Elvis Presley, Michael Jackson, Chris Farley, Heath Ledger, Whitney Houston, Marilyn Monroe, Prince, Jim Morrison. What do all these people have in common? They all died from prescription drug overdose. When you hear the word “drug” what do you think of first? Most would answer probably something like weed, cocaine, heroin, meth, and maybe alcohol even. In the United States, we have a drug addiction problem. But, this “drug” addiction problem largely isn’t any of the drugs listed above. Most Americans would be shocked to know that: “After marijuana and alcohol, prescription drugs are the most commonly misused substances by Americans age 14 and older.” (Drug Abuse.gov) How could this be? Well, when you dive into the issue, you see that individuals get their medication through insurance, and only must pay their co-pay, which is a fraction of what they would pay buying street drugs. So, addicts get their drugs for cheap, and the pills can be just as addicting, if not more addicting than street drugs. Many of these drugs save countless lives a year, and have improved quality of life for humans around the world and will continue to for years to come. But, there must be a point where the system needs to be reevaluated. In recent decades, rises in prescription drug rates have led to a dramatic rise in deaths and hospitalizations due to overdose. In this essay, we will discuss the problem of prescription drug abuse, what the root of the problem may be, and how this problem can be solved through collective effort.

The abuse of opioids in the form of pain killers, heroine, and morphine is an epidemic that effects societies around the world. Opioids are used to relieve pain, and include Vicodin, OxyContin, or Codeine. Opioid addiction does not only affect the overall health of a population, but also the socioeconomic status of communities everywhere. In the United States, opioid addiction in the form of pain relievers is more common than opioid addiction in the form of heroine. “…an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.” (DrugAbuse.gov) The way that people talk about opioid abuse is greatly misleading, with people mostly only addressing heroin addiction while prescription pain pills are abused about four times as often. Opioid addiction in the form of pain medication has been a problem in the United States since well before 1900. The addiction started in the United States with soldiers from the Civil War treated with morphine becoming to the pain killer around the turn of the century. In the early 1900s, heroine was prescribed to patients by doctors as a cough suppressant; during this period, not much was known about these poppy-derived drugs. Opioids effect the brain by binding to pain receptors in the brain, and therefore relieving pain for those who consumed the drug (CNN.com).  Because chemically opioids and heroin are astonishingly similar along with the two drugs acting on the same part of the brain, opioids have a highly addictive nature, especially if used for non-medical purposes. This chemical similarity is why many opioid users often resort to heroin after their prescriptions stop and a dependence has formed. The medication becomes especially addictive if taken in non-intended ways, such as crushing the pill and snorting it, or injecting it, or taking the opioids along with other drugs. (DrugAbuse.gov)

The dangers with opioids comes with the possibility of overdose. Users build a tolerance over time of using the dugs on a consistent basis, to get their “fix,” users feel the need to take more of the drug. The overwhelming availability of opioids has led to an increase in the negative consequences that come with them. According to DrugAbuse.gov, the estimated number of emergency department visits involving nonmedical use of opioid analgesics increased from 144,600 in 2004 to 305,900 in 2008, and death due to prescription opioid pain relievers has more than tripled in the past 20 years. This rapid rise particularly in opioid abuse can be credited to the enormous rise in opioid prescriptions. According to DrugAbuse.gov, prescriptions for opioids have risen from around 76 million in 1991 to around 207 million in 2013. Logically, it does not make sense that the number of individuals who need medication for pain relief would increase three-fold in 22 years. On October 26, 2017, President Trump declared the opioid crisis a “national health emergency,” saying “No part of our society — not young or old, rich, or poor, urban or rural — has been spared this plague of drug addiction and this horrible, horrible situation that’s taken place with opioids,” (NyTimes.com) The president addressing this problem this way declaring it a “National health emergency” will surely lead to a decrease in addiction across the country.

The origin of this issue can be traced to 80s and the 90s when the medical community recognized a problem of undertreatment of pain, or oligonanalgesia. Studies showed doctors had been doing a poor job addressing and treating pain. This was an issue for everyone, but an issue for minorities especially. Minorities were undertreated for pain far more than anyone else. In response to this issue, future doctors in medical school were taught differently than before. They were taught that a patient’s self-report of the pain was a “fifth vital sign.” They were also taught that if patients were prescribed opioids for pain they could not become addicted, which we now know to definitively be false. And lastly, Oxycodone and Hydrocodone were framed as safer alternatives to NSAIDs since NSAIDs can cause stomach ulcers. (Time.com) We now know that NSAIDs are much safer than opioids and that was false. So, yes, the root of the issue may be highly educated professionals with the best intentions for their patients. Another cause of this issue may be the push from the drug companies trying to make money.

It is hard to definitively know what has driven up these numbers over the past few decades, but the statistics have skyrocketed. One thing we know for sure is that chronic pain almost always starts as acute pain as a result from injury/surgery. Many of these patients are prescribed some form of opioid for pain. This pain however can often persist due to a condition of hyperalgesia—a hypersensitivity to new pain (afap.org) . This condition results from taking opioids due to pain. Hyperalgesia and an increase in tolerance levels often lead to a patient needing to take more of the medicine to live a comfortable life. These higher doses can slow down breathing in sleep alone, and when combined with alcohol or sleeping pills, it can be fatal. This is part of the reason for so many deaths today. Beyond the increase in prescriptions, doctors are now more likely than ever to diagnose patients with chronic pain. The Institute of Medicine approximates that 100 million Americans have chronic pain today according to prescriptions. There is no way that 1 in 2 Americans have chronic pain, that number is astronomically too high. 

Another class of drugs often misused and abused are depressants. Depressants can be used to combat insomnia, mental illness, and anxiety. Examples of these drugs include: Valium and Xanax. The abuse of “benzos” (benzodiazepines), a class of depressants including Xanax and Valium, is the most common type of depressant that is abused. (Wed.md) This is due to their potent effects on the body and wide availability. Death and illness rarely result from using these drugs alone, but benzos are often used with alcohol to make the effects much more pertinent, and this mixing of drugs and alcohol can lead to seizures, and even death. Although benzos by themselves are much safer than when consumed with alcohol, taking large amounts of only benzos can still result in serious side effects that can include dizziness, blurred vision, slurred speech, lack of coordination, difficulty breathing, and coma (Wedmd). Benzos are often used as a “date rape” drug because the drug can impair and even completely take away the want and the ability to resist sexual advances. 

Another class of depressants, Barbiturates, are used to help people go to sleep. Most people wouldn’t see an instance to abuse this type of medication, but if you fight through the urge to sleep and stay awake after taking the medication, you will become very intoxicated. Barbiturates are especially dangerous because the correct dose is difficult to determine, and a slight overdose could lead to coma or even death (Web.md). Barbiturates also are extremely addictive, and can have life threatening withdraw symptoms. These types of drugs were first introduced in the early 1900s and became popular for recreational use in the 1960s and the 1970s. Due to the fatal effects widespread misuse, the government took steps to reduce the amount of prescriptions written, and addiction is rare today. Hopefully this is what will happen in the future with the current opioid crisis in the United States. If our government takes the right steps as done in the 1970s, the opioid crisis too can be defeated.

When depressants are used chronically, dependence and addiction can form. This addiction is one of the hardest addictions to overcome. With this addiction comes withdraw symptoms that include: insomnia, weakness, nausea, sexual problems and even seizure. For those who continually take high doses, hallucinations, delirium, and increased body temperature can occur. (Drugfreeworld.org). Generally, chronic use of this drug will cause changes in visual appearance and behavior that effects relationships and work life. The scary thing is unlike other drugs, withdraw symptoms from depressants can be fatal. The widespread availability of these drugs, strong effects on the body, and potential for death make the abuse of this drug a very serious issue. The chronic abuse of depressants can be observed on college campuses all around the United States by college students combining benzos and alcohol, which is when depressants become very dangerous and potentially fatal. “Between 1993 and 2005, the proportion of students who abused tranquilizers like Xanax and Valium increased by 450 percent. (DrugAbuse.com). This is an astonishing statistic that undeniably supports that these prescription rates need to be lowered.

Stimulants are psychoactive substances that cause heightened energy and alertness by amplifying the activity of the central nervous system (DrugAbuse.com). Prescription stimulants, or amphetamines, are used by many with ADHD to help them focus. Drugs that fall into this category include Ritalin, Adderall, and Focalin. Stimulants are normally taken in pill form, but some recreational users crush up the pills and snort them to get “high.” The effects of prescription stimulants are very similar to those of cocaine, so prolonged use can lead to effects like chronic cocaine abuse (headsup.scholastic.com) Stimulants are most often used as a “study drug” with users taking the medication to help them focus and do school work. This is ironic because studies have shown that individuals who do not have ADHD do not experience an increase in cognitive ability at all. Others abuse the drug to try and lose weight, as one of the side effects is reduced appetite. This is not beneficial at all because after stopping the drug, typically individuals gain all the weight back, and maybe even a few more pounds. This method to lose weight is not a long-term solution. The use of stimulants to lose weight can even lead to malnutrition. Stimulants increase dopamine in the brain, the chemical that controls happiness, and that is where the addiction can form. Users will want to take the drug again to return to that euphoric state. As with the other types of drugs mentioned before, chronic use leads to withdraw symptoms which include fatigue, depression, and disturbed sleep patterns (headsup.scholastic.com). These symptoms often lead to a return to drug use.

As mentioned before, the issue behind the misuse and hospitalizations because of stimulants and depressants may be linked to how this generation of doctors was taught in medical school. The fear of undertreating patients very well could have reached outside the realm of only opioids. 

 To make an impact on this issue, there are a few things that can be done: doctors can write less opioid prescriptions. NSAIDs have shown to be just as effective, and in most cases, should be tried before patients turn to opioids for pain relief. Doctors can also be more hesitant to write prescriptions for depressants and stimulants as there have been dramatic rises in prescription rates for those drugs as well. For patients who doctors truly believe need opioids or a depressant, a label needs to be placed on the bottle saying something like “Warning: these drugs are highly addictive even in small amounts. These drugs have been known to cause hospitalization and even death when taken in high amounts. Take with caution.” If less prescriptions are written, less drugs will be on the streets, and mathematically, the number of deaths will decrease.

A sure way to stop this epidemic would be a substitute, and marijuana could be just that. Amanda Reimann, manager of Marijuana Law and Policy at the Drug Policy Alliance, defines substitution as a “conscious choice to use one drug (legal or illicit) instead of, or in conjunction with, another due to issues such as: perceived safety; level of addiction potential; effectiveness in relieving symptoms; access and level of acceptance.” According to this, the ideal substitute would be a more safe, effective, accessible, while being less addictive. There is already evidence that marijuana legalization would lower opioid use. In 2013, when multiple marijuana laws were implemented for the first time, total prescription drug in Medicare fell by $165 Million per year (Leafly.com).  In states where these laws were implemented, the most common drug reportedly substituted for was opioids at 33%, followed by benzoates and antidepressants. Biologically, opioids and THC have analgesic effects on the body because they block pain signals in our nervous system. THC is a cannabinoid, most commonly known for its psychoactive effects, giving users a “high.” Studies have even shown that THC when combined with opioids can produce pain relief similar in comparison to opioids alone. This combination can be used to reduce doses of opioids of patients, and to help addicts break their addiction while still getting pain relief. Cannabinoid and Opioid pain relief both work by binding to receptors at the surface of cells in the brain and setting off a sequence of reactions in the cell that inhibit pain release. The parallel mechanisms of actions allow for effective pain relief when administered together. For these reasons, it is believed that THC could be a viable substitute for opioids. THC could also be used as an alternative to depressants. THC is often used as a sleeping aid, and to reduce stress and anxiety, which is what depressants are used for. THC, without the physical withdraw, intense addiction, and harsh side effects, can be used as a not necessarily more effective, but without a doubt a safer alternative. 

Another cannabinoid that is known for its therapeutic effects is CBD. Evidence suggests that CBD can reduce drug cravings and help curb opioid addiction (Leafly.com) CBD has also been shown to improve cognitive performance, improving focus and mental clarity. According to the definition of a substitution, CBD would be a great substitute for stimulants.

After discussing the issue its self, the roots of the issue, and how this issue can be resolved, this is an issue that we can collectively resolve. Prescription rates of opioids and benzoates has skyrocketed in the past years, and with that so has hospitalizations and deaths from them. The correlation is undeniable. This issue is in the forefront in America today. If President Trump has declared this a national health emergency for the abuse of opioids, reducing the prescriptions of all drugs seems very possible.  We can fix this problem starting at the top with doctors prescribe less of these drugs, and us being more informed as consumers, and knowing when we should take the drugs and when to not take them. If doctors and patients try to further discuss their symptoms and the best methods to treat it, countless lives can be saved.
