Why is America Addicted to Opioid Pain Relievers? | Center on Addiction

Why is America Addicted to Opioid Pain Relievers?

Why is America Addicted to Opioid Pain Relievers?

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Opioid medications, sometimes known as pain relievers, are the most widely prescribed class of drugs worldwide. While the United States represents about five percent of the world’s population, it consumes 80 percent of the global opioid supply. Not surprisingly, the U.S. is also suffering from the most severe opioid addiction and overdose crisis it has ever experienced. But, this didn’t happen overnight. Several factors contributed to the unprecedented use – and misuse – of opioids in this country.

In 1998, state medical boards changed the laws governing opioid prescriptions. Instead of limiting the use of opioids to treat severe cancer-related pain – which had consistently been the case before – they began allowing the prescription of opioids to treat moderate, non-cancer pain. This meant that people with back injuries, broken bones, toothaches and other ailments could now receive powerful opioids, dramatically expanding the medication’s supply.

In the same year, the pharmaceutical company Purdue Pharma, received government approval to market OxyContin, a powerful opioid medication, as a “minimally addictive” prescription opioid. The company claimed that less than one percent of people would become addicted to the drug despite little evidence to support this claim.

To promote OxyContin, Purdue Pharma pursued aggressive marketing strategies, spending over $200 million in 2001 alone. It also directly targeted doctors across the country with campaigns that misrepresented the safety of its product.

Between 1996 and 2000, sales of OxyContin increased from $48 million to $1.1 billion. From 1997 to 2002, OxyContin prescriptions increased tenfold. In 2003, approximately half of all OxyContin prescriptions came from primary care physicians, as opposed to oncologists, surgeons or other specialists who treat people with severe conditions. By 2004, OxyContin was the leading misused drug in the U.S.  

Although much of the blame for the current opioid epidemic can be attributed to unscrupulous physicians and pharmaceutical companies, another important contributing factor is the human brain’s natural inclination towards becoming addicted to opioids.

When first used, opioids make the brain less sensitive to pain and produce feelings of pleasure or even euphoria. However, with repeated and prolonged use, the brain adapts and tries to return to its normal state, all the while becoming less sensitive to the positive effects of the opioids. This is called "tolerance.”

People who have used opioids for a while may become unable to tolerate the same level of pain or discomfort they more easily tolerated before they used opioids. Since their natural ability to feel pleasure becomes compromised by prolonged and repeated opioid use, they experience strong cravings for the drug and its euphoric effects. This occurs because the pathways linking certain pleasure centers in the brain – which communicate through natural chemicals, such as dopamine, and electrical impulses – are radically altered by drug use.

However, when someone uses specific drugs over time, such as opioids, the brain requires higher and higher levels of dopamine to feel the pleasure it once may have felt naturally. As a result, even actions such as eating, spending time with friends or family, and having sex stop feeling as pleasurable and the person craves the drug to simulate the pleasure he or she once experienced naturally or upon initial use of the drug.

Ultimately, the rise of opioid use and misuse in America can be attributed in large part to irresponsible advertising and marketing by certain pharmaceutical companies, which have led a generation of physicians and patients to underestimate the risks associated with an entire class of medication that directly manipulates the brain’s natural inclination toward addiction.

Fortunately, as we continue to learn more about the factors that contributed to the rise of this epidemic we also continue to learn more about how to prevent and treat it. We must change the way we address pain, prescribe opioid medications and treat addiction.  While this epidemic has been in the making more than a decade, the time to act is now. 

Evan Gilmer, M.A.

Evan Gilmer is a senior research associate at Center on Addiction




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