Drug overdose deaths have skyrocketed in the United States over the last few decades, creating what we now know as the opioid crisis. For example, in 1968, a little over 5,000 people died from a drug overdose in the US. In 1990, that number had grown to about 8400. And can you guess how many people died from a drug overdose in 2016? Over 64,000. That’s over 175 deaths from overdose every day and more than 7 every hour.

The Opioid Death Toll Climbs

To get a sense for how bad the problem is in some communities, consider the city of Huntington, West Virginia, which has a population of less than 50,000 people. There was a day in 2016, when Huntington witnessed 26 drug overdoses in less than 4 hours!

Furthermore, the increase in drug-related deaths across the country has actually been accelerating. For example, from 2015 to 2016 there was a 22% increase in overdose deaths, which is the largest increase ever in a single year.

In the county of Summit, Ohio, surrounding the city of Akron, there were 312 overdose deaths in 2016. That’s more than 3 times as many as they had just two years earlier. They actually had to order refrigerated trailers to store all the bodies because the morgues didn’t have sufficient capacity.

In fact, drug overdose is now the single most common cause of death for people under 50 years old in the US. Not car accidents. Not AIDS. Not gun-related deaths. Drug overdoses.

So what’s going on? Why have we been experiencing so many more overdoses today than we ever have in our history?

One word—Opioids. The class of drugs that includes prescription painkillers like codeine, morphine, Vicodin, and Percoset, as well as illegal drugs like heroin.

Learn more: Addiction 101

Why is the Death Toll Rising?

Opioids have been around for thousands of years, and they’ve been the gold standard medical treatment for pain since the Civil War, providing genuine relief to millions of people suffering from severe pain.

But in the 1990s something changed. Pharmaceutical companies began actively promoting the use of opioids in the long-term treatment of chronic pain, based on the belief that patients were unlikely to become addicted. And in keeping with that belief, physicians started prescribing opioids in record numbers.

For example, in 2012, doctors prescribed enough opioid prescriptions for every adult in the United States to have their own supply for an entire month. In 2016, 12 states actually had more painkiller prescriptions than they had people.

Learn more: Your Brain on Drugs

Becoming an Opioid Addict

But what has become painfully clear is that contrary to the earlier beliefs, these prescription painkillers can be quite addictive. In fact, about 25% of people who are prescribed an opioid drug end up misusing it. And over 2 million Americans are now estimated to be addicted to these drugs.

And like other drug addicts, opioid addicts develop pathologically strong cravings to obtain and use their drug. And once the body has become accustomed to the presence of opioids, quitting typically leads to extremely unpleasant withdrawal symptoms, including severe anxiety, muscle aches, diarrhea, and depression.

The end result is that once you’re hooked, it’s extremely tough to quit. And as a result, many users turn to illegal opioids like heroin once their prescription runs out. In fact, about 80% of heroin users first misused a prescription painkiller.

Furthermore, the distribution and sale of prescription painkillers is extremely lucrative, and some corrupt doctors, pharmacists, and distributors have made a lot of money by supplying these drugs to people without legitimate medical needs.

For example, two drugstores around Kermit, West Virginia, sold over three million doses of opioid painkillers in a single year. And do you know how many people live in Kermit? About 400.

Learn more: The Science of Poppies, Pleasure, and Pain

Fentanyl and The Dangers of Synthetic Opioids

Another significant factor that has contributed to the current epidemic of opioid overdoses is the availability of more powerful, synthetic opioids. Particularly FENTANYL.

A generic fentanyl transdermal patch

Fentanyl was originally developed as an intravenous anesthetic for use in surgery. But in the 1990s, it began to be used for pain relief, first as a slow-release skin patch and then as a lollipop, a dissolving tablet, and an oral spray.

It’s very useful in the treatment of pain because it has a relatively high therapeutic index, meaning that the dose required for pain relief is much smaller than a dose that would be lethal. As a result, there’s a fairly wide margin of safety when it’s prescribed by a physician and the dosage is carefully controlled.

But fentanyl is extremely potent. In fact, it’s about 50 times more potent than heroin. So a very small dose can have a very strong effect. And that makes it extremely dangerous when used recreationally and without careful controls, because a dose as small as 3 milligrams can kill an average-sized adult male. That’s less than the weight of a single grain of sand.

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And believe it or not, there are now fentanyl analogs that are a LOT more powerful. One of the worst is a synthetic opioid called carfentanil. Remember I mentioned that fentanyl is about 50 times more potent than heroin?

Well, carfentanil is about five THOUSAND times more potent than heroin. It’s actually used as an elephant tranquilizer. It’s so powerful that it’s considered by many to be a chemical weapon.

In fact, it is suspected to have led to the death of 170 people in the 2002 Moscow theater hostage crisis, in which a group of Chechen nationalists held hundreds of people hostage and demanded that Russian forces be withdrawn from Chechnya.

After a 4 day stand-off, Russian special forces pumped a gas that may have included carfentanil into the theater in an effort to knock everyone out. Unfortunately, the gas was so powerful that about 130 of the hostages died before they could be treated.

Fentanyl, carfentanil, and other fentanyl analogs are now widely available on the street. They’re often cut into other drugs like heroin or cocaine as a way to increase profit margin. And that’s because they’re fairly cheap and easy to get.

The Regulation of Opioids

In fact, these drugs weren’t even regulated in China until March of 2017, and the Associated Press identified 12 Chinese businesses that would willingly export carfentanil for about $1250 per pound to anyone on the internet.

And some people took advantage of that opportunity. For example, in June of 2016 the Royal Canadian Mounted Police seized a one kilogram shipment of carfentanil that had been shipped from China to Canada in a box labelled “printer accessories”.

That’s enough carfentanil for 50 MILLION lethal doses. In other words, that single, one-kilogram shipment was enough to kill the entire population of Canada.

As you can imagine, these extremely powerful synthetic opioids have contributed substantially to the death toll from drug overdose. For example, within 6 months of carfentanil’s introduction to the streets of Akron, Ohio, about 140 overdose deaths tested positive for the drug.

The bottom line is that the opioid crisis is very real, and very deadly. And if we want to stop it, or at least reduce the damage, we need to understand how these drugs work at a biological and neural level. How do they produce the effects that they produce? Why are they so addictive? And is there anything we can do to counteract their effects?

We discuss answers to these questions in the following article. You can read it here: The Science of Addiction: Why Are Opioids So Addictive?

For more with Professor Polk, check The Addictive Brain on The Great Courses Plus.

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