Abuse of opiates

Opium is the raw material for the legal manufacture of morphine, codeine and their derivatives as opioid pharmaceuticals; it is also the raw material for the illegal production of heroin. Morphine and codeine are responsible for both the medical and dependence-producing properties of opium. These two substances, together with morphine-like substances of synthetic origin, have taken over opium's therapeutic role.

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).

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. Scientific research continues to seek an effective analgesic that produces all the beneficial effects of morphine and its derivatives without causing dependency.

Americans use 80 percent of the world's opioids.  Prescriptions for opioid painkillers rose markedly in the early 21st Century. The number one most prescribed drug in the United States in 2010 was the combination of hydrocodone and acetaminophen with over 135 million prescriptions dispensed.  In 2015, more than one-third of American adults were prescribed an opioid drug. 

While women are prescribed opioids more frequently than men, men have a higher rate of misuse – 13% compared to 9% respectively. Of those misusing the drug: 64% said their use of the drug was motivated by need for physical pain relief; 41% reported getting leftover medication from family or friends; 11% said they took the pills to relax or get high.

Purdue Pharma's oxycodone, better known by its brand name OxyContin, is an opiate-based medication that first entered the market in 1996.  20 years later, 30 million Americans, around 3% of the population, were believed to be opioid addicts, many now obtaining their drug illicitly. Over this period, opioid overdose became the country’s leading cause of death, killing more people than guns or cars with an average of 175 Americans dying of overdoses every day (annual total of 64,000).

Politicians, pundits and drug regulators have all weighed in on measures to prevent abuse and the deaths that resulted from illicit use. One result was that opioid prescriptions fell dramatically. By 2021, prescriptions for hydrocodone and acetaminophen were reduced to 30 million, down 100 million prescriptions in around a decade (ClinCalc DrugStats Database). However deaths from opioid overdose rose were higher and rates still rose steadily: the percent change was 29.48% from 2019 to 2020 and 11.48% from 2020 to 2021. An explanation was that the drug supply had increasingly become contaminated with illicitly manufactured fentanyls and other synthetic opioid and benzodiazepine analogues and added to counterfeit pills resembling prescription opioids, benzodiazepines, and other drugs. Among adolescents, fentanyl-involved fatalities increased from 253 to 884 (4.23 per 100,000) in 2021. Fentanyl outpaced heroin as the deadliest drug on Long Island, New York, where overdose deaths doubled between 2013 and 2014.

Opiates can be obtained from poppy straw, smoked usually in a tobacco mixture. Whilst this has not created a significant problem, some states in the USA have enacted legislation and regulations.