As the opioid crisis continues to wreak havoc across America, understanding the root of the problem which plagues our nation remains key to being able to provide solutions. Drugs like fentanyl, codeine, oxycodone, and other synthetic opioids continue to cause thousands of deaths across the country every year. This problem is not limited to the United States, either; the opioid crisis is a significant problem around the world as increasing numbers of individuals find themselves dependent on these dangerous drugs. It was recently estimated that over sixty million people struggle with the effects of opioids worldwide.[1]

In Part I of this series, I looked at the ancient history of natural opioids deriving from the poppy plant and how their spread across the world – both as medical and recreational drugs – led to a period of severe global conflict between the East and West. In Part II, I will explore the development and spread of synthetic opioids and highlight how the American pharmaceutical industry was responsible for initiating a devastating epidemic of overdose deaths across the country in its search for profit.

Synthetic Opioids

The development of synthetic opioids began in the mid-20th century as American and European researchers experimented with alternatives to natural opiates like morphine and codeine (Vaillancourt, 2018). Methadone, developed in Germany during World War II, was introduced in the United States as a treatment for severe pain and later for opioid dependence.[2]

Expanding the Pharmaceutical Opioid Market

In 1960, fentanyl, an extremely potent synthetic opioid, was synthesized by Paul Janssen of Belgium’s Janssen Pharmaceutica.[3] Initially used in anesthesia, fentanyl quickly became popular in medical settings. This marks the start of what was to become a global struggle with fentanyl, as practitioners at the time did not take careful enough account of the extremely addictive effects fentanyl had on individuals who were prescribed it. In spite of the classification of opioids, including synthetic opioids, under a regulatory framework by the United States Government in the 1970s – a system which was aimed at better controlling their distribution and general use – the popularity of synthetic opioids continued to grow, both for medical professionals and among researchers interested in creating ever more potent versions of synthetic opioids.[4] Throughout the 1970s and 1980s, pharmaceutical companies continued to develop various synthetic opioids for legal medical uses, including pain management in cancer patients.[5]

Prescribing Opioids

In the mid-1990s, a large pharmaceutical company called Purdue Pharma launched a drug known as OxyContin, a powerful opioid painkiller. In order to meet its profit margin, the company aggressively marketed OxyContin as a low-risk treatment for chronic pain. This aggressive marketing campaign, which encouraged doctors across the country to prescribe OxyContin for all sorts of problems, including headaches, stomach problems, and sleep troubles, was the beginning of a significant increase in opioid prescriptions nationwide. Not five years later, reports of widespread abuse of prescription opioids began to emerge; we have since been able to link these aggressive marketing practices by Purdue Pharma to the growing public health crisis of synthetic opioid dependence among Americans.[6] The scandal which followed this investigation was not able to stop the widespread use of OxyContin; as doctors stopped prescribing it due to increased concern, an underground manufacturing market emerged to meet the demand from individuals who found themselves unable to live without this highly addictive synthetic painkiller.

Illicit Opioid Manufacture

The early 2000s, therefore, saw a surge in opioid-related overdoses and deaths as prescription opioids became more widely misused.[7] In response to rising prescription opioid abuse, the U.S. government implemented stricter regulations on the prescription of opioids. However, this led some individuals to seek heroin or illicit fentanyl as alternatives when they could no longer get their regular prescription refilled.[8]

This decade also witnessed the emergence of illicitly manufactured opioids entering the illegal drug market – rather than manufacturing the relatively safe (if extremely addictive) oxycodone; these illegal manufacturers began producing their own unregulated versions of fentanyl and heroin in order to profit from the need created by Purdue Pharma and other major pharmaceutical companies. The 2010s, therefore, saw a dramatic increase in opioid overdose deaths, largely driven by this widespread underground world of manufactured synthetic opioids like fentanyl. 

The crisis we know today as the fentanyl crisis was first spoken about during this time; the CDC has reported that fentanyl-related deaths in the United States more than doubled from 2015 to 2016.[9] This means that, over the course of a single year, twice the number of people died from opioid overdose across America. Pharmaceutical companies faced lawsuits and penalties for their role in the opioid epidemic. In 2019, Purdue Pharma filed for bankruptcy amidst thousands of lawsuits over its role in the crisis.[10]

Where Are We Now?

As we have become increasingly aware of this crisis, efforts to combat this devastating opioid epidemic have blossomed into a loud and forceful movement for change. Throughout the 2020s, there has been an increased emphasis on monitoring prescriptions and expanding access to treatment as well as raising awareness about the dangers of synthetic opioids – both legal and illegal.  However, the proliferation and sale of potent synthetic opioids, particularly through illegal channels, remain significant challenges in addressing the crisis.[11]

Americans have a responsibility to work hard against this rising tide of opioid deaths across our country, and being educated is a great place to start. Let’s not be afraid to have difficult conversations about what these dangerous drugs have done to our communities and continue to hold those responsible – both legal and illegal actors – accountable.

If you or anyone you know has been affected by opioid use, please reach out. We are here to help. No one should suffer alone.

Sources:

[1] The Lancet Regional Health – Americas. (2023). Opioid crisis: Addiction, overprescription, and insufficient primary prevention. The Lancet Regional Health – Americas, 23. https://doi.org/10.1016/j.lana.2023.100557

[2] Vaillancourt, F. (2018). The birth of synthetic opioids. Journal of Opioid Management, 14(1), 45-71.

[3] Dean, A. D. (2007). The history of methadone. American Journal of Public Health, 97(2), 203–210.

[4] Stanley, T. H. (2014). The fentanyl story. The Journal of Pain, 15(12), 1215-1226.

[5] U.S. Drug Enforcement Administration. (n.d.). Controlled Substances Act. Retrieved from https://www.dea.gov/drug-information/csa

[6] Morgan, J. P., & Kagan, D. V. (2021). Opioid analgesics: History and overview. Retrieved from https://www.opioidhistory.org

[7] Van Zee, A. (2009). The promotion and marketing of OxyContin: Commercial triumph, public health tragedy. American Journal of Public Health, 99(2), 221-227.

[8] Kolodny, A., et al. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559-574.

[9] Centers for Disease Control and Prevention. (2021). Understanding the epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html

[10] Hoffman, J. (2019, September 15). Purdue Pharma, maker of OxyContin, files for bankruptcy. The New York Times. Retrieved from https://www.nytimes.com

[11] National Institute on Drug Abuse. (2022). Opioid crisis timeline. Retrieved from https://www.drugabuse.gov/drug-topics/opioids/opioid-crisis-timeline