The Joy Plant Tragedy

The cold hard basics behind America's opioid epidemic

By Amelia Taylor-Hochberg

This past May, an investigation by the Los Angeles Times showed that OxyContin, the opioid pain reliever produced by Purdue Pharma, was not working as well as its makers claimed. Prescribed based on the promise that it could keep pain at bay for longer than generic medications, requiring patients to only take one pill every 12 hours, OxyContin was a huge success, winning Purdue $31 billion dollars in revenue in the two decades since it began selling the drug.

The problem is, as the Times discovered, this promise simply wasn’t true for many patients who had been prescribed OxyContin for chronic pain. Before the 12 pain-free hours that Purdue pledged were up, the drug began wearing off, and patients began experiencing withdrawal symptoms. That provoked many patients into taking doses more frequently, or nudged doctors into prescribing more potent dosages. All of this intensified the addiction potential for OxyContin, and made withdrawals (and highs) from the drug all the more intense.

This abusive cycle is what led Senator Edward J. Markey of Massachusetts, who has urged the FTC and FDA to be more proactive in warning people about the risks of opioid painkillers, to call OxyContin “the original sin of the current opioid epidemic.”

Why look at opioids now?

As Senator Markey and the Times investigation alludes to, the U.S. is undergoing what has been called an opioid epidemic. According to a Kaiser Family Foundation survey, more than four out of every 10 Americans know someone who’s addicted to prescription painkillers, and overdose fatalities are higher than ever. Combined with high-profile deaths associated with opioids (including Prince’s overdose on fentanyl this past April), the issue has reached nearly everyone’s doorstep in one way or another. This maelstrom of attention and danger requires a cold, clear look at the basics of opioids, for <and at> all their potentials to help and harm.

What is an opioid?

Generally speaking, opioids refer to any substance that bind<s> with opioid receptors in the brain, resulting in a reduction of pain. Humans produce some opioids naturally, such as endorphins and morphine, known as endogenous opioids.

Many of the opioid substances ingested as drugs are derived from the opium poppy plant, Papaver somniferum, in which case they rely on compounds of opiate alkaloids taken directly from the plant. However, many of the opioids available today do not <no longer> originate from the plant, but ; <rather, they> are synthesized to have similar effects. Generally speaking, the term “opioids” is widely used to refer to any such substance—whether derived directly from the poppy plant, semi-synthetic, or wholly synthetic. “Opiate” is an older, less commonly used term, and specifically refers to substances directly derived from the opium plant.

Here’s a few versions of opioids you may be familiar with already, along with their brand or common names in parentheses:
Opiates: morphine (MS Contin), codeine (Robitussin AC)
Semi-Synthetic: hydrocodone (Vicodine), oxycodone (OxyContin, Percoset), diamorphine (heroin)
Synthetic: methadone (Dolophine), fentanyl (Sublimaze)
 

What's its historical use?

Opioids have been used recreationally and as pain relief for millennia. As early as 3400 BC, there are records of Sumerians cultivating the opium poppy in lower Mesopotamia, calling it “Hul Gil” – the “Joy Plant”. It then spread to use in ancient Greece, Rome, and China, and by the 16th century, was being processed for medical use in Europe. In the early 1800s, morphine was synthesized from opium and soon became the de facto pain medication in the U.S.—less than a century later, heroin was synthesized from morphine.

As the use and varieties of opioids grew, classification and legalization began to vary. In the U.S. in 1970, the Controlled Substances Act classified many drugs, including many kinds of opioids, into a hierarchy known as schedules, distinguished by their abuse potentials, medical applications and potential harm. Diamorphine (aka heroin, a semi-synthetic opioid) was labeled a Schedule I substance—the most restrictive rating—signifying a high abuse potential, no officially accepted medical use, and no reliably safe applications. By contrast, morphine was classified as a Schedule II substance, meaning it also has a high abuse and addiction potential, but it does have an accepted medical use.

In the 1990s, opioid use skyrocketed. In response to the approximately 100 million Americans dealing with chronic pain ( and costing the country an estimated $635 billion each year*), doctors began prescribing opioids more frequently—partially due to their increased production and encouragement by pharmaceutical companies. By 2012, doctors wrote 259 million prescriptions for opioids—that’s more than one for every adult American. As prescribed usage went up, so did abuse and overdose deaths, and in response, doctors and policymakers tried to pull back on Americans’ opioid usage. However, given opioids' generally high abuse potentials, many of those who had received prescriptions legally were now addicted, and sought their fixes elsewhere, often turning to illicit, more potent opioids such as heroin. Between 2000 and 2014, the rate of death by heroin overdose quintupled.

How does it make you feel?

Euphoria, pain relief, and comfort are some of the common feelings induced by opioids. The side effects can include dizziness, nausea, constipation, and respiratory depression (aka hypoventilating, the opposite of hyperventilating, when the body doesn’t expel sufficient carbon dioxide). It’s generally accepted by the medical community that using opioids to treat pain in the short term can, in many cases, be very effective—but for chronic, long-term pain, their effects are controversial, and not reliably seen as effective.

Scientific awareness about a drug can unfortunately be limited by the reported number of crimes or deaths associated with it. And tragically, ignorance about a drug can lead to higher instances of abuse. But what the opioid epidemic reminds us is that all opioids, and all drugs, interact with humans in complex, idiosyncratic ways, that can lead to both powerful relief and intense pain. In the end, it’s the dosage, not the drug itself, that acts as a remedy or a poison—a calculus that a corporate-controlled prescription rate can't so easily safeguard for everyone.

Amelia Taylor-Hochberg:

Species: Homo sapiens

Habitat: Los Angeles, California

Diet: Omnivorous – Sandwiches, open-faced mostly.

Occupation: Journalist / editor

Contact: longhyphen@gmail.com