The drug landscape has changed dramatically over the past 20 years with increasing legalisation of “illicit” substances and their use in medical practice, including cannabis (and CBD-related products) as well as more recently psychedelic agents such as LSD for the treatment of depression. All the while there has been an increasing concern about the use and abuse of prescription drugs with opiate-based painkillers coming to the forefront.
Opioids are increasingly a part of everyday conversation: from Donald Trump’s declaration on ending the US opioid crisis or Future’s infamous rap song quoting “Molly and Percocet”. GQ got in touch with our resident doctor, Dr Tamer Rezk, head of the medical wellness clinic Phycore, to put together a roundup of where we are in 2020.
What are opiates?
Opiates are drugs derived from a plant called opium. Opium has long been known for its medical and recreational effects and is most commonly found in the upper Asian belt (Afghanistan, Pakistan and northern India). Having previously been known as the “drug of joy”, it was reintroduced to the Western world around the 1700s with two wars fought over it. In the US, in the early 1900s it was evident there was an opiate epidemic (comprised of heroin) and with the lead of President Roosevelt, congress passed the anti-heroin act in 1924.
The three main groups of opiates
Natural opiates are ones that occur in the opium poppy and include drugs such as morphine and codeine.
Semi-synthetic/man-made opioids are created in labs from natural opiates. These include drugs such as hydromorphone, oxycodone (the prescription drug OxyContin), as well as heroin (derived from morphine).
Fully synthetic/man-made opioids include drugs such as fentanyl and tramadol that “mimic” the effects of natural opiates.
How do opiates make you feel and why are they so addictive?
As opposed to the hard use of opiates (injecting or smoking heroin), where users report an immediate and intense high, people’s addiction to prescription opiates often starts with a pain syndrome. Apart from reducing symptoms of pain, additional effects are a feeling of happiness, reduced anxiety, relaxation and, in some cases, euphoria.
Opiate abuse often starts with using medication for recreational use (taking it at parties or social events and often at more than the prescribed dose) with a move to dependence (feeling “not right” when off it or experiencing withdrawal symptoms) and finally on to addiction, where the drug damages both the physical and mental health of the person, often leading to a breakdown in personal and professional relationships.
The crisis and the stats
Abuse of prescription drugs has come to the forefront of media and popular culture in recent years. Prescription drugs are thought to be preferred by younger generations compared to “hard” street drugs, as the concentration, quality and supply is easier to find. Data suggests, however, that prescription opiate abuse can often provide a gateway to heroin use.
So, what are the statistics? As of January 2019 (drugabuse.gov data), it is estimated that in the US:
21 to 29 per cent of patients are prescribed opiates for chronic pain
8-12 per cent develop an opioid use disorder
It is estimated that 4-6 per cent of those who misuse transition to heroin and that 80 per cent of those who use heroin first started with prescription opiates
Opiate overdoses lead to 130 deaths per day in the US
The data for the UK is scarce. However, in 2017/2018, more than one in ten (13 per cent) of the UK adult population was prescribed opiate painkillers. The feeling is that there is far less of an awareness as to the number of people suffering with undiagnosed addiction.
Drug use is common and increasingly prescription medications are the drug of choice, often mixed with alcohol and other illicit drugs. If you are concerned about your use and the possibility of addiction then there are a number of resources available to you including Ask Frank (a website where you can find local drug treatment services), your GP or local drug treatment services.
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