I was on Vicodin for a bit. Asked my doctor for more. She gave me a lesser amount and, for a guy with my impulse issues, I'm lucky I did not get permanently hooked. How bad is the opioid crisis?
How bad? Very bad.
This history of opioids is incredible. People used opium (which was pretty weak compared to modern opioids) and noticed it was unfortunately addictive. In the early 1800s, Friedrich Seturner first isolated morphine and found it six times more potent than opium, so he thought maybe being able to use a sixth as much meant people could get the therapeutic benefit but be less addictive. He became addicted to morphine. In the 1870s someone discovered diamorphine, in the hope they could get the therapeutic benefits without the addictiveness, like Seturner had hoped with morphine. The early brand name of diamorphine? Heroin. So I don't need to tell you how that one worked out. Then into the 20th century, stuff like oxycodone and pethidine were discovered, in their never-ending hope to find an opioid that wasn't addictive, and it never worked. That's to set the scene for the latest crisis, which was kicked off because they created slow-release formulas for opioids (mostly old opioids discovered in the early 20th century) and claimed that the slow release would somehow make them much less addictive. So, how likely was this ever going to be, given the above context?
They didn't even present adequate data to defend the case - but they poked and prodded and threw around marketing budgets and pressured the medical community and got it signed off. A lot of it was that they heavily lobbied the medical profession and government by presenting an apparent epidemic of chronic pain and raising pain treatment to be a much more important component of care ("fifth vital sign"), and the regulators were always a little compliant to business. Oh, how the pills rolled out and the money rolled in. And surprise surprise, these slow release formulations turned out to be really quite addictive. Who could have predicted this (except of course absolutely anyone familiar with the history and pharmacology of opioids)?
So, to put the USA's problems in context, the UK has 2500-3000 opioid deaths a year, and the UK has an opioid problem at the upper end of the specttrum for Western countries. As the USA has five times the population, you'd expect ~15,000-18,000 deaths from opioids. It's actually about
70,000, about four times worse. Wowzer. Canada, incidentally, is only marginally better than the USA, I might guess because trends are easily passed from their larger, close neighbour so they followed tack.
The USA also gets in the neck in other ways too, because the other two really dangerous drugs of abuse, methamphetamine and crack cocaine, are also incredibly popular there compared to Europe - Europeans mostly stuck with ordinary cocaine that's much less likely to cause fatal OD, and seemed to prefer hallucinogens (mostly safe) like ecstasy to stimulants. Funny old world. How did the USA manage to go crazy for all three of the worst fucking drugs out there?
