“People are forced into the illicit stream of opioids because they can’t get legal access to meet their opioid needs”

Dr. Scott MacDonald

INTRODUCTION

Opioid use has been recorded throughout history but has recently experienced a sudden and dramatic surge in opioid use and dependence. With about 62 million people using opioids at least once in 2019, and over 70% of drug use deaths being attributed to opioids (WHO, 2021), it can be said that there is more to this issue than we think. In this article, we will be investigating the origins of the current opioid epidemic, its implications, and methods to control it. 

In this blog post, we’ll be breaking down/highlighting/outlining…

• Opioids and Their Effects
• The Legal Gateway
• The Illicit Market
• Harm Reduction

OPIOIDS AND THEIR EFFECTS

Opioids are a broad family of drugs commonly used for pain relief, but also have euphoric effects. Traditionally, the substance is extracted from poppy seeds to treat severe acute pain and terminal illnesses.

1 in 5 Canadian adults seeks healthcare providers for issues regarding chronic pain (Canadian Centre on Substance Use and Addiction, 2020). Opioids such as oxycodone, morphine, and codeine are often prescribed for pain management. They work by binding to receptors on nerve cells to block the transmission of pain signals, hence blocking or dulling the feeling of pain. The drugs are harmful as it stimulates the brain’s reward system, releasing dopamine and making it addictive. 

During an overdose, opioids bind to receptors in the brain that are responsible for breathing, and high enough doses can cause one to stop breathing, preventing the brain from getting oxygen. 

With prolonged use the user would become tolerant to the drug, hence needing higher quantities and potency levels to achieve the same effects. Due to its stimulating nature, long-term use will also cause physical dependence, resulting in harsher withdrawal symptoms that discourage the user from quitting. 

THE LEGAL GATEWAY

In the mid-90s, the opioid medication Oxycontin was heavily marketed by the pharma industry as a pain reliever with few addictive properties. Though this claim lacked scientific evidence, the effective marketing strategies and strong lobbying power created a surge in the use of opioids.

Marketing cost was spared no expense, with the industry providing gifts, retreats, and other incentives to those who prescribed Oxycontin to their patients. In 1996, Purdue Pharma urged hospitals and private practices to screen patients for chronic pain, and then sold their solution, Oxycontin.

45% of the United States Food and Drug Administration (FDA) budget is provided by Big Pharma through the Prescription Drug User Fee Act, requiring pharmaceutical companies to pay fees to the FDA (U.S Food and Drug Administration, 2021). As a result of this act, the industry’s lobbying power has prevented the creation of policies that would control the use of the drug.

With its increased availability and accessibility to both care providers and patients, by 2015 nonmedical use of prescription opioids was the 3rd highest form of substance abuse (MCLELLAN, 2017), making it more common to misuse prescription opioids than cocaine. 

THE ILLICIT MARKET

Opioids are very addictive. When patients begin taking prescribed opioids, they are extremely likely to become dependent on them. If patients are prescribed opioids, they should be taught how to manage their pain and reduce their dependence on them  – but this is not done. Instead, patients that are still dependent on opioids are left to manage pain on their own– and so they do, by either using other medications or seeking the black market. 

This new demand fuelled the illicit drug market to supply medications similar to and stronger than Oxycontin. Dubbed the “gateway drug”, opioid dependence can lead to the use and addiction of other harmful substances such as heroin.  Synthetic products such as Fentanyl and Carfentanil also contributed to the growth of the illicit drug market. Though similar in function, these products are lethal in small doses and more potent than morphine.

The products found in the illicit market are not safe, as they can be contaminated and consist of different potencies in what appears to be the same dose. In 2019, over 94% of opioid-related deaths are accidental (Gomes et al., 2021). So, not knowing the potency of the drug can cause fatal results. 

HARM REDUCTION

Some steps have been taken to address unintentional opioid deaths such as the use of monitoring systems and Naloxone kits. 

Monitoring systems are placed to prevent the misuse of prescriptions. One way this is done is by tracking the prescribing practices of healthcare providers and the filling practices of the patients. Another way is by permitting health care providers to access their patient’s prescription history and limit prescriptions to those with high opioid usage. Yet this system would likely contribute to the existing issues of discrimination by reinforcing existing biases.

Naloxone kits are used as first aid to treat opioid overdose, as an overdose can prevent oxygen from going to the brain. After the antidote is given the patient needs to be treated further, but depending on how they purchased the opioids, the patient or those with them may not seek help fearing repercussions. 

Though these solutions can be useful in tracking the healthcare systems use of opioids and treating opioid overdose, they do not contribute to the larger factors causing a substantial amount of people to become dependent on opioids. Without proper policies in place, there is a high chance we will be exploited by the next highly marketed drug. 

What Can We Do To Help? 

(Government of Canada – Canada’s opioid overdose crisis): https://www.canada.ca/en/services/health/campaigns/drug-prevention.html  

Hesitancy When Seeking Help 

(Government of Canada – About the Good Samaritan Drug Overdose Act): https://www.canada.ca/en/health-canada/services/opioids/about-good-samaritan-drug-overdose-act.html

Written by: Ragshica Sotheeswaran, HBSc