Opioid Crisis: From the Civil War to Trump, How Painkiller Epidemic Took Hold of America

10_30_pills — Prescription pain killers are helping to fuel America's drug addiction problem John Moore/Getty Images

Health Opioid epidemic Drugs Heroin Fentanyl

On Thursday, President Trump declared the current opioid crisis a public health emergency. Two new investigative reports examine how the Sackler family, owners of Purdue Pharma (maker of OxyContin) has profited from the epidemic. A new report by the Police Executive Research Forum (PERF) states that in 2016, 11 people died every day on average from drug overdoses in Ohio, the state with the most such deaths. More people died from drug-related deaths in 2016 than in the entirety of the Vietnam War, according to the report.

Tapping into our opiate receptors to erase pain and increase pleasure is not new, however. Opioids are drugs derived from opium, the poppy plant drug that many people associate with Sherlock Holmes and other Victorian-era characters. But opium goes back much further in time. Poppies were grown in Mesopotamia before 3000 B.C. and judging by the Sumerian name for them—"joy plant"—the effects of the plant were known.

Several countries in Asia grew and traded opium for centuries. The British got in on the act in the 1700s, moving opium from India to China, where it was used medicinally. But that restricted use soon gave way to recreational use as the British forced large quantities of the drug into China, leaving the country flooded with addicts and devoid of the silver given in exchange. Opium was banned in China in 1839 and 2.6 million pounds of the drug were tossed into the sea. Tensions between the British and the Chinese escalated, other nations entered the fray, and war ensued.

Morphine, the active ingredient in opium, was synthesized in the early 1800s. Used as a pain reliever during the Civil War, the drug got many soldiers hooked. The common cold medicine codeine is also derived from opium. In 2015, the U.S. Food and Drug Administration restricted codeine to adults only. The drug is a component of home-brewed methamphetamine, an addictive stimulant, and many pharmacies now track and restrict sales.

All opioids work the same as opium, interacting with pain receptors in both the brain and in the body. They relieve pain and produce an extreme euphoria. These two features and the likeliness of dependency have fueled a nationwide epidemic—in addition to other crucial features such as marketing by pharmaceutical companies and doctors' prescribing habits. Users also quickly build a tolerance to opioids, leading them to seek increasingly large amount of opioids to produce the same high. Overdoses are the inevitable result. The Centers for Disease Control and Prevention (CDC) reported that in 2016 drug overdoses claimed the lives of as many as 65,000 Americans.

Drugs derived from opium, such as morphine, are sometimes called opiates, but most people use "opioid" to refer to synthetic, non-synthetic, and semi-synthetic opium-derived drugs. In the 1990s, following the 1996 introduction of OxyContin, doctors began prescribing vast amounts of synthetics opioids, a phenomenon that many state-filed lawsuits now claim was spurred by pressure from the pharmaceutical companies selling the drugs. Opioids quickly became the most widely prescribed drug in the U.S, and according to the CDC, it still is. What neither the pharmaceutical companies nor the doctors prescribing the medications could predict was just how addictive these opioids really were.

Related: Who are the Sacklers? How America's opioid crisis is linked to relics from Ancient Egypt

Of course it isn't only prescription drugs that are killing people; heroin and fentanyl are now leading causes of overdose deaths. These drugs are also both opioids, attaching to the same opioid receptors in the brain and body, producing similar highs, and with the same propensity to cause dependency. Heroin abuse existed well before the current opioid epidemic, but prescription opioids have created a new influx of heroin users in the past 30 years. When drug abusers run out of their prescriptions or cannot afford to buy painkillers off the black market, they turn to heroin and fentanyl.

But illegal opioids are more dangerous than oxycodone, the active ingredient of OxyContin, which can successfully treat pain without leading to dependency. Unlike prescription painkillers, heroin is classified as illegal and has no accepted medicinal uses in the United States. Fentanyl is sometimes used as a last choice pain medication for terminal cancer patients, but has little other medicinal use. These days the chemical is used to increase the potency of weak heroin. Carfentanil, an elephant tranquilizer, has also found its way to the streets of the U.S. opioid epidemic. The drug seems to be pushing the crisis to its extreme. "Even a few grains of it can be fatal," says the new PERF report.

The World Health Organization emphasizes that there is currently no single treatment for opioid dependency. Although President Trump vowed to save the nation from this deadly scourge, it's not clear how he plans to do with and without additional funds being added to address the crisis.