Opium is an important raw material for the legal manufacture of morphine, codeine and their derivatives as opioid pharmaceuticals. It is also the raw material for the illicit production of heroin. Morphine and codeine are responsible for both the medical and dependence-producing properties of opium are derived from its main constituents. These two substances, together with morphine-like substances of synthetic origin, have taken over opium's therapeutic role. Both the natural and the synthetic groups of narcotics include substances with varying degrees of desirable and undesirable effects, all of which are abused as prescription and non-prescription drugs to some degree.
Opium is the coagulated juice from the unripe capsule of the poppy plant (Papaver somniferum), which contains 10% morphine. It grows in temperate and subtropical climates and appear to have originated in the eastern Mediterranean region about 5,000 years ago. Its use spread rapidly to Persia, Egypt, China and Europe, where the "panacea laudanum" praised by Philippus Paracelsus, the sixteenth century alchemist and physician, was a preparation of opium. The value of its medical application, as well as its non-medical use, continue to spread, especially in poppy producing areas, and it became a popular treatment for various diseases.
International concern over the abuse of opium and the opioids led to the formulation of the first international treaty on narcotics control – the International Opium Convention, signed at The Hague in 1912 (coming into force in 1915).
In addition to the traditional poppy sources, poppy straw is now emerging as a new drug of abuse. Opiates can be obtained from the straw and smokes, usually in a tobacco mixture. Whilst this has not, as yet, created a significant problem, some states in the USA have already enacted legislation and regulations.
Synthetic opiates with strong morphine-like effects were developed in the late 1930's, with a view to obtaining a strong but non-addictive analgesic which could be used to alleviate pain. Several synthetic alternatives now exist, but scientific research continues to seek an effective analgesic that produces all the beneficial effects of morphine and its derivatives without causing dependency.
Overall, studies show addiction affects about 26 percent of those using opioids for chronic non-cancer pain, eg each year, about 3 million Americans, most under the age of 25, have their wisdom teeth removed, and most if not all receive a prescription for opioids. Women, people over the age of 49 and those without college degrees were most likely to receive a prescription, and the unemployed, uninsured and adults with an annual family income below $50,000 had the highest prevalence of opioid misuse and addiction. An estimated 5 percent of adults (11.5 million people) misused the drugs and nearly 1 percent (some 1.9 million people) reported addiction. While women are prescribed opioids more frequently than men, men have a higher rate of misuse – 13 percent compared to 9 percent respectively. Of those misusing the drug: 64 percent said their use of the drug was motivated by need for physical pain relief; 41 percent reported getting leftover medication from family or friends; 11 percent said they took the pills to relax or get high.
Prescriptions for opioid painkillers rose markedly in the early 21st Century. Americans use 80 percent of the world's opioids. In 2015, more than one-third of American adults were prescribed an opioid drug. As reported in 2017, fifteen percent of seniors on Medicare were prescribed an opioid upon discharge following an acute hospitalization and 42 percent of them were still taking it three months later. Opioid overdoses have become the leading cause of death for Americans under the age of 50.
The number one most prescribed drug in the United States in 2010 was the combination of hydrocodone and acetaminophen with over 135 million prescriptions dispensed. Between 1999 and 2017, nearly 218,000 people died of an overdose of prescription opioids, including oxycodone, better known by its brand name OxyContin. According to 2017 estimates from the U.S. Department of Health and Human Services, more than 130 people died of an opioid overdose every day in America (and, for the first time in recorded history, Americans were more likely to die in an opioid overdose than a car crash). Fentanyl (an opioid) now outpaces heroin as the deadliest drug on Long Island, New York, where overdose deaths doubled between 2013 and 2014.
Politicians, pundits and drug regulators all weighed in on measures to prevent abuse and the deaths that resulted from illicit use. One result was that opioid prescriptions fell dramatically. At last count (2021), prescriptions for hydrocodone and acetaminophen were reduced to 30 million. That is down 100 million prescriptions in less than a decade (ClinCalc DrugStats Database). However deaths from opioid overdose rose were higher and rates still rose steadily; the percent change was 29.48% from 2019 to 2020 and 11.48% from 2020 to 2021. Among adolescents, fentanyl-involved fatalities increased from 253 to 884 (4.23 per 100000) in 2021. An explanation was that the illicit drug supply has increasingly become contaminated with illicitly manufactured fentanyls and other synthetic opioid and benzodiazepine analogues and added to counterfeit pills resembling prescription opioids, benzodiazepines, and other drugs.
The drug industry created the opioid addiction epidemic by introducing long-acting opioid painkillers like OxyContin and changing pain prescription guidelines to make opioids the first choice for many types of chronic pain. The drug industry also promoted the long-term use of opioids, even though there is no evidence that using these drugs long term is safe and effective, and downplayed the risk of addiction to these drugs. The U.S. government approved opioid legislation that feeds profits right back to the drug industry by focusing on treatment for painkiller addiction and making anti-addiction drugs more easily available. Between 2013 and 2015 alone, 68,177 physicians received in excess of $46 million in payments from drug companies marketing narcotic pain relievers. In all, that amounts to 1 out of every 12 doctors in the U.S.
Now that prescription opioids are considered a new epidemic, deserving of sophisticated and sensitive social remedy, why was this approach not applied to heroin addiction (criminalized and demonisation of users). Was it because of class distinction? Or race discrimination?
Women are increasingly being prescribed opioids during pregnancy and after delivery, creating addicts in the womb and destroying families by creating drug-dependent mothers and infants. Of the 1.1 million pregnant women enrolled in Medicaid in 2007, nearly one-quarter of them filled a prescription for an opioid drug.