Opioid-addiction epidemics nothing new
NEW YORK — While declaring the opioid crisis a national public health emergency Thursday, President Donald Trump said: “Nobody has seen anything like what’s going on now.”
He was right, and he was wrong.
Yes, this is the most widespread and deadly drug crisis in the nation’s history. But there has been a long string of other such epidemics, each sharing chilling similarities with today’s unfolding one.
There was an outbreak after the Civil War when soldiers and others became addicted to a new pharmaceutical called morphine, one of the first man-made opioids. There was another in the early 1900s after a drug was developed to help “cure” morphine addiction. It was called heroin.
Cocaine was also developed by drugmakers and sold to help morphine addiction. It cleared nasal passages, too, and became the official remedy of the Hay Fever Association. In 1910, President William H. Taft told Congress that cocaine was the most serious drug problem the nation had ever faced.
Over the next century, abuse outbreaks of cocaine, heroin, and other drugs like methamphetamine, marketed as a diet drug, would emerge and then fall back.
Trump vowed in his recent remarks “we will free our nation from the terrible affliction of drug abuse.” But the grim reality is that these drugs never disappear completely once they’ve emerged.
The good news, though, is that drug epidemics do fade considerably — usually because reduced supply and demand eventually diminish the number of new addictions, experts say.
In 1900, when cocaine and heroin were legal and popular, about 1 in 300 Americans had a drug addiction. The estimate today is 1 in 133, and the drugs are deadlier than ever.
There were fewer than 3,000 overdose deaths in 1970, when a heroin epidemic was raging in U.S. cities. There were fewer than 5,000 recorded in 1988, around the height of the crack cocaine epidemic.
More than 64,000 Americans died from drug overdoses last year, according to the U.S. Centers for Disease Control and Prevention.
This epidemic started around 1995, kicked off by a drug called OxyContin, which like heroin and morphine before it, was meant to be a safer and more effective opioid. OxyContin and competitor drugs were designed to release the medication slowly over long periods of time, making them supposedly safe and effective enough to use for months to treat chronic pain. But patients found themselves addicted, and drug abusers found that they could crush the tablets and snort or inject them, delivering the drug to the bloodstream much more quickly.
Aggressive marketing and distribution pushed hundreds of millions of pills into communities. Then more and more addicts turned to cheaper, illegal alternatives, like heroin and fentanyl, an opioid medication developed to treat intense, endof-life pain in cancer patients that is 50 to 100 times more powerful than morphine.
“It’s a very complex epidemic” that is nowhere close to being over, said Dr. Anne Schuchat, the CDC’s principal deputy director, in an interview earlier this year.
What has worked for previous epidemics?
The supply is often reduced by a combination of regulations, law enforcement and economics. And historians say that demand slows when drug users became so outcast that even those looking for a risky thrill or a way to escape began to stay away.
Past epidemics have also shown what doesn’t work. Many experts, including some in law enforcement, say that arresting users and dealers does not seem to slow epidemics. “We cannot arrest our way out of the heroin and opioid addiction crisis,” said Brian Moran, Virginia’s secretary of public safety and homeland security, speaking at a federal hearing in July.
Health officials are fighting the current epidemic on three fronts: Preventing overdose deaths, helping people recover from addiction, and preventing new addictions.
There appears to be some success on the third front.
A recent federal report noted a downward trend in “opioid misuse” in adults younger than 50. Prescription rates are falling, though they remain far higher than years ago. And according to a closely watched University of Michigan study of adolescents, use of the opioids OxyContin and Vicodin has been low and falling for several years. In 2016, heroin use was the lowest in the survey’s 41-year history.
“I suspect we may be past the peak [of the epidemic], at least in terms of initiation,” said Jonathan Caulkins, a drug policy scholar at Carnegie Mellon University.