Spring 2018

7 nmdental.org the withdrawal symptoms were equal. Dr. Alexander Lambert and Charles B. Towns (1906) noted their seven day regimen of using belladonna delirium and a five day purge of heroin to cure heroin addiction. During the Civil War and after, many veterans become addicted to opium and its products. The US Congress (1890) legislated narcotics by imposing a tax on opium and morphine. As heroin addiction rose to alarming rates, the US Congress banned opium in 1905, and in 1906 passed the Pure Food and Drug Act requiring labeling on patent medicines, and in 1909 outlawed the importation of opium to the US. The 1914 passage of the Harrison Narcotics Act required doctors and pharmacists who prescribed narcotics to register and pay a tax. The US Treasury Department’s Narcotics Division (the first federal drug agency) banned all legal narcotics sales forcing addicts to buy from illegal street dealers. This created a thriving black market in Chinatowns across the country as the majority of illegal heroin came from China. World War II disrupted the drug trade. After the war, the British gave independence to Burma. Opium cultivation flourished, but the government outlawed it in 1962. Most of the heroin to the US came from Turkey via the Mafia and through the French transferring South East Asian opium until 1972. In order to maintain relationships with warlords during the expansion of communism in Southeast Asia so that they could pay for their arms, ammunition and transport, the sale of opium from Laos, Thailand and Burma to illegal drug dealers in the US exploded expedited by the CIA’s charter airline, Air America, transporting opium to the US. In 1973 President Nixon created the Drug Enforcement Administration under the Justice Department consolidating all the federal powers of drug enforcement to this agency. After Saigon fell, ‘Mexican Mud’ replaced ‘China White’ until 1978 when the US and Mexican governments sprayed opium fields with Agent Orange. The Golden Crescent area—Iran, Afghanistan and Pakistan—stepped up to the plate. In 1984 the US State Department concluded that crop substitution in third world countries did not work without plant eradication and criminal enforcement. Even so, they reported poor results. In 1988 the single largest heroin seizure in Bangkok headed to New York of 2,400 pounds came from Burma. In 1990 the US Attorney General indicted Khun Sa,the Burmese Warlord, on trafficking charges of 3,500 pounds of heroin over an 18th month period including the Bangkok seizure. In 1992 Columbia drug lords filled the vacuum as the DEA and the Thai army destroyed opium poppies all over the Golden Triangle region. Even with President Clinton’s focus on institution building and strengthening democratic governments to promote legitimate economic opportunity, the Triangle produced 2,500 tons a year. Afghanistan produced a bumper crop in 1999 of 4,600 tons. So the Taliban banned poppy cultivation the following year eradicating opium production in the country. When the Taliban was overthrown, heroin flooded into Pakistan. By 2002 Afghanistan regained its positon as the world’s largest opium producer. By 2006 Afghanistan harvested 6,100 tons of opium or 92% of the world supply. In 2007 the number rose to 95%. In 2004 consumer groups filed a lawsuit against Purdue Pharma, the maker of Oxycontin, for allegedly using fraudulent patents and deceptive trade practices to block the prescription of generic medications for patients in pain. The same year a Tasmanian company published a genetically-engineered opium poppy that did not produce morphine or codeine. The FDA licensed Purdue to provide extended release Palladone, hydromorphone capsules, for around the clock pain relief. The DEA withdrew new guidelines to pain specialists that would have arrested them for providing adequate pain relief so that the doctors could treat pain aggressively. However Dr. William E Hurwitz was sent to prison for excessive prescription use of opioid painkillers to chronic pain patients. He testified that an abrupt stoppage of these prescriptions as”tantamount to torture.” In 2008 half of the US prison populations of 2,300,000 were non-violent, drug-related inmates. In 2009 WHO announced that 80% of the world’s population did not have access to adequate pain relief. Proceedings of the National Academy of Sciences (2010) confirmed that mice (and humans?) can synthesize their own morphine. For years the medical establishment argued over the dependence of opioids and its efficacy in reducing pain. Various articles and letters written in the 1980’s reported that addiction was rare in inpatients suffering from diseases associated with chronic pain. However there were no long- term controlled studies of opioid for chronic pain. Purdue Pharma and other opioid manufacturers encouraged opioid use for chronic pain. Now there is an estimated 25 million adult Americans who suffer from daily pain and another 23 million who suffer from recurrent pain. The best known alternatives are psychologic in nature such as cognitive behavioral therapy, relaxation and pain coping skills training and self-hypnosis, but only 200,000 patients use these methods as they are expensive and not necessarily covered by insurance. Purdue marketed Oxycontin as non-addictive because it was released within the body over 12 hours. Recreational users crush or dissolve the pills. There is a ready supply of opioid drugs through Medicaid and Medicare services and when these are not available black tar heroin at a quarter of the cost of a Oxycontin is available on the streets. Hence the epidemic of drug heroin overdose deaths increased by 137% between 2000 and 2014. Heroin and prescription opioid overdoes increased by 200%. The CDC guidelines note that patients with severe chronic pain need opioids but prescribers require intensive involvement and strict rules negating the marketing by opioid manufacturers, the cost-benefit calculations of insurance carriers and the creative entrepreneurship of drug traffickers. References www.opioids.com/timeline Meldrum ML. The Ongoing Opioid Prescription Epidemic: Historical Context. American Journal of Public Health. 2016 August: 106(8): 1365-1366.