Evolution of the epidemic, part 1

Dear Denise:

I’ve read that the US is the only country dealing with an opiate epidemic and they prescribe way more pills than anywhere else, while there is some abuse and misuse of medications everywhere.  How and why did this evolve into such a problem and why is it so prevalent in places like Surry County?




Dear Cheryl: 

There is quite a complicated answer to this question related to a long history going back many years and places.  Because of limited space here I am going to try to give you the short overview.

Using pills to feel better or ease anxieties is not a new thing.  As far back as the 1950’s there was major use of pills like valium and Librium which were attributed to helping the “ladies” deal with life.  But it wasn’t until the same Pharmaceutical companies developed medications to deal with cancer pain and end of life pain later on in the 1980’s did things start to get out of control.  These new formulas made from opiates were so effective that doctors saw that their patients didn’t have to die in agony and cancer patients too, could be relatively free of most pain from these drugs.  Most people will have heard of morphine for this use.  That was one of the original ones used. 

As time went on it was thought that these drugs could be used in a limited way on chronic pain patients.  After all, why should anyone be in pain if they didn’t have to be?  All along this way of thinking seemed ok because it was somehow understood and accepted that there was only a minute chance that these drugs were addictive.  No one had really done any major studies on these drugs and the only medical study was a very tiny sample of statistics that was not much of a study at all, but somehow it got to be the gold standard of why they felt this medication was not addictive.  (That is for sure what the Pharmaceutical companies preferred everyone believed anyway). 

IN the late 1980’s it was determined to qualify pain by naming it the “fifth vital sign” (the other four being pulse, blood pressure, body temperature, and respiration) although pain cannot really be measured objectively like the others. Patient surveys began to dictate the ratings of hospitals and medical practices.  The marketing of these medications was very sophisticated and patient targeted and even if a doctor would want to offer other recommendations like exercise or diet changes, or other things unrelated to pills, they felt they could not because patients wanted the quick and easy fix of the pills and would rate them poorly on the surveys.  In turn, the hospitals would loose their good ratings and financial support. It just all ended up in the promoting of these pills in every way.  Did you know that the US is the only country that allows the Pharmaceutical companies to advertise on television?  Every other ad is for some kind of pill.  Ask your doctor is heard many times a day during these commercials.

Of course, it has become understood over time how addictive opiates are, now that a whole generation depends on them.  They are given to teens after wisdom teeth removal, any kinds of sports injuries, to anyone in any kind of pain, really.  A pill for everything, easy fix.  It is part of our “instant gratification society.  Opiates are in a class of their own. Generally, the more you use and more often you use them, the more you need and more often you need them.  I guess I would say access and ease of use is key to the popularity both for legitimate use and illegal use. 

And now we are in the epidemic which is bringing death, crime, heartbreak, and domestic disruption to Surry County and the rest of our country. 

Not enough time to get into the evolution of opioids as prescribed medication to the major use of heroin and fentanyl in this letter.  Still opioids but a whole different evolution.

This is a problem that needs lots of attention or we in Surry County as well as the whole US will be losing entire generations to death, mental illness, and social problems all due to these drugs.

I hope this gives you some insight into the issue. Perhaps next week we can continue on with how heroin came into Surry County.



Evolution of the epidemic, part 2

Dear Cheryl:

Last week I covered the evolution from the 1950’s and beyond with pills, especially opiates, for end of life and cancer pain.  We covered how about 2 decades ago pain became the fifth vital sign along with blood pressure, pulse, body temperature, and respiration.  More pills became available and more pills were prescribed, legally by doctors.  One of the issues with these pills is that people do trust their doctors and these were prescribed.  No one really thought anything negative would result.  Even when it became known that these opiates were addictive, people still trusted that they were safe because they were prescribed.  As with many things in our society, some of this opiate epidemic was driven by greed.  Most doctors are caring and try to do right for their patients.  They followed what they knew.  But some pain clinics and pain doctors found an easy way to make a lot of money and took advantage.  Lots of opportunity in the environment groomed by the Pharmaceutical companies.

As the years went by and there had been so many deaths from opioid overdoses as well as this epidemic wreaking havoc in communities and families, people became educated and advocacy groups began to emerge.  Families marched on Washington and sent letters to their representatives in congress.  Moms, especially, researched doctors who were prescribing to their children for no reason or to others in the family, and legislation turned into new guidelines for prescribing opioids.  Pills became more expensive and less available.  They became harder to buy on the streets and to “doctor shop” for them.  BUT, people addicted to these highly addictive opioids still craved the “high” and soon found another way to satisfy the craving with another drug more easily available and less expensive with the same “high”.  The drug dealers jumped right on this and started to make heroin very easy to get.  People switched to heroin and never looked back. 

I would like to take a moment here to clarify something that I found surprising when I began to research this while this was happening in my family.  As a mom not versed on addiction or drugs at all I had my preconceived ideas.  While learning about the opioid epidemic and abuse of prescription drugs, I had this false sense of calm because my family member was only using pills, not heroin.  In my mind I had this idea that pills,  because they were legally prescribed by doctors (when not abused and illegally acquired) were less bad and horrendous, than a drug like heroin.  Taking a pill seemed so far removed from heroin, needles, and other paraphernalia.  Well, please let me set you straight, and educate those of you who, like me, were not up to speed on all of this.  One common way of abusing these pills is to melt them and then snort them through a narrow tube or to inject the liquid.  Yes, exactly what is done with heroin.  I guess the delivery is more efficient.  Hard to really understand any of this.  Consider yourself educated and updated. Opioid abuse is opioid abuse no matter how you look at it. 

Back to the evolution to heroin.  So, heroin is very commonly used here in Surry County.  The highway system around here makes for easy delivery and exchange.  Also, in my research, I have learned that usually one doesn’t die from a pure heroin overdose or a single drug.  Most addicts will either mix more than one drug or add alcohol to the mix.  Unfortunately, the other big factor is the addition of a drug called fentanyl and another called carfentanyl, which is being added (cut into) the illegal drugs like heroin, cocaine, and meth for higher highs but much higher chance of death. It is impossible to look at the drugs and know if these drugs have been added.  People are taking chances and some want the bigger high and hope to live.  It is even added sometimes to pills that look just like legally prescribed drugs. 

So, this is happening all over the US and Surry County is not immune to it.  We at Surry County Opiate Response hope to figure out how to “heal” Surry County.  We are hoping to educate the communities in Surry County so we can all work together to this goal.



Denise Krochta

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