The Dark Side of Opioid Prescriptions

The prescription of opioids has led to a national epidemic, where the CDC claims “over 932,000 lives were lost in just the United States alone to this drug” (CDC, 2022) according to, The Opioid Epidemic Demands Public Health Solutions, Not False Claims About Imigration. Unfortunately, it only gets worse as it has been reported that “another 1.2 million people are expected to die from opioids by 2029.”(Debu Gandhi, Trinh Q. Truong, 2022)  Just to put it in perspective, the New York Times stated that there was a total estimate of around “650,000 to 850,000 casualties” (Guy Gugliotta, 2012) in the American Civil War.  So, opioids have beat the death count of the Civil War without even firing a bullet. Opioids have been a problem for years now and yet some doctors are still prescribing opioids. In 2017, alone, the CDC reported a total of “191 million opioid prescriptions”(CDC, 2017) were dispensed for American patients;with Alabama being the state with the most opioid prescriptions. According to the Whitehouse on September 23, 2022, Joe Biden set a plan in motion to combat the opioid and overdose epidemic by signing a bill that grants the states and territories of the USA “1.5 billion dollars”(Whitehouse, 2022). With this funding, “U.S. states and territories are expected to increase access for the treatment of substance abuse, remove barriers to public health interventions like naloxone, expand access to recovery support services such as 24/7 Opioid Treatment Programs, increase investment in overdose education, have peer support specialists in emergency departments, and allow states to invest in other strategies that will help save lives in other hard-hit communities”(Whitehouse, 2022). People have argued against this bill for many reasons, but I for one, favor it as a person who has been affected by overdose. These elements could be key for changing the tides of war against opioids. I believe fully that there are many ways to combat opioids and the overprescription of them.

 The prescription of opioids first began in America during the 1860’s. Opioids were used on soldiers who fought in the Civil War who suffered wounds from combat. The first opioid used was morphine.  Interestingly enough those who were treated with this opioid began to develop dependencies and addictions to this drug in the following years after the Civil War. This could be marked as the first sign of people developing serious health issues due to the use of medical drugs. Not long after opioids began to be used by the public to treat pain. As of 1996, a new FDA approved opioid hit the market.  This new opioid was oxycontin, which was used to treat pain for people who recently had surgery or suffered from a serious injury. In reality, a doctor could prescribe you an opioid based on how much pain you’re in from a specific injury that was suffered previously. It was stated in, The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy, by Art Van Zee, that “Oxycontin was heavily marketed and publicized as sales for the opioid in 1996 reached 48 million dollars and began to grow in the following years. As of 2000, the total sales of Oxycontin reached 1.1 billion dollars as Oxycontin was highly available. The availability of Oxycontin began to make the drug more abusable and as of 2004, Oxycontin became a leading drug of abuse in America.”(Art Van Zee, 2009) As people who abused opioids skyrocketed, so did overdose deaths. On October 26th of 2017, President Trump officially declared the opioid epidemic as a national health emergency. As a writer and researcher, I did some digging and found a chart that shows the dramatic increase in opioid overdoses from 1999 to 2020 made by the NIDA (National Institute of Drug Abuse) in an article called Overdose Death Rates. In 2010, it was reported that “around 15,000 people had died due to prescribed opioid use, and 21,089 people died due to opioids in itself ” (National Institute on Drug Abuse, 2022). As of 2020 those numbers have risen to “16,416 total overdose deaths” (National Institute on Drug Abuse, 2022) related to prescribed opioids as well as the overdose death count involving any opioid had reached an “all time high at 68,630 people”(National Institute on Drug Abuse, 2022). It was reported by the U.S. Department of Health And Human Services in an article called the Opioid Crisis Statistic that “in 2019, an estimated 10.1 million people over the age of 12 misused opioids in the past year.” (U.S. Department of Health and Human Services, 2021).

As the statistics became more alarming I began to wonder, why do people get so addicted to opioids? So I researched and came to find that people who use opioids experience the following feelings; “the individual’s pain goes away and the individual starts to feel a high sensation in which they feel happy and relaxed, some even reported being confused a lot of the time” (National Institute on Drug Abuse, 2021); for no reason. When the individual comes down from that high, it is reported by the Faculty of Pain Medicine of the Royal College of Anaesthetists in article Side Effects Of Opioids, that they will suffer from the following short term side effects; “nausea, vomiting, constipation, pruritus (severe itching of the skin), dizziness, dry mouth and sedation”(Faculty of Pain Medicine of the Royal College of Anaesthetists). As for the long term effects of opioids besides possible addiction and overdose, it is reported from the National Library of Medicine in an article called Long-Term Opioid Therapy Reconsidered, that “people can suffer from serious fractures, breathing problems during sleep, hyperalgesia (abnormal hypersensitivity to pain), immunosuppression, chronic constipation, bowel obstruction, myocardial infarction (heart attack), and tooth decay secondary to xerostomia (dry mouth to the point where your saliva glands can not produce a sufficient amount of saliva)”(Michael Von Korff, Andrew Kolodny, Richard A. Deyo, Roger Chou, 2012) .The prescribing and refilling of prescribed opioids from doctors has decreased from year to year since 2018, due to the passing of the Substance Use Disorder that Promotes Opioid Recovery and Treatment for Patients and Communities act on October 24th, 2018. Still in just 2020 alone, there was a staggering total of “142,816,781”(CDC, 2021, U.S. Opioid Dispensing Map) opioids prescribed.

  As of recently though people have begun to question doctors and even held doctors accountable for their excessive prescribing of opioids. Many doctors have been sentenced to jail time and have lost their doctor’s licenses due to their overprescribing of opioids. This is a good thing as it has been reported from a study conducted by webmd in 2020, that “nearly 30% of all physicians were receiving kickbacks from big pharmaceutical brands to prescribe certain drugs.” (Robert Preidt, 2020). As immoral doctors begin to get prosecuted across America, this shows the public that medical fields are not perfect, but are working harder to become better. I have found many examples of immoral doctors as of recently, for instance; in an article called Alabama “pill mill” doctors get 20 year prison sentence, “two pain specialists in 2017, were receiving kickback payments from an opioid manufacturer to prescribe immense quantities of fentanyl.”(Owen Dyer, 2017) The two pain specialists owned a company called “Physicians’ Pain Specialists of Alabama”, they also owned a pharmacy that processed most of the opioid prescriptions. Both doctors were “heavy prescribers” and “received a prison time of 20 and 21 years in incarceration.”(Owen Dyer, 2017). I also came across another article called, 93 Year old doctor is sentenced to 10 years in prison for opioid distribution, which goes into detail of a “Las Vegas doctor who was sentenced to 10 years in federal incarceration as well as fined 2.5 million dollars.”(Owen Dyer, 2017). This 93 year old doctor was charged with a 10 year sentence because it is said that he was prescribing “oxycontin, xanax, and other medically prescribed drugs for no legitimate medical reason.”(Owen Dyer, 2017). It is stated that this doctor was responsible for distributing opioids to “a network of dealers and addicts to more than 230 people, in which the federal court had heard from.”(Owen Dyer, 2017). As diabolical as those two court cases sound, an even bigger whale of a court case has just reached a verdict including 12 physicians of the Michigan and Ohio area. On March 9th, 2022, The department of justice’s office of affairs released the following report,  16 Defendants, Including 12 physicians, Sentenced to Prison for Distributing 6.6 Million Opioid Pills and Submitting $250 Million in False Billings.The 16 defendants were in charge of a “$250 million dollar health care fraud scheme which include the exploitation of patients who suffer or suffered from addiction.”(U.S. Department of Justice Office of Public Affairs, 2022). They were also in charge of the illegal distribution of over “6.6 million opioids”(U.S. Department of Justice Office of Public Affairs, 2022) in the Michigan and Ohio area. All of the defendants of this case were given between a “9 year and six month sentence in prison as well as millions of dollars in fines.”(U.S. Department of Justice Office of Public Affairs, 2022). 

Although, the Doctors are seemingly doing it for a check. I would like to look at the families destroyed by opioids and the effects of opioids in the drug market. Families all over America have been affected in many ways by the overprescription of opioids. Besides the obvious loss of life from overdosing on opioids; families also face the scary realities of addictions. It is commonly known that addicts who are in need of their drug will rob, burglarize, assault, and even murder to get their fix. This addiction though can also play a role in domestic abuse. More than half of domestic abuse cases are connected to drug and alcohol use. The major problem that has been discovered in homes dealing with opioid addiction is communication. In an experiment posted by Wolters Kluwer, “three groups were made to understand family communication and overall well-being of young adults in the context of familial opioid misuse using the family systems framework; group 1 had no familial opioid misuse with high family cohesion, group 2 had familial opioid misuse with moderate family cohesion, and finally group 3 was those with or without familial opioid misuse and low family cohesion. Group 3 had the lowest family communication out of all the groups as well as a lower overall well-being compared to group 1.”(Khalid Alhussain, Drishti Shah, James Douglas Thorton, Kimberley M. Kelly, 2019). Wolters Kluwer wrote, “the results showed that higher family cohesion may positively influence young adults to cope with issues related to familial misuse. Families who have been affected by opioid misuse face internal problems, where bad experiences lead to negative family cohesion. With no good emotional bonds to family members, children feel disconnected to family members who use and don’t use. This can cause a separation in the household emotionally for children and spouses/husbands.” (Khalid Alhussain, Drishti Shah, James Douglas Thorton, Kimberley M. Kelly, 2019).

Doctors however, do not have to see the ugly side of opioid abuse. Doctors who are immoral can just keep refilling their patients’ prescriptions. Doctors who go down this immoral path have been brought to light through investigations conducted by law enforcement, thankfully. Doctors appear to be getting paid on the back end for just prescribing an opioid by the industries who produce them. As the industries who produce opioids have become very invested in getting doctors to prescribe their opioids for a back end payment at the expense of the public’s health, leaving families devastated. 

Interestingly enough, what is not talked about too often in that the medical use of opioids is how people make the switch from prescription opioids to street drugs. This is caused by doctors continuously filling their patient’s prescriptions and then stopping suddenly because of the legal measures taken to stop opioid addiction.  Another common cause is that the doctor is a good doctor and realizes this patient is using these opioids for the wrong reason. Once this happens the addict will do anything to experience the high so they do not suffer from withdrawals. This is when addicts make the transition from prescribed opioids to street drugs; such as crystal meth, heroin, cocaine, and other street drugs that can possibly be contaminated by the life threatening drug; fentanyl. From there, it is typically a rollercoaster ride for the addict and families as the addict attempts to battle his or her unstoppable addiction while facing intense withdrawals. Unfortunately, many people have lost their lives to this battle with few survivors walking away from their addictions with good health. If someone is addicted to opioids and is trying to quit they will suffer from the withdrawal effects.Withdrawal effects for opioids typically start 12 hours from the last dose. These withdrawal effects are common to heroin withdrawals which include shakes, sweating, chills, nausea, vomiting, muscle aches, headaches, bone aches, insomnia, runny nose, yawning, and tearing; and that’s just the physical side effects. Emotional withdrawal effects include being emotional, depressed, anxiety, agitation, irritability, and a lack of mental clarity. 

As the war on drugs rages on, so does the war on opioids, as its been reported by grandview research, “the opioid industries market value has been evaluated at 22.66 billion U.S. dollars in 2021 with a projection in 2022 to be evaluated at 22.77 billion dollars.”(Grandview Research, 2022). To make matters worse the revenue forecast for 2030 is expected to be “25.33 billion dollars.”(Grandview Research, 2022). There is a lot of money being made off of opioids and the prominent global companies who push the production of opioids includes; “Purdue Pharma L.P., Johnson & Johnson Services inc., Hikma Pharmaceuticals PLC, Pfizer inc, AbbVie inc., Sanofi, Sun Pharmaceuticals Industries Ltd, and finally Grunenthal.”(Grandview Research, 2022). These companies are major forces in the production of opioids and have led to countless deaths because of addiction. As a united front we the people need to stop letting big name companies tempt or incentivize our doctors into prescribing their manufactured drugs.

 One way to do this is by stopping the use of opioids.  The only problem is that they are the best thing on the market for treating pain.  Even though they can be highly addictive, if used properly, with the right supervision the drug can be helpful. What would have to be eliminated is how addictive opioids can be because of the feeling they give people. This seems to be merely impossible as that sensation is what lets patients not feel pain, but what if there were other options we could use? I found an interesting article called, Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study, it discusses two different alternatives to deal with different types of pains a patient may experience.  These alternatives are hyphenated as “A/C” which means acupuncture and chiropractors. This provides patients with a natural alternative that has been proven to relieve pain in patients. Acupuncture is not as powerful in relieving pain as opioids, but nonetheless it does the job by puncturing and pinching certain nerves in the skin that can relieve stress or pain in any area of the body. Chiropractors will relieve patients pain through cracking bones and relieving tension in joints. Like acupuncture it is a more natural approach, but it does not relieve pain as quickly as opioids as well. Through these two alternatives though, we can provide patients who suffer from chronic pain or recent traumatic surgeries with a natural option that does not impose a threat to further increase of opioid addiction and life loss from opioid use. These two options can take time to fully relieve the patient from pain, so I decided to look at a quicker natural alternative that can relieve a patient’s pain while substituting the use of opioids. This has led me to an article/experiment that was approved by the University of California, Berkeley, called, Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report, where I found significant data that supports the use of cannabis in treating pain as well as helping people lean off from their opioid use. The study used a cross-sectional survey to gather data about the use of cannabis as a substitute for opioid and non-opioid-based pain medication. “Of those who were studied it was reported that thirty percent (841 out of 2,897 participants) of the participants used or actively uses opioid based medication in the last six months. Of those who were using or used opioids it was reported sixty one percent of those participants do use cannabis. From that sixty one percent, ninety seven percent of participants ‘strongly agreed/agreed’ that they were able to decrease the amount of opioids they consume when they also use cannabis. Ninety two percent of the sample said that cannabis had more tolerable side effects than opioid-based medications. Eighty one percent of the sample said taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids.”(Amanda Reiman, Mark Welty, Perry Solomon, 2017) Interestingly enough though, “seventy one percent of the samplers said that cannabis produces the same amount of pain relief as opioid based medication.”(Amanda Reiman, Mark Welty, Perry Solomon, 2017).  To finish the experiment on a high note; “ninety two percent of the sample prefer cannabis to opioids for the treatment of their condition as well as ninety three percent of the sample would be more likely to choose cannabis to treat their condition if it was made more readily available.”(Amanda Reiman, Mark Welty, Perry Solomon, 2017). This sample survey experiment shows me that cannabis can be used as a natural pain reliever and can be substituted for opioids. Not only this, though it seems cannabis can also be used to help people get off their opioid addiction.  It was stated in the experiment that those who used opioids would decrease the amount of opioids they consume with the use of cannabis. 

With the use of these three natural alternatives I believe we can stop the use of opioid  addiction and cut out the overprescription of opioids altogether. As acupuncture does not seem to have any health risks at all other than soreness and minor bleeding or bruising where the needles are stuck, these risks can only occur if you are using an inexperienced acupuncture practitioner. As for chiropractors, the side effects for patients seem to be minor as they could experience headaches, fatigue, or pain in the specific spot that was being treated. For cannabis, though there are some side effects, they are not as drastic side effects as opioids. These side effects include possible dry mouth, dry or red eyes, drowsiness, fatigue, dizziness, and possible cannabis addiction or cravings. Although the addiction aspect is still their patients it has been proven that it is almost impossible to overdose from cannabis. The only way to overdose on cannabis is to smoke your exact weight in cannabis which is extremely hard to do because just a gram of cannabis can help treat your pain as well as make you feel happy.

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