Opioids are a class of neurological drugs that are used primarily in the use of pain management. Dr. J. Fred Stoner from New Castle, Pennsylvania and President of Pain, Addiction, and Law Symposium (PALS), is a pain management physician, as well as a pathologist, and while he understands the benefits of opioid use at therapeutic levels for his patients, he also understands the ill effect of the drugs on patients in the long-term, and also in the population of people using opioids as a recreational drug. Over the past decade, the US and the world in general has seen a rise in the use and misuse of opioids and opioid-related deaths.
History of Opioids
Although the opioid crisis has happened fairly recently in the past few decades, the use of related substances has been traced back thousands of years, with archeological sites dating back to 5000BC having been found with Papaver somniferum seeds, commonly known as opium seeds. Egyptian and Greek cultures knew the plant as a plant of joy, while Hippocrates was well versed with its use as a sleep and pain aid. During the early 19th century, morphine and codeine were made from the plants to be used for pain management, as well as cough and diarrhea control. During the late 19th century and 20th century, synthetic and semisynthetic opioids such as heroin were created as clinical medications, although the addictive properties were found, and the US criminalized recreational opioid use early on in the 20th century. In 1959, fentanyl, a synthetic opioid was discovered and found to be almost 50 times more potent as heroin. Today, there are over 100 different opioids known.
Opioids work by acting primarily on the opioid receptors in the central and peripheral nervous systems, as well as other systems such as the gastrointestinal system. There are three main subtypes of the receptor, although more than 15 in total have been discovered. The receptors, mu, kappa, and delta, each serve a different purpose as receptors, and Dr. J. Fred Stoner also mentions that it is important to note that the mu receptor has been found to have three subtypes of its own; it has been found that subtype 2 of the mu receptor is involved in dependence and addiction.
With the rise in the number of synthetic and semi-synthetic opioids available, pharmaceutical companies began advising physicians that the newer drugs did not exhibit dependence properties, and it would be safe for patients to take them long-term. It became evident in the years to come that this was not true, and patients in fact were becoming highly addicted. It was quickly found that many patients after coming off their prescriptions began seeking opioids elsewhere, a majority of the time being in the form of heroin. Dr. J. Fred Stoner explains that a major concern with illicit opioid use and addiction is the possibility of respiratory arrest and eventual death, which has been on the rise during the 21st century. In 1999, the National Center for Health Statistics found that there were just under 17,000 drug related overdose deaths, with just over 8000 being due to opioids, and this number rapidly grew to over 70,000 in 2017, with almost 48,000 of those being attributed to opioid use and overdose. With new laws and measures being put in place, as well as the more prominent use of naloxone as a opioid-blocking agent, the general trend of opioid misuse and deaths while still rising at an alarming rate, has seemed to slow down ever so slightly, although many countries in the past few years have declared national emergencies, stating that opioid use has become an epidemic.
Along with opioids, other substances have also seen a rise in the general trends of usage and abuse, although not always talked about. One of the biggest issues is teenage use of prescriptions drugs to get “high”. Many states across the US have become aware of “drug parties” where teenagers will take whatever medications they are able to find and take them as a means to get high or attain euphoric feelings. Other drugs at the forefront of abuse are cocaine, Xanax, and methamphetamines, all abused for the high that people feel when using them. Dr. J. Fred Stoner states while not all drugs cause addiction, many have the potential to lead to death, and the trend that is being seen is alarming to both healthcare professionals and lawmakers alike.
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