Muhammad Khizar Hayat, Year 1
In 2017, the opioid epidemic (widespread misuse of opioids) in the USA claimed the lives of 68,400 people (Ahmad et al., 2022), more than gun violence that year. The ongoing crisis isn’t isolated to the USA, however: in Britain opioids on par with Class A drugs are easily accessible to the public. The actual effectiveness of opioids is questionable, with some people who feel completely relieved of pain and some left completely stupefied by the drugs. This poses a large question: how did this happen, and who is to blame? In this article, I will investigate the role of legislators, doctors, and pharmaceutic companies, as well as possible solutions for this problem.
Opioids are defined as “substances used to treat moderate to severe pain”. The opioid family includes drugs such as heroin, morphine, and codeine which are derived from the opium poppy. The largest and oldest opium producers include Afghanistan, Pakistan, Burma and India. Ancient Sumerians called the plant Hul Gil or the “joy” plant, suggesting the dissociative nature of the drug. Opium was commonly used in Islamic empires as an anaesthetic during surgery and other medical treatment. Avicenna described the effects of opioids in his book The Canon of Medicine, mentioning analgesia, respiratory depression, and neuromuscular disturbances. Nowadays, opioids are available ‘over-the-counter’ in the form of co-codamol, which contains codeine mixed with paracetamol. Due to the extremely addictive nature of opioids, it is not advised to take co-codamol for more than three days, yet there is virtually nothing stopping someone from buying more. On top of that, doctors can prescribe much more powerful drugs, such as codeine, which achieves levels of sedation akin to heroin and morphine. Fentanyl, the most powerful opioid available on prescription, is 50-100 times stronger than morphine.
Humans have known of the potential harmful effects of opioids since approximately 1025 CE. The question is, why has the abuse of these drugs proliferated to such a stage?
One reason why opioid misuse has increased could be the complacency of doctors. Criticism befalls doctors, as some believe that it is easier for doctors to simply prescribe a pain-killer rather than treat the cause. Less than 10% of patients who receive opioid treatment for chronic pain find it effective, experiencing more side-effects than benefits. The analgesic, effect of opioids may be useful to treat acute pain, however in cases of overuse an inability to feel pain for long periods can be detrimental – patients could severely harm themselves without knowing. The largest risk of opioid misuse is overdose, resulting in respiratory depression and death from hypoxia. The rise in overdose rates has been correlated with increasing prescription rates, which some argue can be linked to the mass production of opioids by pharmaceutical companies.
According to the NHS business services Authority, 12.8% of the adult population were prescribed opioids in 2017/18. Despite this being a decrease from 2016, it is still a problem. In America, drug companies saturated the market with 76 billion oxycodone and hydrocodone tablets (codeine compounds), with only 6 companies dispensing 75% of those tablets. Opioid sales in America rose 40% between 2006 to 2012, peaking at $8.5 billion. Purdue Pharma sold $3.1 billion worth of OxyContin. In total, 76.2 billion opioids were produced in the period between 2006 and 2012 in the US. In Brighton, Colorado, a town with a population of mere 38,000, 2000 pills were ordered each day during that time. The McKesson pharmaceutical corporation filed only 16 of 1.6 million orders into Colorado as suspicious. This shows how the drug companies in America eventually flooded the streets with opioids, causing the epidemic that ravages America to this day. Similarly in Britain, GSK raked a total of £4.1 billion in operating profit from opioid manufacturing..
What is to stop these corporations from producing extreme quantities of drugs and in turn addicting more and more of the population? Why didn’t they stop dispensing drugs when they reached a certain threshold? The answer to both questions is simple: profit. Profit can drive these companies to produce more opioids, advertising them to the public, which then increases the demand, and feeds into this vicious cycle. Surely this shouldn’t be legal, which makes us want to investigate the role of the legislators in this problem.
McKesson in America spent $2,6 million on lobbying politicians and lawmakers for their own personal gain. In the past decade, Big Pharma spent $2.5 billion on the careers and campaigns of politicians. These are some examples of how to encourage lawmakers to ignore the foul practices of drug companies. This creates large holes in the legislation which allow the volume of opioids produced to continually increase. These examples from the US are reflected in the UK market as well, with Pfizer and GSK playing large roles in the UK’s economy.
These large gaps in legislation probably wouldn’t exist if the drug companies didn’t bring in such large amounts of revenue for countries, and conversely there wouldn’t be such high demand for opioids if doctors made less prescriptions. Perhaps if the pharmaceutical giants produced alternative drugs to opioids, that would aid the problem as well.
Evidently, there is no clear solution to the problems of doctors, drug companies and diplomats, so what can we do to help?
Educating people about risks associated with opioids can help them realise the problem. Many people have opioids advertised to them by their doctors or even in the public space, in countries where it is legal. If educated, patients could make more assertive decisions even if prescribed opioids, and by rejecting them—contribute to decreased demand. Education about the use of opioids poses its own problems, however. People may start taking opioids to feel cool, promoting social status; it could even be that suicide rates are effected when the prospect of a painless death is more publicised. If education is not be the best solution, what could be?
Placebo is investigated as a possible replacement for opioids. The placebo effect can be used in place of actual drugs, as the brain believes it will work wonders. This may be effective; however, it poses the risk of being ineffective in people who are too aware of how a placebo to works. This wouldn’t work on people who use herbal remedies, as they do not believe entirely in the power of a tablet so they might reject the placebo.
In brief, the opioid problem is an extremely difficult one to solve, with each solution carrying associated risks. It is also extremely difficult to pin the blame for why the opioid crisis has occurred, as all segments of the authority involved are equally culpable. The future holds uncertainty for the case of opioids in Britain, but wishful thinking, paired with reflection on the events that have led us here, offer the possibility that circumstances might change. Drug companies might realise the error in their ways and cut down on the production of opioids, compelled by new legislation, in turn making doctors decrease the number of prescriptions. For the present, however, that notion seems not just wishful—but outlandish.
References
Ahmad, F.B. & Rossen, L.M., 2022. Products – vital statistics rapid release – provisional drug overdose data. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm [Accessed January 23, 2022].
THE WORSLEY TIMES 
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