Opioid addiction is usually a result of pain, which is often associated with back pain, the number one cause of disability in America. According to the Centers for Disease Control and Prevention, “The number of drug overdose deaths decreased by 4% from 2017 to 2018, but the number of drug overdose deaths was still four times higher in 2018 than in 1999. Nearly 70% of the 67,367 deaths in 2018 involved an opioid. From 2017 to 2018, there were significant changes in opioid-involved death rates.”
The history of opium, a nectar milked from the pod of the poppy, is almost as old as the history of the human race. To help our patients in the future, we must know and understand the genesis of this deadly drug.
In 1803, a pharmacist’s assistant discovered a crystallizable isolate of opium he called “morphine,” and it became the palliative treatment for almost every human woe. It was put in many elixirs and even sold without a prescription.
By the end of the nineteenth century, the drug’s drawbacks were already obvious. Although a pharmacist’s reference guide of the period observed that regular use led to “tremors, paralysis, stupidity, and general emaciation,” the German pharmaceutical firm Friedrich Bayer & Co. offered a new product in 1898—a cough suppressant called “heroin.” Three times more powerful than morphine, the syrup induced such an alluring sense of well-being that it hooked hundreds of thousands of opioid-dependent people on both sides of the Atlantic. Again, it was nonprescription. Can you imagine heroin being sold over the counter?
Finally, the cough suppressant had brought such decay and devastation in American cities that Congress passed the Harrison Narcotics Tax Act in 1914, requiring physicians to register with the government if they wished to prescribe it. Physicians ordering the drug for patients whom they recognized to be addicted could wind up in jail. Most doctors stopped prescribing painkillers except for patients who were hospitalized.
OxyContin arrived on the market in 1996. Six years later, the drug produced annual sales of $1.5 billion. Over the two decades that followed, OxyContin would rack up $35 billion in revenue.
Data from 2018 shows that 128 people in the United States die daily by overdosing on opioids. The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health, as well as social and economic welfare. The CDC estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.
The CDC defines opioids as a class of drugs used to reduce pain. Prescription opioids include oxycodone, hydrocodone, morphine, and methadone. Doctors usually prescribed these drugs to treat pain following surgery. In your experience, are you aware of opioids being commonly prescribed by doctors for other purposes, such as chronic pain?
How did this happen?
In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive. Opioid overdose rates began to increase.
In 2017, more than 47,000 Americans died because of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 1.7 million people in the United States suffered from substance-use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin-use disorder (not mutually exclusive).
What do we know about the opioid crisis?
What are HHS and NIH doing about it?
In response to the opioid crisis, the Department of Health and Human Services (HHS) is focusing its efforts on five major priorities:
What can you do?
Early in my career, I did lay lectures every week in my office, which moved to dinner talks. I was always campaigning for the benefits of chiropractic and about the side effects of drugs and medications. We are asking every chiropractor to again work tirelessly to educate their patients about the dangers of drugs and surgery and the benefits that we can provide with chiropractic, laser, nutrition, non-surgical spinal decompression, and other acute and chronic conditions suffered by many Americans.
"Chiropractic offers a different standard of care that utilizes the body's natural healing powers to eliminate pain"
As chiropractors, we work with patients daily to relieve their pain without the use of prescription opioid pain medication. If doctors worked together to treat patients with chiropractic care and other forms of alternative therapy without prescribing opioids, there would be less exposure to opioids and less addiction. We must all take on this responsibility.
We are slowly making a difference because now a few states are trying to mandate that chronic pain patients need to try physical therapy, acupuncture, chiropractic, massage, or some sort of natural or alternative medicine that doesn’t use drugs or surgery before they can be prescribed those medications. Chiropractic offers a different standard of care that utilizes the body’s natural healing powers to eliminate pain. We can help many people and prevent them from getting prescriptions and going down the road toward opioid addiction. Maybe it’s time that chiropractic is considered primary care while drugs and surgery are thought of as alternative care. We should no longer be considered alternative care providers; “alternative” should reflect the highest risk, not the lowest.
Dr. Eric S. Kaplan, is President of DISC Centers of America, the largest group of Chiropractic clinics in the U.S.A., utilizing Non-Surgical Spinal Decompression. He has worked with two Presidents of the United States and two U.S. Surgeon Generals. He is CEO of Concierge Coaches, www.conciergecoaches.com, the #1 Chiropractic firm in Spinal Decompression and Neuropathy training nationwide.
References
1. HEAL Initiative Research Plan (NIH, June 2018)
2. As Opioid Use Disorders Increased, Prescriptions for Treatment Did Not Keep Pace (NIDA Notes, July 2018)
3. HHS Works to Improve Testing for Fentanyl (0:42) (May 2018)
4. All Scientific Hands on Deck to End the Opioid Crisis (Nora Volkow and Francis Collins, May 2017)
5. Using Science to Inform Practice and Policy: A Coordinated Approach to Research Priority Setting (Summary of December 11, 2017 meeting)
6. National Drug Early Warning System (NDEWS) - New Hampshire HotSpot Study Finds Extensive Poly Drug Use in Fentanyl-related Deaths
7. NIDA-Funded Opioid Research
8. FDA grants marketing authorization of the first device for use in helping to reduce the symptoms of opioid withdrawal (FDA, November 2017)
9. Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas — United States (MMWR) (CDC, October 2017)
10. Underlying Factors in Drug Overdose(link is external) (JAMA, October 2017)
11. NIH Director Francis Collins on America's opioid crisis (5:08)(link is external) (Washington Post, September 2017)
12. Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000-2015(link is external) (JAMA, September 2017)
13. New Opioid Overdose Materials for Patients (CDC, August 2017)
14. Blog - Addressing America's Fentanyl Crisis (April 2017)
15. Blog - The CDC Provides Crucial New Guidance on Opioids and Pain (April 2016)
16. Testimony - What Science tells us About Opioid Abuse and Addiction (January 2016)
17. Testimony - What is the Federal Government Doing to Combat the Opioid Abuse Epidemic? (May 2015)
18. Testimony - America's Addiction to Opioids: Heroin and
