Opium is harvested from the seed pod of the Poppy plant “Papaver Somniferum”. The opiates morphine, codeine, and others are naturally present and extracted from the poppy. Opioids for medical, recreational, spiritual, and cultural purposes date back centuries. In 1950, Chinese immigrants brought opium to the United States. The use of opium was introduced as a patented, unregulated medicine called Laudanum. This product could be ordered in the Sears Roebuck Catalogue. In the early 1900’s the original Coca-Cola formula contained alcohol and cocaine. It wasn’t until 1914 that the Harrison Act removed all opioid products from over-the-counter use, but did not make them illegal.

Fast forward to 1970 when President Nixon declared the War on Drugs and Congress passed the Controlled Substance Act. This Act created the Drug Enforcement Administration (DEA) and established the schedules for all controlled substances. Unfortunately, the war on drugs was not successful. In 1990, medical protocol adopted a 5^th vital sign in the patient evaluation: pain level and untreated pain. The Epidemic was created in part by a Pharmaceutical Industry that marketed and promoted the use of opioids in pain management. These semi-synthetic and synthetic opioids were promoted initially as non-addictive.

National data collected from 2016 confirmed 47,000 opioid-related deaths. That was more deaths than reported in motor vehicle fatalities. As a result, many states (including North Carolina) are now adopting legislation to deal with opioid misuse and promote prevention.  The North Carolina Stop Act of 2017 made changes to physician prescribing of controlled substances and changes in reporting.

Opioid addiction and the altered chemistry of the brain is understood but complex. Genetic predisposition plays a role in making some individuals more prone to addiction than others. Males seem to have a higher addiction rate than females. Age-wise, the 25 to 55 age group seems more vulnerable. Also, addiction for some can occur in as little as 3 days of being prescribed an opioid-controlled drug. Current rehabilitation and treatment programs have not been as successful and have a high relapse rate. The problem with opioid use is increased patient tolerance. Tolerance for opioids increases with use, requiring higher doses to achieve the same level of pain relief. Increased dosage leads to increased risk of respiratory failure and death. Future research is attempting to unlock the secrets of addiction, cravings, and rewiring of the human brain. Hopefully, advances will be made in this war against the Opioid Epidemic.

Rick L. Hartman, OD, FAAO