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America’s rising tide of drug overdoses, a symptom of deeper problems

Overdose death

Summary: America has a drug problem, a symptom some deeper sickness of our minds or souls. Sick people often ignore warnings that would allow them to respond and recover. So it is with nations. It’s time for us to ask what is wrong with America.

America is among the most drugged major nations in the history of the world. The data comes in with each month’s news (we’ll look at the horrific prescription drug use by children another day). For example — 17% of US adults report using prescriptions for psychiatric drugs in 2013 (mostly long-term use). “Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race” by Thomas J. Moore and Donald R. Mattison in the JAMA Internal Medicine, February 2017 (see the NBC News story about this).

But opioids are the killers. America consumes 85% of the world’s opioid production (natural and synthetic; see below).  The casualty toll is rising. See these sad graphs about Overdose Death Rates from the National Institute on Drug Abuse.

A few grains of fentanyl (2 milligrams) is a lethal dose. Photo by AP/Cliff Owen.

Conclusions

Of the thousands of articles each year about America’s massive drug use, legal and illegal, few ask why we consume so much more drugs than other developed nations. Drugs are just the symptom for deeper problems (e.g., 20% of US adolescent girls had a major depressive episode in 2015).

We boast about America being exceptional, but these records should force reflection about what we have become. This is a symptom of a broken society — a warning we should not ignore. What has gone wrong with America?

China gets its revenge for the Opium War — on us.

In the mid-19th century the UK fought two wars with China over, among other things, the Brits right to import opium into China — the Opium Wars. Now the US, the heirs to British world hegemony, experience one of those moments of irony that make history so interesting — as China gives America ever more powerful designer drugs. See “Deadly chemistry” by Kathleen McLaughlin in Science, 31 March 2017 — “Underground labs in China are devising potent new opiates faster than U.S. and Chinese authorities can respond.” Excerpt…

“Fentanyl and its analogs are new faces of a worsening scourge. The United States consumes 85% of all the world’s natural and synthetic opiates, which in 2015 factored in 33,091 U.S. deaths, up more than 4000 from the previous year, according to the U.S. Centers for Disease Control and Prevention. Opioid overdoses have quadrupled since 1999. When average U.S. life expectancies for men and women edged downward last year, for the first time in decades, many health professionals blamed opiate abuse.

“The opium poppy is no longer the starting point for many of the opiates on the street. The new compounds, often sold mixed with heroin, originate in illicit labs in China. …

“Chinese labs began tweaking the fentanyl molecule, which is easy to alter for anyone with basic knowledge of chemistry and lab tools. By adding chemical groups, unscrupulous chemists have created new, unregulated variants, some of them even more potent than the original. …the chemical one-upmanship has deepened the opiate crisis, as new and nastier substances appear on the streets in places like Cincinnati. The fentanyl derivatives not only allow makers and dealers to elude law enforcement; they blindside public health authorities and make addiction even riskier. …

“Fentanyl crosses the blood-brain barrier with ease. It binds to opioid receptors and floods the brain with dopamine, which creates intense euphoria but also slows the heart and depresses breathing. For most individuals, a lethal fentanyl dose is about 2 milligrams—an amount so minuscule that in a test tube it looks like a few grains of salt clinging to the glass. Carfentanil is 100 times stronger, making it about 10,000 times more potent than morphine. …

“China eventually banned methylfentanyl, driving down its production and pushing it deeper underground. Its crackdown on fentanyl and several analogs in 2015 led to a marked decline in those synthetic opiates in the United States, DEA says. And last month, after extensive negotiations with DEA, China added carfentanil and three more fentanyl analogs to its list of controlled substances.

Even before China scheduled carfentanil, the scourge had begun to fade in Ohio. …But a new threat has appeared. Traces of an unidentified fentanyl analog have cropped up in several batches from crime scenes. Hamilton County’s scientists will search for a molecular match, add it to the list—and hope the new wave is less deadly than the last.”

For More Information

For more about this problem see “Opioid Addiction: 2016 Facts & Figures” by the American Society of Addiction Medicine.

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