MONTHLY SERIES (Part 10)–UNDERSTANDING ADDICTION, RECOVERY, & WELLNESS: Opioid Epidemic
The Opioid Epidemic in the USA
The addicted are looking for a rewarding feeling that they relate to a substance that they have experienced in the past. Take away that substance and addicts will, with great ingenuity and intensity, find a substitute to gain the desired feeling. Sometimes this substitute can be more dangerous to the addict than the original substance (i.e. substituting heroine for alcohol).
Brief History
The use of opium for both recreation and medicine goes back for thousands of years. It is derived from the opium poppy and morphine is the extract that causes the more intense mood altering effects. Morphine was extracted from the opium plant in a pure form in the early 19th century. About the same time the hypodermic needle was improved and was used regularly. Morphine was used regularly and in large quantities with the soldiers during the American Civil War to alleviate the pain from wounds suffered in combat. Many of these soldiers became addicted to morphine. Some called this addiction at the time, ‘the soldiers’ disease.
Recent Past
My social work practice goes back to the 1960s in Detroit and at this time, heroine was a serious crime problem. The addicts were people on the fringes of society: prostitutes, struggling artists, hippies, and minorities. This all changes in the 1980s when cocaine became the street drug of choice for young people and crack for many young black people. This cocaine abuse had negative effects across the county even in small towns that I worked in as a therapist. It was more unusual to find a person with an opioid addiction at that time in my practice.
Current Situation
At present, we have a complete turn around in that opioid use disorder is seen much more where cocaine use disorder less so. This all started in the 1990s when pain issues were promoted by the pharma industry, in cooperation with research medical universities, as a major problem. Physicians were trained that a patient treated for pain would not get addicted. These same physicians and for that matter researchers had very little experience with the process of addiction. The result is that huge numbers of people have become addicted to pain pills primarily opioids. Physicians became aware of the problem with government oversight as people were dying because of overdoses of opioid medication. As a result, physicians often turned off the opioid pain pills to these patients.
Consequently, these patients often turned to the street and began using heroine which is cheaper then opioid pain pills. Synthetic opioids are now often abused– Fentanyl especially, is a current problem. It a substance that is bought on the street and most street fentanyl is manufactured illegally. Hospitals use commercial Fentanyl for cancer victims and serious pain problems. In my practice I have heard about this problem with Fentanyl but have not actually seen it.
Addict Profile
From my experience, opioid addicts often are middle class, white people with blue collar jobs. Many are living in rural areas. It appears to be a condition that effects both men and woman in equal degree. These addicts started using opioid prescription drugs, often abusing the prescriptions. They do not think of themselves as addicts because they are using prescriptions approved by a physician.
As a trained therapist, who does psycho-social medical assessments when clients are first seen in treatment, I often find that opioid addicts are addicts to other mood altering chemicals like marijuana, alcohol, and Benzodiazepines to name a few.
The clientele also includes both young and older people from all races but predominantly white with more older people than in the past. There were times when grandparents would get their grandchildren to go into areas where they could buy heroine for grandmother or grandfather. One could buy any kind of pill on the street but heroine was less expensive. People can find and buy just about any medication without prescription.
Conclusion
In American history, we have often been effected by all kinds of addictions. We “medically-treated” pain with morphine and in recent decades with opioids. Alcohol has always been a problem and still is. All of these mood altering drugs continue to be used and abused. In my upcoming posts, I will explain what kind of treatment the public should advocate for. The next post will get into medicine that can actually help in the recovery process.
QUESTIONS
Do you have a specific question related to addiction and recovery? Please send your comments and questions to eaglekenj@gmail.com and I will cover it in a future blog post. Also, stay tuned for details regarding my online program, “Addiction, Recovery, Wellness.”
Kenneth J. Orlich, LMSW, LMFT, CAADC, ACSW is a clinical social worker, family and marriage therapist, and addiction specialist with over 35 years of experience working as a clinician with the addicted.
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