The Plant of Joy: War on Drugs
In 2016, doctors and health care providers in the United States wrote a total of more than 214 million prescriptions for opioid medications. This comes down to a rate of 66.5 prescriptions for every 100 people. The number of opioid prescriptions has quadrupled since 1999. As of today, more than 130 people die per day from opioid-related drug overdoses per the U.S. Department of Health and Human Services website. There are more deaths from opioids than the number of deaths from suicide and motor vehicle crashes or the number of deaths from cocaine and heroin combined. (Manchikanti, 2012) The epidemic continues to grow with no signs of stopping.
The number of deaths involving opioids has risen so much that it now affects the average U.S. life expectancy. There is no easy solution to a problem as complex as this one. The government struggles to determine a succinct strategy that will solve this crisis. In 2017, the opioid epidemic was declared a public health emergency and a 5-point strategy was enacted to combat it. The opioid abuse epidemic is one of the greatest medical crises in the U.S. of the 21st century and requires government intervention and the cooperation of health care providers to be resolved. This paper seeks to analyze the reasons leading up to this state of emergency and what steps can be taken from this point.
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In order to understand how we have ended up in this devastating situation, it is necessary to review the history of opioids and how they came about. Opioids have been used to treat pain for thousands of years. The natural source of opiates is the flower of the poppy plant, Papaver somniferum. The origins of its use for pain relief dates back to 3400 B.C. in Mesopotamia (Bushak, 2016). It was grown by Sumerians where it was known as the “Joy Plant”. They collected white milk from the plant which contained the analgesic morphine, known to produce feelings of euphoria. Hippocrates, known as the “Father of Medicine”, prescribed drinking the juice of the poppy as a narcotic for pain. It was used increasingly in surgical procedures and executions. In the Middle Ages, it seemed to disappear from the documentation. This is because it was regarded as an evil substance during the Holy Inquisition. It returned to Europe in the 1600s and was traded throughout the world. In the 1700s, an opium epidemic took off in China. The government struggled to decide how to stop the epidemic and banned smoking of opium and allowed it only for medical use. This didn’t solve the problem and the emperor, Kia King, banned opium outright. In Germany in 1803, a significant discovery was made that accelerated the use of opioids as we know it. A scientist, Friedrich Sertürner, discovered the active ingredient, morphine, which marks the beginning of the synthetic opioids known today.
An epidemic is defined by Merriam-Webster dictionary as affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time. The opioid epidemic in America began in the 1990s when pharmaceutical companies mistakenly told doctors that opioid pain medications were safe to prescribe to patients and they would not become addicted (Public Affairs, 2018). Therefore, providers started prescribing them more than ever before. It became clear quickly that the medications were being misused widely and that they were in fact extremely addictive in nature.
Pain is a complex sensation that is subjective and open to interpretation. The experience is different for everyone and some people have higher pain tolerances than others. Pain can be any sort of physical or emotional feeling of discomfort or damage to the body’s tissues over time or occurring from trauma (Salani, 2018). Acute pain is pain that onsets suddenly but is ultimately a temporary condition, like an injury. Chronic pain is pain lasting longer than twelve weeks due to a long-term condition or diseases such as cancer, fibromyalgia, or arthritis. Pain used to be known as the 5th vital sign, after pulse rate, temperature, respiration rate, and blood pressure. In 1996, the American Pain Society announced pain as the 5th vital sign, after realizing that pain generally goes untreated. This was later revoked, and the pain was redefined as a symptom of the condition.
Looking back on this, pain should never have been treated as a vital sign and this mistake, along with a lack of knowledge of the long-term effects of opioid medications, led to a vast over-prescription rate for opioid painkillers. Pain is subjective and should not have been considered with the same weight and legitimacy as a diagnostic for treatment compared with the other signs, which cannot be challenged as they are objective facts and measurable with technological instruments. Pain is an emotional experience and people have different tolerances for pain.