINES
The CDC releases guidelines for prescribing opioids for chronic pain. It encourages non-opioid therapies, prescribing lower doses and short-acting opioids, and monitoring progress. These guidelines do not pertain to pain related to cancer, palliative or end-of-life care.
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1, 3 Meldrum, A Capsule History of Pain Management
2 David J. Hart, Organic Synthesis Via Examination of Selected Natural Products. (pg. 405)
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1 Meldrum, A Capsule History of Pain Management
2 Elaine Casey, History of Drug Use and Drug Users in the United States, Facts About Drug Use, 1978.
1, 2 Meldrum, A Capsule History of Pain Management
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1, 4 PBS Frontline
2, 4 Meldrum, A Capsule History of Pain Management
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2 PBS Frontline
3 History.com
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2 NY Magazine
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1 california-drug-rehabs.com
2 NY Magazine
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1 NY Times
2 National Institute on Drug Abuse
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1 Dowell
4 National Institute on Drug Abuse
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2 NY Times
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INTRO
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Opium has been around since at least 3400 BC. Known as the "joy plant," it was cultivated by Sumerians in lower Mesopotamia, now current-day Iraq. Its use, both as a pain reliever and soporific, spread through the Middle East, India, Greece, China and Europe.