Arndt1

Erin Arndt

Dr. Freymiller

CAS 137H

3 November 2016

Pharmageddon

A Paradigm Shift on Prescription Drug Abuse in America

I was functioning at a higher level, I was a better mom, a better wife, said Cari Creasia,

a stay at home mom of Kent Washington in an interview with PBS Will Lyman. Having a

steady supply of 300 to 400 pills a month Cari made up ailments to receive more narcotic

prescriptions from her doctor. Her life became consumed by the pursuit of the next high. She

was clean for about 18 months before she became addicted to heroin, abandoning her family for

a life on the streets, her only motivation in life to seek out her next high. This is becoming an all

too familiar scenario in suburban middle class families in America. Individuals take a huge risk

by using prescription medications to get high or spaced out, and not only is this highly illegal,

but it extremely dangerous for their well being. There are a variety of harmful symptoms that can

occur from taking a drug that is not specifically prescribed to an individual. These symptoms

range from sleepiness and confusion to respiratory problems and death. (Newton 70). A

combination of both the lack of knowledge pertaining the addictive properties of pharmaceutical

grade drugs and later in history, when large pharmaceutical companies in their haste to approve

drugs for commercial and financial gain, caused American citizens to be exploited by putting

their health at stake in addition to being primed for drug abuse. From the early 1800s until

present the abuse of prescription grade drugs has been prevalent in the United States. Millions of

Americans would become addicts over roughly 200 year span.

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The1800s

Americas prescription drug abuse problem originates not actually within the United States, but

back to Germany, where Friedrich Stretrner, a chemist isolates morphine from opium. Morphine

is found to be a soporific drug, one that induces sleep, and is effective in producing this result. It

also found to be effective in the treatment of acute and chronic severe pain (Newton 17). In the

1820s morphine became available without a prescription in the U.S. (Newton 18). This allowed

for the development of commercial means for manufacturing raw ingredients, also at this time

morphine was thought to have little to no side effects.

By the start of the American Civil war in 1861 the prevalence of morphine had never

been so extreme. Morphine was used to treat dysentery, surgical pain, and the aliment of

battlefield wounds. By then end of the war in 1865 the overuse of morphine for pain treatment

lead to a severe morphine addiction among war veterans (Newton 19). This can be seen by the

sheer amount of opium, which is the main component of morphine, imported to the U.S. From

1860-1869 the U.S. imported 1,425,196 pounds of opium, an increase of 351%, while the U.S.

population only grew 133% (Newton 24). In 1887 the U.S. Congress passed the first law

regarding Opium. Restrictions were placed the importation of opium but only on specifically

Chinese immigrants; these restrictions did not apply to Americans (Newton 317). Racial

discriminations such as these really speak to the social norms and ideals of the era. There was an

ever growing tension between Chinese immigrants in San Francisco and the already established

American population. This conflict is amplified by the establishments of laws like these, which

establish a firm belief that drug problems dealing with opium are not an American problem,

they are a foreigners problem. The denial of drug addiction as an American problem at the
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Legislative level seriously hindered the United States ability to acknowledge the ever growing

drug problem inflicted on hundreds of thousands of Americans.

1900-1965

At the turn of the century Americans were still reeling with their morphine addiction. Throughout

the twentieth century uninformed Americans would become victim to the addictive strength of

some of the worlds most potent drugs. Laws, acts and amendments would come to pass, but

U.S. Congress and other legislators were not exactly informed entirely well in regards to how

addiction to these substances work. They continued to see them as criminal acts rather than

medical issues that affected people psychologically and physiologically.

The United States passed the Pure Food and Drug Act of 1906. The passage of this act

indicates that there is a growing concern for the safety of Americans, and that people are

beginning to question the safety of the drugs and whether they actually help or hinder Americans

in the long run. The U.S. Congress continued to tighten restrictions on narcotics specifically by

enacting Harrison Narcotic act of 1914, stating that anyone who sells narcotics must be licensed

by the government and sales of narcotics will be taxed (Newton 35). The U.S. department of

Justice determined addiction to narcotics and drugs alike as criminal behavior (Newton 35). By

determining that addiction to prescription medication was a criminal behavior instead of a

medical problem. This continued to be the governments attitude towards drug addiction until the

early 2000s. During the early 1900s heroin was commonly used as a painkiller. When heroin

was first synthesized it was coined the heroic drug, implying that it could cure just about any

pain, which was one of its main selling points. Although this heroic drug seemed to be doing

wonders for reducing pain, it was discovered to be extremely addictive, thus the Heroin Act of
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1924 banned the importation, possession and all reasons of any use of Heroin in the U.S.

(Newton 38).

The status of prescription only drugs was never entirely outlined, and because of this it

allowed for many pharmaceutical companies, pharmacists and doctors to misconstrue, and edge

around rules set in place previously. As a result of years of unclarity the Federal Food, Drug and

Cosmetic Act became effective in 1938 allowed the FDA to make regulations to monitor and

control synthetic chemicals used in medication. This act also required that drugs that are to be

prescribed must have a label to be prescribed legally. This amendment was passed as the Durham

Humphrey Amendment in 1951, and took effect in 1952 (Newton 48).

The Drug Abuse Control Amendment of 1965 was passed and declared that the illicit use

of depressants, stimulants, and hallucinogens was illegal for any other reasons than for a

prescribed medical purpose. This amendment did not include narcotics in this amendment,

allowing for opioid substances to remain in over the counter drugs (Newton 319).

1970-Present

There were no federal laws prohibiting the sale of drugs opium at a national level until 1970 with

the enactment of the Controlled Substance Act (Newton 320). Until 1970 pharmacists were able

to give medication containing opium over the counter until then, although there were several

local laws that were put in place before the national law went into effect (Newton 320). The fact
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that opium medications were available over the counter until 1970 explains why there was an

exponential growth of addiction during the mid 20th century that carried into the 21st century.

The Controlled Substance Act of 1970 started the decade off with a bang. This act was meant to

update and consolidate all previous amendments, acts and laws regarding the illegal recreational

use of prescription medications (Newton 320). This act outlined a drug categorization system

based on three criterion, the drugs potential for abuse, its value in medical treatment in the

United States, and its safety under medical supervision. The schedules range from, I including

drugs that have a high potential for abuse and have no accepted use for medical treatment in the

United States, to schedule V where drugs in this category have little potential for abuse, have

accepted medical applications in the U.S. and are generally safe to use under medical supervision

(Newton 41).

Purdue Pharma, previously made its main profit off a drug MS Contin, a morphine pill

specifically designed for cancer patients in hospice (Ryan). Once their patent for the drug ran out

in the late 1980s, meaning generic alternative versions of the drug could be sold at a lower price,

they sought to develop a new drug to be their main source of revenue (Ryan). Purdue Pharma

had already developed a timed release mechanism, now they just needed something to apply it

to. They turned to oxycodone, also known as Percocet, and applied the time release mechanism

they developed to it, making the pain relief supposedly last for 12 hours instead of the usual six

hours that oxycodone delivers on its own (Ryan). Purdue Pharma called this time release version

of oxycodone OxyContin, and claimed that it delivered 12 hours of sustained pain relief, giving

them a huge competitive advantage in the pain relief market where most drugs only last 6-8

hours (Ryan). Their first round of clinical trials barely reflected this claim (Ryan). The first study

included 90 people and a third of them experienced pain 8 hours into the dose, and required
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medication, according to an FDA analysis of the study (Ryan). OxyContin eventually hit the

market in 1996, after being approved by the FDA (Ryan). Narcotic painkillers effectiveness

varies from person to person, in effect the dosage will vary from patient to patient. Purdue

Pharma, although they were aware of the variability of dosage requirements, asked doctors to

maintain the 12 hour doses (as it is their claim to their wonder drug) and strengthen the does if

the patient is still experiencing pain (Ryan). By the fifth year after its release, OxyContin was

accumulating more than $1billion in annual revenue (Ryan). Purdue Pharmas sales of

OxyContin would continue to grow progressively over the years until 2007.

While Purdue Pharma continued to crank out more and more OxyContin, the U.S.

Congress would establish the Prescription Drug, and Controlled Substances Monitoring Program

in all fifty states in 2002 (Newton 320). Purdue Pharma eventually went under a criminal

investigation by the U.S. department of justice in 2007 (Ryan). The top three executives pled

guilty to downplaying the addictive tendencies OxyContin had, and fas a result had to $635

million in fines (Ryan). This is concrete evidence of big pharmaceutical companies wielding

power over the heads of Americans and even physicians for the sake of their own financial gain.

About half of the Americans who were surveyed between the years 2007 and 2010 said

they took at least on prescription drug, about a third took between one and four drugs daily, and

about one tenth taking five or more daily (Newton 45). This data showed correlations between

drug type the age of people being prescribed medication. There was an increase in the amount of

antidepressants being used by adults from 19 years old to 64 years old; an astonishing increase of

381%. There was also a 357% increase of adults over 65 years of age taking antidepressants

(Newton 45). While antidepressants are not addictive in the same way narcotics are, they are still

a habit forming drug, and doctors often misdiagnose two thirds of their patients, making people
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dependent on medication they did not need in the first place (Newton 46). The increase of

prescription medication that Americans are taking in the early 2000s decade is astonishing.

In 2009, for the first time in the history of the United States the number of fatalities due

to drug overdoses exceed the number of fatalities related to vehicular accidents (Newton 321).

Deaths from drug overdoses are fueled by the exponentially increasing amount of prescriptions

being administered to the American public. In 2010, as a result of lawsuits and concerns

regarding OxyContins safety as a drug Purdue Pharma was forced to discontinue shipping the

original OxyContin formulation to pharmacies in turn for a reformulated version that produced

less side effects, while still producing the desired medical result, pain relief (Newton 321).

The amount of opioid prescriptions nearly tripled from 76 million in 1991 to 219 million

in 2011. Most of those prescriptions were for hydrocodone and oxycodone (Volkow). That is an

increase of 288% in 20 years. These numbers reflect the ever growing population of Americans

becoming dependent on prescription drugs, and most likely abusing them to a greater degree. As

the amount of prescription drugs the average American took daily increased, it is evident that

prescriptions of opioid medications helped make that number climb so high (Volkow).

In 2011 Barack Obama heeded warning to Americans in his speech Epidemic:

Responding to Americas Prescription Drug Abuse Crisis, Obama outlined major issues

pertaining to our safety as a nation and the steps to deal with this crisis.

By 2012, the number of opioid analgesic prescription dropped by 19% since 2010 and the

number of opioid related deaths dropped by 20% since 2010 as well (Newton 75). Although it

may seem that these numbers indicate improvement, the real cause for the change is the ban of

the opioid narcotic Propoxyphene and the improved formula of OxyContin (Newton 75). During

the same time frame, the amount of heroin related deaths increased while prescribed opioid
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related deaths decreased, suggesting that the ban of Propoxyphene and the improved formula of

OxyContin made abusers switch to heroin, a more intense and inexpensive alternative that

produces a similar if not more intense high (Newton 321). Indicating a possibility that people

who were addicted to prescription narcotics moved from from illegally obtained prescription

drugs to street drug dealers.

At the start of 2013 Americans were receiving 10 million prescriptions daily (Newton

69). Not only does this seem excessive, but it is ultimately would lead to a significant amount of

the prescriptions to be abused. As a result of the increasing rates at which hydrocodone was

being used for non-medical purposes ultimately caused the DEA to reschedule hydrocodone from

schedule III to schedule II in 2014, defining it as more susceptible to abuse and limiting its

medical uses (Drug Enforcement).

A prescription drug abusers body eventually build up a tolerance to the drugs they use,

requiring them to take higher and higher doses to achieve the same high. Sometimes the

prescription drugs they use recreationally no longer are able produce a high strong enough for

them so they turn to stronger drugs such as heroin. Aside from the horrible side effects that the

drugs themselves that the abusers experience, the ways in which they inject the drug is not

always sterile. Heroin is not the only drug that can facilitate the spread of HIV from sharing

needles, Opana, and opioid analgesic is a popular drug to also be injected with a needle.The act

of sharing needles of those addicted to opioid analgesic Opana, oxymorphone, lead to an

outbreak of 150 HIV cases in Scott County Indiana. As a result the governor agrees to the needle

exchange program in mid May of 2015 (Newton 323).

In late 2015 the DEA had agents raid pharmacists, physicians, and street dealers who sold

prescription drugs for nonmedical purposes. The raid occurred in Alabama, Arkansas, Louisiana,
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Mississippi, where more than 200 individuals arrested it was quoted as being largest operation

against illegal trafficking of prescription drugs in U.S. history (Newton 323). This is one of the

most progressive actions that has taken place since America as a whole began realizing the

severity of the drug epidemic.

The fact that legislative, legal and administrative rules were accumulating over the

twentieth century reflects on the struggle that the American public was having to use addictive

prescription medications responsibly and legally. Yet the amount of prescriptions that Americans

are receiving has been exponentially growing since the late 20th century.

Conclusion

This exploration revealed that the United States needs to be proactive and begin resolving the

prescription drug epidemic that currently is gripping the Nation. One step that could be taken

towards the rehabilitating the addicted is the installment of methadone clinics. They could be

essential to turning this problem around, by helping those affected resist cravings and prevent

relapses (Newton 116). The three main perpetrators of this nationwide crisis is attributed to the

pharmaceutical companies who withheld information regarding properties certain drugs they

were producing, uninformed legislators who made regulations on prescription drugs, and

miscommunication between prescribing physicians and their patients, resulting in addicted

Americans are looking for the next high. Through proper education of the detrimental effects of

prescription drug abuse and the installment of rehabilitation facilities and methadone clinics, the

Nation as a whole can move forward from this internally caused epidemic and prevent it from

affecting our nation at large again.

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Works Cited

Chasing Heroin. Narr. Lyman, Will. Frontline. PBS, 23 Feb. 2016. Web. 29 Oct. 2016.

Drug Enforcement Admin. Schedules of Controlled Substance. Washington. 2014. Web. 26 Oct.

2016.

Newton, David. Prescription Drug Abuse. Santa Barbara: ABC-CLIO, 2016. Print.

Ryan, Harriet, Girion Lisa, and Scott Glover. You Want a Description of Hell? OxyContins

12-Hour Problem. Los Angeles Times. May 2016. Web. 31 Oct. 2016

United States. Office of National Drug Control Policy. Epidemic: Responding to Americas

Prescription Drug Abuse Crisis. Washington: GPO, 2011. Web. 28 Oct. 2016.

Volkow, Nora. Prescription Drug Abuse. National Institute on Drug Abuse. 2014. Web. 27 Oct.

2016.