Timeline: The Rise of Synthetic Opioids in Georgia

A Brief Glimpse At The Local Epidemic in Georgia

While Georgia had, for the most part, followed national trends for drug overdoses, the death rate from overdose in the state has risen at an accelerated rate over the past few years, especially with regard to those caused by opioids. In 2001, 559 people in Georgia died of a drug overdose, while 243 of those were from opioids. In 2015, 1,307 people died of an overdose, 900 of which were opioid-related. Of these deaths, 549 were attributed to prescription opioids. Georgia’s drug overdose death rate now closely mirrors that of motor vehicle accidents.

During that same time period, when you measure overdose deaths per 100,000 people, Georgia’s rate of increase surpassed that of most other states. The nationwide average rose from 1.4 to 5.5 per 100,000 people, while in the state of Georgia alone, the rate climbed from 0.6 to 5.5 per 100,000. Once behind, the state has now caught up and seems poised to surpass national averages for drug overdose deaths, with opioids getting much of the blame.

In recent years and even months, opioids seem to be more and more in the news. A batch of overdose deaths here and there has added up to a real epidemic that is sweeping the nation. Opioid abuse and deaths from overdose have reached crisis level in the country, and particularly so in the state of Georgia.

Georgia’s death rates from opioid overdoses are climbing at alarming rates over the past few years, but state officials have a hard time pinpointing the start of the problem. More information is available on the global and national scale, however locating the source has thus far been elusive. And though opioids are fresh on the scene in the drug spotlight, opioids are nothing new at all.

Recent Opioid Epidemic and Actions

The FDA released a timeline on significant events addressing opioid misuse and abuse and the sheer volume of actions in the past few years shows how big of a problem this has become.

We’ll stick with OxyContin since it is seemingly at the center of the opioid abuse epidemic. The timeline begins in 1995 with the oddly-timed approval of OxyContin and things snowballed from there. At the time, OxyContin was the first formulation of oxycodone that could be taken every 12 hours, instead of every four to six hours.

The active ingredient in OxyContin, oxycodone, has been known to be a highly addictive substance since the 1960s. Furthermore, the drug was released to the market at a time when the U.S. medical community was reporting that many patients in pain were not getting appropriate treatment. People were craving pain treatment. This was when pain was added as a “fifth vital sign.”

At the time, the belief was that the controlled-release of OxyContin would lead to less abuse potential, since the drug would be absorbed slowly and not give an immediate rush or high. The product even came with a label that warned of the danger of abuse of OxyContin, and that crushing a controlled-release substance tablet and injecting it could result in a fatal overdose. What they didn’t expect, however, was that crushing the pill and taking it orally or snorting it would become rampant and lead to a high level of abuse.

But soon, problems began to arise. Abuse and overdose deaths from prescription opioids, including OxyContin, began to rise. According to the FDA, the number of people who admitted to using OxyContin for nonmedical reasons went from roughly 400,000 in 1999 to 1.9  million in 2002, then spiked to 2.8 million in 2003. The number of emergency department visits related to the abuse of pharmaceuticals increased more than 98 percent between 2004 and 2009, with the majority of deaths and ED visits attributed to opioids, especially OxyContin.

Although the FDA did work to increase warnings on the drug, the data demonstrates that it wasn’t enough.  In 2001, OxyContin changed their label to add and strengthen warnings about the drug’s potential for misuse and abuse. Two years later (2003), the FDA sent OxyContin’s manufacturer, Purdue Pharma, a warning letter for misleading advertisements. The warning argued that the ads “left out and minimized the serious safety risks associated with OxyContin and promoted it for uses beyond those which had been proven safe and effective.” Specifically, the ads did not clearly present information from the product label’s boxed warning regarding the potentially fatal risks and the danger of abuse.

It wasn’t until 2010 that the FDA approved a new form of OxyContin that was designed to curb abuse of the drug. The problem was, by then, people weren’t using OxyContin to get high anymore. Users of the drug had moved on to other “street” forms of opioids that were cheaper, and packed a bigger high. Sixty-six percent of users participants in one survey reported switching to another form of opioid.

Since the start of 2014, the FDA has taken 29 forms of action to help combat the growing opioid epidemic. And yet the crisis appears to be beyond the FDA’s control, as street drugs have taken over for prescription opioids as the drug of choice. And since they are unregulated and often unknown mixtures of substances, overdoses are becoming more prevalent.

What Are The Origins of Opium?

In the early 1800s, German chemist Friedrich Wilhelm Adam Serturner isolated morphine from opium. The substance is named morphine after Morpheus, the god of dreams.

During the 19th century, morphine became a staple of medical treatment in the United States. It was used to treat pain, anxiety and respiratory problems. It was also used to treat consumption and so-called “women’s ailments.”

The hypodermic needle was invented in 1853, which made the drug easier to administer. It became more commonly used in minor surgical procedures to treat neuralgia and was the pioneer of opioids being used as medication.

Morphine was largely used during the Civil War as a pain killer, which led to one of the first famous (or infamous) periods of opioid addiction in American history. Named “Soldier’s Disease,” many soldiers were given morphine for battle injuries and later became addicted to the drug. The post-war rash of addicted soldiers gave the condition its name.

As morphine abuse became more prevalent, a safer alternative to use as a painkiller was sought. This led to the creation of heroin, which was synthesized from morphine in 1898. In 1910, German chemical company Bayer actually began offering heroin as a cough suppressant and “non-addictive” substitute to heroin. After that proved not to be true, other options were sought after once again.

During the 1900s, clinicians and pain societies successfully lobbied for the increased use of opioids for all pain types, not just surgical procedures. Fast forward to the 1990s, and the prescription opioid landscape changed, as new medications entered the market, allowing physicians to expand their scope of the treatment of pain. During this time, a number of opioid pain medications were formulated to release the medicine over a period of time, rather than at once. Morphine, Fentanyl, Oxycodone and Hydromorphone all had this capability. Pharmaceutical companies began to market themselves aggressively and in turn the market grew for pain medications.

It was estimated that by 1999, four million people, or around two percent of the U.S. population age 12 and under, were using their prescription drugs for nonmedical reasons. From thi group, 2.6 million people had misused pain relievers, 1.3 million had misused sedatives and tranquilizers while 900,000 more misused stimulants.

As the world entered the 21st century new standards for pain management began to emerge. Pain was now considered the fifth vital sign by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The amount of opioid prescriptions also rose during this time, which led to the significant increase in the abuse and misuse of such brand-name drugs as OxyContin, Vicodin, Percocet and Lortab in the early-to-mid 2000s. These drugs all contained the opioids oxycodone and hydrocodone. This abuse doubled between 1998 and 2008.

By 2002, 6.2 million Americans were abusing prescription drugs, including opioids. Emergency room visits that resulted from the abuse of drugs also increased dramatically. Pharmaceutical companies began researching new formulations of pain medication that would be more difficult to abuse. While some were approved by the FDA, none were able to prevent oral abuse of opioids.

The increased misuse and abuse of prescription painkillers in the early 2000s caused 48 states to implement prescription drug monitoring programs. These programs continue to evolve as the opioid crisis in the United States spreads at an alarming rate. Proper education and preparation during these tough times is the best defense you and your loved ones have in order to not become another overdose statistic in Georgia or any other state for that matter. 

Contact Georgia Drug Detox today if you or a loved one is seeking professional treatment for opioids.

Sources:

Langford, Jim. “Prescription Opioids and Heroin Epidemic in Georgia.” SARA. 2017. 15 Mar. 2019. http://www.senate.ga.gov/sro/Documents/StudyCommRpts/OpioidsAppendix.pdf

“Emerging Trends and Alerts.” NIDA. 6 Mar. 2019. 15 Mar. 2019. https://www.drugabuse.gov/drugs-abuse/emerging-trends-alerts

“Georgia Opioid Summary.” NIH. Feb. 2018. 15 Mar. 2019. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/georgia-opioid-summary