Abuse of opiates

Opium is an important raw material for the legal manufacture of morphine, codeine and their derivatives as opioid pharmaceuticals. It is also the raw material for the illicit production of heroin. Morphine and codeine are responsible for both the medical and dependence-producing properties of opium are derived from its main constituents. These two substances, together with morphine-like substances of synthetic origin, have taken over opium's therapeutic role. Both the natural and the synthetic groups of narcotics include substances with varying degrees of desirable and undesirable effects, all of which are abused as prescription and non-prescription drugs to some degree.

Opium is the coagulated juice from the unripe capsule of the poppy plant (Papaver somniferum), which contains 10% morphine. It grows in temperate and subtropical climates and appear to have originated in the eastern Mediterranean region about 5,000 years ago. Its use spread rapidly to Persia, Egypt, China and Europe, where the "panacea laudanum" praised by Philippus Paracelsus, the sixteenth century alchemist and physician, was a preparation of opium. The value of its medical application, as well as its non-medical use, continue to spread, especially in poppy producing areas, and it became a popular treatment for various diseases.

International concern over the abuse of opium and the opioids led to the formulation of the first international treaty on narcotics control – the International Opium Convention, signed at The Hague in 1912 (coming into force in 1915).

In addition to the traditional poppy sources, poppy straw is now emerging as a new drug of abuse. Opiates can be obtained from the straw and smokes, usually in a tobacco mixture. Whilst this has not, as yet, created a significant problem, some states in the USA have already enacted legislation and regulations.

Synthetic opiates with strong morphine-like effects were developed in the late 1930's, with a view to obtaining a strong but non-addictive analgesic which could be used to alleviate pain. Several synthetic alternatives now exist, but scientific research continues to seek an effective analgesic that produces all the beneficial effects of morphine and its derivatives without causing dependency.

Prescriptions for opioid painkillers have risen markedly.  Americans use 80 percent of the world's opioids.  According to 2017 estimates from the U.S. Department of Health and Human Services, more than 130 people die of an opioid overdose every day in America (and, for the first time in recorded history, Americans are now more likely to die in an opioid overdose than a car crash).  Between 1999 and 2017, nearly 218,000 people died of an overdose of prescription opioids, including oxycodone, better known by its brand name OxyContin. 

As reported in 2017, fifteen percent of seniors on Medicare are prescribed an opioid upon discharge following an acute hospitalization and 42 percent of them are still taking it three months later, suggesting addiction may be an issue  In 2015, more than one-third of American adults were prescribed an opioid drug and opioid overdoses have become the leading cause of death for Americans under the age of 50.  In 2013, about 23,000 Americans died from overdosing on prescription drugs; painkillers accounted for about 16,000 of those deaths.  

This grim picture doesn’t only involve illicit street drugs.  Between 1999 and 2017, nearly 218,000 people died of an overdose of prescription opioids, including oxycodone, better known by its brand name OxyContin.

Overall, studies show addiction affects about 26 percent of those using opioids for chronic non-cancer pain, eg each year, about 3 million Americans, most under the age of 25, have their wisdom teeth removed, and most if not all receive a prescription for opioids. Women, people over the age of 49 and those without college degrees were most likely to receive a prescription, and the unemployed, uninsured and adults with an annual family income below $50,000 had the highest prevalence of opioid misuse and addiction.   An estimated 5 percent of adults (11.5 million people) misused the drugs and nearly 1 percent (some 1.9 million people) reported addiction. While women are prescribed opioids more frequently than men, men have a higher rate of misuse – 13 percent compared to 9 percent respectively. Of those misusing the drug: 64 percent said their use of the drug was motivated by need for physical pain relief; 41 percent reported getting leftover medication from family or friends; 11 percent said they took the pills to relax or get high.