Why the opioid crisis is really happening

In order to end the crisis, we must understand it.

Dec 25, 2017

PHILADELPHIA, PA – JULY 31: Mike, 22, a heroin addict who began using opiates when he was 13, pauses to shoot-up by a railway underpass in the Kensington section of Philadelphia which has become a hub for heroin use. (Photo by Spencer Platt/Getty Images)

The current narrative around the opioid crisis goes something like this: Drug companies got thousands of people hooked on legal opioids for pain. Those people eventually abused pills or turned to heroin to satisfy their addiction, and now we see record overdoses as a result.

Dr. Josh Bloom is the Senior Director of Chemical and Pharmaceutical Sciences at the American Council of Science and Health (ACSH). The ACSH concerns itself with busting myths and correcting misconceptions in the medical community, and Dr. Bloom sees dangerous consequences to the current opioid narrative. Herb sat down with him to find out what those are and get the real story.

Most people who overdose don’t start out using opioids for pain

The crisis did start with widespread abuse of Oxycontin in the 90s, but it wasn’t just because people were taking prescription pills. “These were people who were snorting and injecting high doses of Oxycontin, which is pure Oxycodone, and that’s highly addictive,” says Dr. Bloom. Only one to two percent of overdoses from heroin, fentanyl, and other drugs consist of people who started on opioids in order to treat pain.

According to Dr. Bloom, the issue of who is likely to OD is significant because, in response to the rising death tolls, regulatory bodies have been restricting opioids and sometimes keeping them from people who need them. “Worse than the downside of pain drugs is withholding them from people,” Bloom says. “That’s barbaric.”

While doctors are often blamed for the overprescription of highly addictive meds, Dr. Bloom says it’s actually “the pill mills” who are responsible. Pill mills are pain clinics that profit from issuing thousands of opioid prescriptions indiscriminately.

A botched solution

In 2010, Purdue Pharma released an abuse-resistant form of Oxycontin. The previous formulation of OxyContin was a problem because it enabled users to grind up the pill and inject or snort a large dose of pure oxycodone. The new pills congeal when they’re ground, making a gummy substance. “Abuse-resistant Oxycontin comes, and it should have been a good thing, but in fact, it was the worst thing that could have happened,” Bloom says.

Once it was impossible to abuse Oxycontin and take massive doses all at once, recreational use of the drug declined steeply. This is when heroin use started to skyrocket. “Those lines criss-cross. It’s not an accident,” says Dr. Bloom. A year after abuse-resistant Oxycontin hit the market, the Centers for Disease Control officially declared an opioid crisis.

“Fentanyl is the worst drug that has ever hit the streets in the history of the world,” says Dr. Bloom

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LISBON, ME- MARCH 18: For Corey Coburn’s mother and sister, Heidi-Sue Stuart and Meghan Stuart, the grief caused by his death is still fresh. Corey overdosed on fentanyl in November 2015. When he wasn’t using, Corey was funny and very kind – the kind of person who once hugged a crying stranger who had just hit his car, and told her “everyone makes mistakes.” (Staff Photo by Michele McDonald/Portland Press Herald via Getty Images)

Drug dealers often tell customers fentanyl is other drugs. Usually, drug dealers won’t even mention or know that they’re actually selling one of the deadliest opioids. And, fentanyl is so cheap and easy to acquire that it’s started showing up in non-opioids, like cocaine. There was even a rumor that fentanyl-laced weed would become a problem.

In New Hampshire, one of the states most afflicted by the crisis, fentanyl played a part in 70 percent of drug overdoses. Fentanyl has been the largest driver of recent overdoses. A single grain of too much fentanyl can result in death. It’s also very easy to synthesize.

Opioid crisis solutions

According to Bloom, lawmakers and other organizations have largely ignored fentanyl, instead focusing on pills “which were never the problem anyhow.” Bloom sees one solution: methadone.

Methadone is an opioid that helps manage withdrawal symptoms. It’s been used to treat heroin addiction for decades. But in order to gain public acceptance, it must be destigmatized. “There’s a puritanical attitude about switching out one drug for another. Well, too damn bad,” Bloom says. “One drug will keep you alive while you’re still addicted, the other will kill you.”

Methadone is not a silver bullet

Even with a massive influx of methadone to combat the crisis, people will still die. The damage has already been done. Assigning blame, and much of it does lie with Purdue Pharma, is irrelevant to preventing more deaths in the future. To ensure fewer deaths, Bloom says, we must first collectively understand the problems we face.

Dec 25, 2017