Clearing and Opioids Part 1: The Opioid Epidemic and How We Got Here
It’s tough to avoid — when we talk about pain, the topic of opioid drugs often crops up. Many of us have taken prescription opioids, and even more of us have been affected by the opioid epidemic. Since opioids and opiates are such a big part of the overall pain conversation, we wanted to address them in a little more depth. For transparency, Clearing acknowledged that opioids may be suitable in very specific cases, but that for most cases of chronic pain, alternate pain relief approaches may achieve more sustainable, long-lasting success.
A brief history of opioids
If the word ‘opioid’ sounds like ‘opium’ to you, you’re not wrong. Opioids, which are synthetic narcotics formulated to silence pain signaling in the body, share a lot in common with natural opium, which is a non-medical drug that induces a sometimes euphoric sense of lethargy and painlessness.
Opium, heroin and morphine come from poppies (and yes, even the poppy seeds speckling your breakfast muffin contain trace amounts of opium.) As early as 3400 B.C., ancient Sumerians called the poppies “Hul Gil,” meaning “joy plant.” The Bible mentions opium as well. People took poppy extracts to help with toothaches, broken bones, and pretty much anything else that hurt. Relief was hard to come by then, and many cultures didn’t have anesthesia or dependable painkillers.
In 1898, Bayer started producing medical heroin for pain relief, though the U.S. government outlawed it by 1924. Still, soldiers injured during WWII welcomed morphine as a miracle drug, despite its addictive nature.
By the 1980s, pharmaceutical companies claimed to have developed drugs with the pain-conquering properties of opium products, but with lower addiction risks. In 1995, the FDA approved OxyContin. OxyContin and similar opioids, drug companies argued, were more strictly and precisely formulated, were more consistent, and weren’t as likely to foster addiction. These claims, however, have been crumbling throughout the past thirty years.
Why were opioids such commonly prescribed painkillers?
Opium derivatives like morphine and synthetic opioids like Oxycontin and Fentanyl have stuck with us because they often do work at quelling stubborn pain. They deliver a two-punch knockout to pain, first by jamming the body’s pain communication system while flooding the body’s natural painkiller receptors, and second by relaxing muscle groups, convincing the body and mind that everything is basically fine.
Unfortunately, this one-two punch is so “relaxing,” the body no longer notices pain signals and often lapses into a drowsy state. At high doses, sometimes the muscles that control breathing relax too much, leading to a coma or even death.
Does the U.S. really have an opioid epidemic?
Across the nation, more than 50 million Americans struggle with chronic pain. People in pain very much want to get their lives back, so it’s not surprising that patients who were once prescribed opioids find the struggle to get their prescriptions renewed or to find effective alternatives to be a very frustrating process.
Some patients try “pill mills,” clinics that prescribe OxyContin and other opioids without necessarily offering alternatives. While attempting to navigate a pain management landscape that keeps letting them down, others end up trying black market medications or street opiates like heroin.
This is a cascade of pain-relief seeking that often ends in tragedy. Opioids now kill more Americans than any other kind of drug overdose. In 2019, close to 50,000 Americans died from opioid overdoses, and 10 million misused prescription opioids.
Part of the epidemic’s nastiness is due to how opioids function in the body. As the body adapts to opioids, it can require higher and higher doses to render the pain tolerable. The body, however, can only take so much. Opioids aren’t picky about who they affect, either — teenagers, veterans and senior citizens all show up in the grim statistics.
Why are so many Americans in pain?
We don’t know for sure. We do know that more than 50 million Americans have chronic pain, and even more struggle with periodic pain throughout their lives.
Pain has a mental component, too, and can feel more severe for people who are also depressed or lonely. Unfortunately, many Americans confess to being lonely and struggle to find happiness. This loneliness might make them feel more stressed and more sensitive to pain.
So what can be done about chronic pain?
As a glimmer in the midst of the opioid epidemic, researchers have been finding many non-opioid ways to treat pain. In a few, very specific circumstances, such as recovering from surgery, doctors still advise prescribing opioids for limited periods of time. But in most cases, including for patients with chronic pain, opioids fail to maintain their effectiveness, and too often lead to addiction and a cycle of negative results.
In the U.S., the Department of Human Health and Services (HHS) advocates a five-point strategy against opioid misuse:
- Offer better access to treatment and recovery services
- Support drugs that reverse overdoses
- Use public health principles to learn more about the epidemic
- Conduct better research on pain and addiction
- Find and publicize better approaches to pain management
Clearing’s part in offering something better than opioids
Clearing supports the HHS mission to help end the opioid epidemic and find better ways to deal with pain. We connect patients in pain with specialists who have advanced training in pain management strategies and treatments.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.