Opioid Epidemic Changes Discourse on Drug Addiction

Battle against opioids gives addiction research more political capital

Learning her son was a heroin addict left Melissa Forsyth in a state of depression.

“I just never thought it would happen to me,” she said. On top of her self-blame, her Staten Island community wasn’t particularly understanding either. Drug addiction just didn’t happen in a good family like hers.

When her son joined a treatment program, Forsyth joined therapy for family members of addicts and gained an understanding of her son’s affliction that offered solace and hope.

“You learn to understand that it’s literally a brain disease, that new pathways are opened up in the brain by the drugs and it starts affecting the cognitive thought process,” she said. “I learned not to blame myself. … It helped me to learn how to be happy again.”

New Take on an Epidemic

Last year, over 52,000 people died of drug overdoses. More than 33,000 deaths involved opioids, a four-time increase since 1999, thanks in part to the over-marketing and over-prescribing of opioid painkillers like oxycodone.

With over 2 million people in the United States addicted to painkillers last year and almost 600,000 more to heroin, new approaches to drug addiction are needed. And so, research decades in the making is finally receiving mainstream attention.

The knowledge that helped Forsyth turn her life around has been known to experts for at least 15 years, said Emily Feinstein, director of health law and policy at the National Center on Addiction and Substance Abuse, a nonprofit.

It’s really been in the last four or five years that we’ve seen a lot of change happening.
— Emily Feinstein, director of Health Law and Policy, National Center on Addiction and Substance Abuse

“[But] it’s really been in the last four or five years that we’ve seen a lot of change happening,” Feinstein said.

The delay was partly caused by the pervasive view that drug addiction was solely a character or behavioral issue, she said.

“People didn’t want to talk about addictions 15 years ago. They were taboo,” she said. And that approach proved ineffective.

For example, research shows that “just say no” talks at schools had no effect or even encouraged drug abuse among students by making drug use seem common. The threat of incarceration also mattered little to addicts and sometimes even drove a wedge between police and communities.

Meanwhile, research showed drugs stimulated brain changes that perfectly aligned with the asocial behaviors people associated with drugs, suggesting there was more to addiction than just weak willpower.

Brain Disease

One of the pioneer researchers of the neurological effects of addiction was Susan Tapert, psychiatry professor at the University of California–San Diego.

She compared the brain scans of teenagers who had drinking and drug problems with those without.

The results were disheartening. Teen drinkers showed visibly hindered brain development. Adding marijuana made it worse.

*
*

Extensive research has now shown that repeated drug use rewires the brain’s reward system. Over time, this system breaks down and “people addicted to substances experience an overall reduction in the sensitivity of the … system,” states a recent report from the U.S. surgeon general.

Users lose the sense of pleasure they once gained from other activities, like watching a movie or eating tasty food.

Drug use also activates the part of the brain that helps us develop habits and suppresses the part that helps us with self-control. It even activates stress neurotransmitters that make users feel bad when not high.

As the research snowballed, there was no more denying it: Drug abuse physically changes the brain, much like a disease.

Forsyth’s son Joe, after years of recovery, said drug users carry responsibility for their choices, especially for their decision to try the drug that first time.

But research shows that after that first attempt, stopping may be easier said than done.

Drugs change some people’s brains more than others, research has revealed. These people are innately susceptible to addiction, and a family history of addiction may be partly responsible.

There’s been resistance to describing drug addiction as a disease, Feinstein said, for fear addicts would assume a victim mentality.

She argues that other diseases, like diabetes, may also stem from how people lead their lives. But “that doesn’t mean you just sit home and do nothing and you allow your disease to profligate,” she said.

Still, voices like Feinstein’s and Tapert’s didn’t find a larger audience until the opioid trend arrived.

A bottle with a hydrocodone (the generic name for drug sold under other names by various pharmaceutical companies) label and hydrocodone tablets spilling out isolated on white background. Hydrocodone is a popular prescription semi-synthetic opioid that is used to treat moderate to severe pain. Hydrocodone is said to be one of the most common recreational prescription drugs in America. (Roel Smart/iStock)
Hydrocodone tablets. Hydrocodone is said to be one of the most common recreational prescription drugs in America. (Roel Smart/iStock)

Opioids

Popping pain pills was a trifle compared to the heroin explosion in the ’70s or the meth epidemic in the ’80s. That changed in 1996 when drug producer Purdue introduced OxyContin, a painkiller based on the chemical oxycodone, which is synthesized from an alkaloid found in the opium poppy and chemically similar to heroin.

Purdue poured over $100 million into promoting OxyContin as a safe and effective painkiller in its first six years on the market, boosting prescriptions from about 300,000 in 1996 to more than 7 million in 2001.

Yet the company underplayed the fact that an 80-mg OxyContin pill can be about as potent as a bag of street heroin.

Opioid overdoses and treatment admissions shot up.

When Purdue changed the makeup of OxyContin pills to make them harder to snort and smoke in 2010, many addicts promptly switched to heroin.

Suddenly, it wasn’t just the stereotype of poor kids from broken families using heroin. Well-off kids from seemingly stable families, like Forsyth’s, fell victim too.

That changed the debate, Feinstein said. Over the last several years, public perception has begun to change, from viewing drug addicts as petty criminals to seeing them as people who need help.

There’s still a ways to go, Feinstein said, but we’ve already passed a few milestones.

In 2010, addiction treatment began to be covered by insurance plans under the Affordable Care Act.

In July, Obama signed the Comprehensive Addiction and Recovery Act, which allocates over $180 million a year to fight the opioid epidemic.

On Dec. 13, Obama also signed the 21st Century Cures Act, earmarking $1 billion for states to counter opioid abuse.

Both bills passed with minimal opposition and both view drug addiction as a health problem, Feinstein said. They promote treatment and more sophisticated prevention programs.

With the influx of synthetic opioids like fentanyl from China and cheap heroin from Central America, the opioid epidemic will likely continue, but so too will the development of treatment and prevention programs.

RECOMMENDED