Humans have a long and complex history with plants. Long before civilization and even prior to the Agricultural Revolution, humans had realized that plants have a multitude effects on human physiology including appetite suppression, pain relief, energy supply, and immune system stimulation. It has been hypothesized that the adoption of an omnivorous diet was a decisive factor in moving early humans out of the stream of animal evolution and into the fast-rising tide of language and culture. It is also hypothesized that the consumption of psilocybin-containing mushrooms was the integral force in the transformation of Homo sapiens from a middling species to the dominant force on the planet. These psychedelics played a role in tripling the human brain size and reorganizing the brain’s information processing capabilities. Nevertheless, few plants can lay claim to such a complex and tangled relationships to human beings as the opium poppy. On one hand, we disparage users with terms such as “addicts” and “junkies,” and are immersed in a drug war against heroin but on the other hand, we develop, market, and distribute increasingly powerful legal synthetic and semi-synthetic opioids. Opioid addiction is not a modern phenomenon, however, the scale and scope of the problem is not only entirely modern but also symptomatic of our over-medicalized culture.
As covered in the last post, we have been addicted to the properties of the poppy from the beginning of history. The pharmacology of the plant inherently takes advantage of the endless human capacity for obsessional behavior and addiction. In fact, compared to other species, addictions and obsessions seem to be unique to Homo sapiens. However, in the age of industrialization and mass production, our addictions and obsessions are not limited to individuals or small groups of individuals but have scaled to entire segments of the population. By the 1960s, heroin was the leading cause of death among people age fifteen to thirty-five and in the last 25 years, there have been 300,000 opiate-related deaths in the United States. A case study that illustrates this phenomenon is the story of Purdue Pharmaceuticals and the development of Oxycontin. In 1995, morphine based MS Contin commanded 80% share of cancer pain market and accounted for 25% of Purdue Pharmaceutical’s net profit. In 1997, they projected an untapped opportunity in non-cancer pain and launched OxyContin (12 hour sustained release form of oxycodone) to treat not only cancer pain but also nonmalignant pain such as back pain, osteoarthritis, injury, and trauma pain to compete against Percocet and Vicodin. Whereas Percocet contains 5-10mg of oxycodone, OxyContin contained 80-160mg of oxycodone. Purdue supplemented Oxycontin’s release with an extensive media and “educational” campaign aimed at general practitioners rather than pain specialists. This included paid three-day seminars touting the dangers of undertreatment of pain. Simultaneously, Purdue established Partners Against Pain (PAP), a campaign aimed at patients suffering from long term pain. Within five years in 2000, OxyContin was the eighteenth best-selling drug in America and the most popular opioid painkiller. Recreational users soon learned that they could defeat the time release by crushing the tablet or injecting the pill and when laws made it more difficult to obtain OxyContin, users moved en masse to heroin. More recently, Insys Pharmaceutical utilized similar incentive schemes to push its fast acting fentanyl – Subsys – to the top of the charts. Subsys is a synthetic opiate that can be absorbed through the mouth or the nose leading to euphoric effects with a high risk of addiction, overdose, and death. The majority of Subsys sales have come from patients without cancer. Now that prescription fentanyl is an increasing focus of law-enforcement authorities, street versions of the drug can be quickly made from chemical ingredients often imported from China and pressed into pills or cut into heroin.
In an earlier post, I wrote about the medical-industrial complex laden with its optimized production, marketing, and distribution networks combined with sophisticated incentive schemes which have turned medicine into a $3 trillion dollar industry and in turn has transformed us into over-medicalized and overtreated zombies. For example in 2007, nearly a third of the appropriation levied by the seven biggest pharmaceutical companies went to marketing and sales including a fifth of that in the form of free meals and drug samples given to physicians. Is it any surprise that vast segments of the population are rendered helpless in the face of this onslaught? We are literally driven into a state of dopamine frenzy. Our opioid, obesity, sugar epidemics are all consequences of similar phenomena of overconsumption, over-medicalization, and over-treatment. Is it any surprise that our society is buckling from the downstream cost pressures and struggling to contain their deleterious impacts on society? We are seemingly nowhere close to uncovering the brain mechanisms behind addiction and even further from developing a targeted therapy to prevent addiction. Therefore, in order to have maximal short and medium term impact, we must implement scientifically sound policies, bolster the social safety net in the hopes of preventing a new population of addicted individuals and decreasing the direct and indirect harm of addiction.