When the CDC published -prescribing guidelines has been around since at least 3400 BC. Opioid Epidemic in the U.S.: in 2016, it brought national attention to a problem Known as the "joy plant," it was cultivated by plaguing Americans across the country. Overdose Sumerians in lower Mesopotamia, now current-day deaths related to prescription and Iraq. Its use, both as a reliever and soporific, have reached epidemic proportions. In fact, spread through the Middle East, India, Greece, How Did We Get Here? they have quadrupled since 1999, according to the CDC.1 China and Europe. [PBS] 1 CDC

1700s Colonial America 1800s-30s 1850s-60s 1870s-90s 1900s-10s 1920s

MORPHINE 1920: NARCOMANIA FREE HEROIN Friedrich Wilhelm A German pharmaceutical Physicians raise concerns with addiction, A philanthropic Sertürner of Germany company develops also known as “narcomania.”1 vorganization isolates morphine from hydrocodone, another provides free heroin to morphine addicts to help opium.1 He calls it painkiller.1 OPIUM AND LAUDANUM Americans are now buying over-the-counter pills and 1 morphine, after them quit. Americans crush the pills and inhale Doctors prescribe opium to their patients to manage 1855: HYPODERMIC NEEDLE elixirs that contain to treat menstrual cramps, 2 Morpheus, the Greek the powder for a more intense high. pain as well as help with , coughs, and other Alexander Wood of Scotland devises the teething and other aches and . 1923: LEGAL NARCOTICS BANNED god of dreams.2 maladies. Also popular are laudanum, an opium first hypodermic needle to administer morphine 1906: FOOD AND DRUGS ACT All legal narcotics are banned under the U.S. compound in pill form, and later Sydenham’s to a patient suffering from neuralgia.1 1898: HEROIN Pharmaceutical companies must accurately label Treasury Department's Narcotics Division.2 1 1830s: INDUSTRIAL Laudanum, a mixture of opium in and spices. A German pharmaceutical their products and list dangerous ingredients, REVOLUTION 1924: ANTI-HEROIN ACT CIVIL WAR company synthesizes such as , heroin and .3 Colonists cultivate opium in their gardens.2 The U.S. begins Doctors administer morphine to injured American heroin from morphine and U.S. makes the manufac- 3 manufacturing morphine. ture and possession Even founding father Thomas Jefferson grows soldiers. Veterans who remain addicted after the war introduces it as a cough 1914: NARCOTICS TAXED opium at Monticello.3 suffer from what is called the “Soldier’s .” 2 and cold remedy. It is of heroin illegal.3 1 Meldrum, A Capsule History of Pain Management The Harrison Narcotics Tax Act taxes those who considered less addictive 4 1,2 Frontier Medicine, (pg. 36) 2 David J. Hart, Organic Synthesis Via Examination 1 Meldrum, PBS Frontline, 2 Elaine Casey, History of Drug Use and import, manufacture, or prescribe narcotics. 1 NY Magazine, 2 PBS Frontline, than morphine.2 3 Book: Thomas Jefferson's Flower Garden at Monticello, (pg. 59) of Selected Natural Products. (pg. 405) 3 Meldrum Drug Users in the United States, Facts About Drug Use, 1978. 3 History.com 1 PBS Frontline, 2 Meldrum, 3 FDA, 4 PBS Frontline, Meldruma 1,2 Meldrum

2016: CDC GUIDELINES Over 6 The CDC releases guidelines for prescribing opioids 1930s-50s 1970s-80s 1990s-00s 2010s for chronic pain. It encourages non-opioid , out of 10 prescribing lower doses and short-acting opioids, and NEW PAIN KILLERS monitoring progress. These guidelines do not pertain Percocet ( and acetaminophen)1 and to pain related to cancer, palliative or end-of-life care.4 deaths involve Vicodin (hydrocodone and acetaminophen)2 come an opioid.1 on the market. Both are short-acting pain relievers.

259M 59,000+ Every day, 1938: FOOD, DRUG AND COSMETIC ACT 91 people die To ensure consumer safety, the U.S. government from an overdose of enacts the Food, Drug and Cosmetic Act. heroin or prescrip- 1 It also tightens controls over medical devices. 2016: OPIOID DEATHS KEEP RISING tion opioids.2 The New York Times estimates drug overdose deaths 1955: ACETAMINOPHEN in 2016 at over 59,000. They are the leading cause of Better known as Tylenol, 1980s: OPIOIDS DEEMED ‘SAFE’ 1996: OXYCONTIN DEBUTS death of Americans under 50.5 2012: 259 MILLION acetaminophen is available Two events indicate that opioids are safe to OxyContin, a long-acting painkiller, hits the market. In 2012, the number of prescriptions written for via prescription (for prescribe for chronic pain and not addictive. In an aggressive marketing campaign, the drug’s 2016: AND 2017: PRESIDENTS ACT opioid pain medication reaches 259 million, enough children only). It is made manufacturer claims OxyContin is less addictive than In 2016 Former President Obama asks Congress of opioid for every adult in the United States to have a bottle available to adults a One is a letter, “Addiction Rare in Patients Treated its short-acting cousins, Percocet and Vicodin.1 for over $1 billion to fight the opioid epidemic.6 prescriptions 2 of pills.1 few years later. with Narcotics,” published in the New And in 2017 President Trump signs an executive % originate from 1 2 Journal of Medicine in 1980. Another is a study, 2002: OVERDOSE DEATHS order to create the President’s Commission on FDA, NY Magazine 2015: OPIOID DEATHS NEARLY TRIPLE 50 primary care “Chronic Use of Opioid in Non-Malignant Overdose deaths from opioid drugs, including heroin, Combating Drug Addiction and the Opioid Crisis.7 Overdose deaths from prescription opioids and providers.3 Pain: Report of 38 Cases,” published in 1986 in Pain. reach over 10,000.2 heroin reach 33,000,2 almost triple the number of 1 CDC, Dowell, 2,4 CDC, 3 National Institute on Drug Abuse, 1, 5,6 7 1 california-drug-rehabs.com, 2 NY Magazine, 3 The New Yorker NY Times, 2 National Institute on Drug Abuse overdose deaths since 1999.3 NY Times, nbcnews.com 1,2,3 CDC