five: Opioid abuse and evidence-based practices for a global epidemic


Opium originated in lower Mesopotamia in 3,400 BC and was used in many regions of the world throughout history before making its way to the US. It was not until the 1860s that opium-based drugs, such as morphine, were used by Civil War doctors to treat the pain of wounded soldiers. The Bayer Company later introduced heroin as a cough suppressant and an alternative to morphine, with the US government placing restrictions in the 1910s–1920s that outlawed heroin and required a prescription for opioids. The Controlled Substance Act was passed in the 1970s, which created five different groupings, or schedules, for all substances based on their medical use, potential for abuse, and safety.

Opioids are a class of drugs used to treat pain and include both prescription medications (for example, OxyContin, hydrocodone, morphine, and fentanyl) and heroin. Misuse or abuse of opioids can lead to an addiction, which is clinically referred to as opioid use disorder. The opioid crisis began in the 1990s with the development and increased prescription of OxyContin to treat pain. US-based drug manufacturer Purdue Pharma assured that patients would not develop an opioid use disorder and pharmaceutical sales skyrocketed, with aggressive marketing strategies and plans to expand sales globally. That decade ended with a rising number of fatal overdoses directly related to the use of prescription opioids.

While efforts focused on the global seizure of pharmaceutical opioids, the unattended effect was rising global opium production, which resulted in an increase in heroin with low cost and high availability.

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