MINISTERUL EDUCAȚIEI

COLEGIUL NAȚIONAL „GRIGORE MOISIL” ONEȘTI,

BACĂU

LUCRARE DE ATESTAT LA LIMBA

ENGLEZĂ

SESIUNEA MAI 2023

Prof. COORDONATOR CANDIDAT,

Velicu Magdalena Diaconu Cristiana-Raluca-Liliana

Clasa a XII-a C- Științe ale Naturii, Engleză Intensiv

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 THE OPIOID CRISIS IN THE UNITED STATES OF
AMERICA

'I've been dead twice... Ten minutes

later I wanted more heroin'

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 TABLE OF CONTENTS

ARGUMENT......................................................................................................4
INTRODUCTION..............................................................................................6
CHAPTER I. WHAT ARE OPIOIDS?............................................................7
I.1. The definition of opioids.............................................................................7
I.1.1. How do opioids work............................................................................7
I.1.2. Are there different types of opioids......................................................7
I.1.3. How are opioids taken..........................................................................8
I.2. What were opioids originally used for.A small history of opioids.............8
I.2.1 The first opioid epidemic.......................................................................9
CHAPTER II. OPIOID ADDICTION........................................................11
II.1. How opioids affect an individual............................................................11
II.2. Testimonies from opioid addicts.............................................................13
II.2.1 Josh Moe............................................................................................13
II.2.2 Caitlyn................................................................................................13
II.3. The relationship between marijuana and opioids....................................14
CHAPTER III. THE OPIOD CRISIES IN AMERICA............................15
III.1. How did the covid pandemic affect the opioid crisis.............................16
III.2. What are the effects of the opioid crisis on children.............................17
III.3. How did the US respond to the opioid crisis.........................................18
FINAL CONSIDERATIONS.......................................................................20
WEBLIOGRAPHY.......................................................................................21

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 ARGUMENT
Drugs were created to give people an euphoric feeling, to break them away from
a mundane reality and give them a new perspective. However in time, this
euphoric feeling has ended up being a need and thers becoming an addiction.
Doctors define drug-addiction as an irresistible craving for a drug, out-of-
control, compulsive use of the drug, and continued use of it despite repeated,
harmful consequences. In this respect, opioids are highly addictive and this is
the reason why I have chosen this topic for my assignment paper, with the weets
to showing how drugs can destroy people, although at first it seems like a piece
of heaven. I believe that the opioid crisis in America starting in 2000 and
continuing to this day is one of the best examples to show the true reality of
high risk drugs.

First of all, opioids are drugs created in chemical laboratories, being a much
more harmful drug and causing an even greater addiction. Both legally-
prescribed and illegal opioids may cause euphoria― a pleasurable sense of
well-being ― in some people. Not everyone experiences euphoria when taking
opioids, but for those who do, there is a risk of repeatedly using the drug
because of the way it makes them feel. Using any opioids to achieve the
euphoric effect, even for a short time, leads to the risk of substance use disorder,
overdose and death. People using a needle may end up suffering from
infections, hepatitis even HIV.

Furthermore, opioids have been a reason of terror on the American streets,

leaving behind only death and pain. More and more people have always been
attracted to the sensation that opioids offer, even though they are not cheap and
are illegal. Some people believe that it is not the drug itself that causes
addiction, but the reality that is offered after consuming it. Although the effect
is a pleasant one, the consequences are rather serious. When an opioid dose
wears off, you may find yourself wanting those good feelings back as soon as
possible. This is the first milestone on the path towards potential addiction.

Last but not least, it can not be denied that your personal history and the length
of time you use opioids play a role, but it is impossible to predict who's
vulnerable to eventual dependence and abuse of these drugs. Legal or illegal,
stolen and shared, these drugs are responsible for the majority of overdose
deaths in the U.S. today. It is my firm belief that this is a serious problem that
4
needs to be addressed because millions of people have died and will continue to
die if measures are not taken in this regard. It is certainly difficult to succeed in
stopping the distribution of opioids on the streets of America, but it is not
impossible to help the people who are addicted to these drugs. The volunteers of
some medical associations, pass, with a special ambulance, through these
neighborhoods full of poverty, giving people sterilized syringes so that they
don't get different diseases from using the needles and syringes that they find on
the streets. Other people who want to make a difference in these communities
collect the used syringes, found everywhere on the streets of the depraved
neighborhoods, in special boxes.

Taking everything in consideration, the opioid crisis will certainly remain for a
long time one of the biggest problems that America is currently facing, with
more and more people overdosing on this type of drug.

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 INTRODUCTION

Considering the context in which we live now, each of us has heard of drugs at
some point, in a certain context. We can call many things drugs, being addicted
to them without realizing it or intentionally. Coffee, technology, cigarettes, they
can all be called drugs, but when it comes to the streets of America, drugs have
been taken to another level and they are called high-risk drugs.
Codeine, heroin, morphine and other opioids have been destroying whole
communities of people, families and children for decades. The lives of these
people take a terrible turn when they are introduced to opioids. No matter how
mentally prepared people think they are and that they will take it one time and
then quit, addiction acts slowly, individuals not being able to realize when they
have becomed addicted to the drug. Once the substance reaches the blood, and
the sensation is felt to the maximum, the second time when the opportunity
arises to take more, no one will say no.
Some people find themselves in that feeling, it is the way they would like to feel
every day, even when they are sober, but the feeling offered by opioids will not
be achieved when the body does not have this substance.
When we have in front of us a man or woman who is addicted to any kind of
opioids, our first thoughts are not the nicest. We have to understand that they
didn't want to get to that point, everything started from a mistake, which at first
seemed innocent.
Curiosity, entourage or the desire to feel something else puts some people in
front of a difficult decision. Do I take this drug or not? Most of the time for
most of the people, the answer is yes. Even if the first thought was no, the more
they think, the more that no will turn into yes, this being the first step that will
lead them into a miserable life, living on the streets and looking every day for a
way to maintain their addiction.

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 CHAPTER I. WHAT ARE OPIOIDS?
I.1. The definition of opioids

Opioids, sometimes
called narcotics, are
medications prescribed
by doctors to treat
persistent or severe
pain. They are used by
people with chronic
headaches and
backaches, by patients
recovering from
surgery or experiencing
severe pain associated with cancer, and by adults and children who have gotten
hurt playing sports or who have been seriously injured in falls, auto accidents,
or other incidents.
I.1.1. How do opioids work
Opioids attach to proteins called opioid receptors on nerve cells in the brain,
spinal cord, gut, and other parts of the body. When this happens, the opioids
block pain messages sent from the body through the spinal cord to the brain.
While they can effectively relieve pain, opioids carry some risks and can be
highly addictive. The risk of addiction is especially high when opioids are used
to manage chronic pain over a long period of time.
I.1.2. Are there different types of opioids
There are many types of prescribed opioids that are known by several names,
including:
 Codeine
 Fentanyl
 Hydrocodone
 Oxycodone
 Oxymorphone
 Morphine
These medications are often sold under brand names such as OxyContin,
Percocet, Palladone, and Vicodin.

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The different types of opioids are prescribed by doctors in different strengths
and administered in various forms, depending on the patient, the situation, and
the type and level of pain.
Heroin is an illegal and highly addictive form of opioid with no sanctioned
medical use.
I.1.3. How are opioids taken
Many opioids are taken in pill form, but they can also be taken as lozenges or
lollipops. Some are administered through a vein, by injection or through an IV,
and others can be delivered through a patch placed on the skin or with a
suppository.
I.2. What were opioids originally used for.A small history of opioids
Heroin, morphine, and other
opiates trace their origins to a
single plant—the opium poppy.
Cultivation of the plant dates
back to the earliest years of
human civilization, and opium
use was well known in ancient
Mesopotamia. The narcotic
drug has been used both
recreationally and as a medicine
for centuries.

References in the Odyssey(Homer

referred to opium's healing
powers in the Odyssey) and the
Bible, and use by known leaders
and minds like Homer, Franklin,
Napoleon, Coleridge, Poe, Shelly,
Quincy, Hitler and many more,
have removed the label of
immorality from its use. Wounded
soldiers, from the American Civil, British Crimean, and Prussian French wars,
were allowed to abuse the drug. By 1830s one third of all lethal poisoning was
due to opium-marking the first recognition of a social evil.

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 Isolation of Morphine
from opium by
Serterner in Germany
in 1805, hypodermic
syringe by Pranez in
1850s, synthesis of
morphine by Tschudi
in 1952, and
manufacturing of
synthetic derivatives-
called opioids and
Heroin eased the use.
I.2.1 The first opioid epidemic
The Civil War caused this massive epidemic of opioid addiction among
veterans. In a lot of ways this is the first example in U.S. history of the problem
of opioid addiction becoming really epidemic in the true sense of the word.
It was epidemic both in scale, just the sheer number of people who got addicted,
and also the fact that after the Civil War it becomes front page news. It becomes
a really major public health, and also kind of a cultural, crisis in the post-Civil
War decades.
One estimate suggests that by 1890, several hundred thousand Americans, many
of them, probably, Civil War veterans, were addicted to opioids.

The 1861-
1865 war
claimed over
700,000 lives,
and maimed
and sickened
tens of
thousands of
people.
Soldiers and
sailors suffered terrible wounds, and many underwent amputation at the hands
of surgeons who had few other remedies.
Doctors had been aware of the danger of opioid addiction well before the Civil
War. They knew about drug tolerance, that if you take opioids over time, the
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longer that you take them, the more that you need. They knew that it was a
problem that eventually led to overdose.
But it was never front page news until the Civil War caused the number of cases
to just go through the roof.

Opium was also a valuable

pharmaceutical. It does so many
different things. It was used to kill pain,
stop deadly diarrhea and suppress
coughs. Opium was like a godsend for
the soldiers. And it was the crucial drug
as the war broke out.

The weapons of the Civil War produced

ghastly wounds. Bullets were large and made of soft lead. They tended to not
just go through and through, so they wouldn’t leave clean wounds.
At first, opioids were dispensed in powder or pill form. One doctor reported that
he would pour some powder in his hand and have the needy soldier lick it. But
the advent of an opium derivative, morphine, and the use of the hypodermic
syringe gave doctors a faster way to administer a more potent drug.

After the war, the sick and wounded found that opioids were easily available in
hometown stores, and they continued using what had helped them during the
conflict.

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 “Opium … bound me up with
cords that God only knows
how often I tried to break,
and as many times failed,”
Albert W. Henley, a
physician in the Confederate
army, claimed in 1879.

CHAPTER II. OPIOID

ADDICTION
II.1. How opioids affect an individual
It is not yet known why some people become addicted to opioids and others do
not. Typically, opioids produce pain relief and, for some people, euphoria ― a
sense of heightened well-being. Experiencing euphoria after taking opioids may
be a warning sign of vulnerability to opioid addiction. This euphoria can even
occur in people using opioids as prescribed by their doctor.
Early in the process of opioid use disorder, people may take an opioid drug
because of the pleasurable effect. Over time, the pleasant sensations diminish. A
person may take opioids more frequently or at higher doses to restore the
euphoria or, as the condition progresses, to avoid withdrawal symptoms.
Taking an opioid regularly increases the risk of becoming addicted. The time it
takes to become physically dependent varies from person to person, but it is
usually a couple of weeks. Taking an opioid for a day or two is not a problem
for most people, but some studies show that even the first dose can have
physiological effects that can make someone vulnerable to opioid use disorder.
OUD (Opioid Use Disorder) is characterized by symptoms such as the
following:
Physical dependence: This is a physiological change that occurs when using a
substance. When the person stops taking the drug, they experience withdrawal
symptoms such as cravings and sweating.

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It is important to understand that a person can be physically dependent on
opioids without unhealthy use. For example, a patient with cancer who has
chronic pain may be physically dependent on opioids but not addicted to them.
Increasingly heavy, frequent, unhealthy or risky use: The person continues
to use an opioid even though it causes problems with health, safety, financial
security or personal relationships. A person with an opioid use disorder is
unable to control the use of opioids, and behaviors associated with getting and
using opioids increasingly interfere with daily life.
Cravings: These are overwhelming physical and emotional urges to take the
drug, despite an understanding of potential consequences to well-being.
Other signs of an opioid use disorder: Someone struggling with an opioid use
disorder may not show signs right away. Over time, there may be some signals
that the person needs help, such as:
 Drowsiness
 Changes in sleep habits
 Weight loss
 Frequent flu-like symptoms
 Decreased libido
 Lack of hygiene
 Changes in exercise habits
 Isolation from family members or friends
 Stealing from family members, friends or businesses
 New financial difficulties

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 II.2. Testimonies from opioid addicts
II.2.1 Josh Moe
”On a hot, humid summer afternoon, I find myself in another filthy Minneapolis gas
station bathroom. Near tears, I’m frantically trying to find a vein through all the scar
tissue I’ve built up on my arm. Each time I stick myself, some of my precious heroin
leaks from the syringe—heroin I spent my last 40 bucks to buy.
I’m sweating profusely, yet have chills. My skin is crawling and I’m cramping all
over. My entire body is weak and I feel like I’m going to vomit. My heart is racing
and with every beat, my body begs for relief. I’m out of money. Out of a job. Out of
school. Out of second chances. Finally, I get the flash (blood flowing into the syringe
— the sign that I’m in the vein). Before I finish the injection, I feel the sweet relief,
flowing through my body. My pain goes away. I stop sweating. My heart rate drops.
All is well. At least for now.
I wish I could say that was my last day as an addict, but it would be another year
before I finally got clean. I went from popping painkillers, to snorting OxyContin,
morphine and Dilaudid. Eventually, I graduated to injecting heroin multiple times a
day. I wish I could isolate a point in time when I knew I was addicted, but addiction is
subtler than that. Drugs go from merely being a part of your life to becoming your life.
It was wonderful in the beginning. Opioids have the ability to induce a powerful
feeling of well-being not attainable naturally or even with other drugs. There’s
reduced anxiety, euphoria, pain relief, and a host of other good feelings, including
“the nods,” where you feel like you’re sleeping, but remain conscious.
As time went on, I started experiencing the negative side of addiction. I’d get violently
ill if I went more than a day without drugs. I needed more and more to achieve the
same effects, which meant I needed more and more money to fund my habit. As time
went on, I started experiencing the negative side of addiction. I’d get violently ill if I
went more than a day without drugs. I needed more and more to achieve the same
effects, which meant I needed more and more money to fund my habit.
Finally, I couldn’t take it anymore and asked for help. It takes a long time to rewire
your brain. Throughout addiction, you hijack the reward systems in your brain, which
makes mental recovery even harder than the physical withdrawals. Cravings can be
intense, leaving those in early recovery quite vulnerable. I was always told that
recovery is simple, not easy.”
II.2.2 Caitlyn
“My name is Caitlyn. I am 27 years old. I am currently 20 months clean off of heroin
and methamphetamine. I was about 21 when I first started using. It started with
smoking and it just continued into where I became an every day several times a day
IV drug user, I would mix heroin and meth.

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When I first started I was working full time and going to school full-time paying for
my own apartment, and I had a really good life. After the first couple months of using,
I quit my job, I dropped out of school, and I received an eviction notice for not paying
my rent. So from there, I became homeless and soon after lost my car. Next, I went
about for five years just on the streets stealing daily from stores just to be able to
support my habit.
Recovery was always in the back of my mind, but I never knew which direction to go
so I just kept using. Soon my family and friends didn’t even recognize me and wanted
nothing to do with me.
I was in and out of jail on the run from the cops and things weren’t looking good.
After I got out of jail, I decided I needed to get into a residential program. Since then I
have gone from 196 mg of methadone a day down to 14 mg of methadone per day. I
have been tapering off of methadone every week. I am almost there!”

II.3. The relationship between marijuana and opioids

Marijuana
contains THC,
a
psychoactive
chemical that
acts on
specific
cannabinoid
receptors
within areas
of the brain
associated
with
concentration,
thinking, sensory and time perception, pleasure, memory, and coordination.
Research has shown that the combination of marijuana and opioids can be
therapeutic to some people suffering from chronic pain. In one study,
individuals who smoked marijuana while being administered small doses of
oxycodone experienced enhanced pain threshold and tolerance compared to the
effects of taking oxycodone alone.
The synergistic effects obtained by combining these drugs can be very
beneficial to patients as it would allow lower doses of opioids to provide pain
relief, reducing the likelihood of prescription opioid addiction and overdoses.

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However, marijuana and opioids both have depressant effects, and when
combined at nonmedical doses these drugs can suppress the central nervous
system to dangerous levels. This can result in decreased brain function, low
blood pressure, extreme sedation, coma, and death.
Unfortunately, the combination of marijuana and opioids among recreational
users is a common occurrence. One study found that 7 out of 10 teens who take
prescription opioids for nonmedical reasons combine them with other drugs or
alcohol, with marijuana being the most commonly co-ingested substance.
Studies have shown that the use of marijuana increases the abuse potential for
opioids as well as other undesirable side effects. Analysis of data from the
National Epidemiologic Survey on Alcohol and Related Conditions suggests
that marijuana users are more than two and a half times more likely to misuse
prescription opioids and develop prescription opioid use disorder compared to
nonusers.
A recent study published in the Journal of Addiction Medicine also showed that
combined use of opioid and marijuana was linked to greater symptoms of
anxiety, depression, and substance use problems.

CHAPTER III. THE OPIOD CRISIES IN

AMERICA
DURING THE past two decades opioids have become one of America’s worst
public-health problems. The magnitude of abuse—spanning prescription
painkillers, heroin and synthetics such as fentanyl—is staggering. In 2016 11m
Americans mis-used prescription opioids, and 2.1m adults reported that they
were addicted. In the
year to September
2018 opioid overdoses
killed 48,000 people.
That took the total
death toll since 2000 to
400,000, greater than
the number of
American combat
deaths in the second
world war, the Korean
war and the Vietnam
war combined.
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 III.1. How did the covid pandemic affect the opioid crisis

Drug overdose deaths surged in the United States during the first year of the
COVID-19 pandemic, increasing by 30.6% in just 12 months. The growth was
widespread throughout the country, with forty states experiencing statistically
significant increases in their drug overdose death rates from 2019 to 2020.
Much of the growth in drug overdose deaths was driven by synthetic opioids
such as fentanyl, which increased more than 50 percent from 2019 to 2020. The
emergence of fentanyl in the U.S. illicit drug trade is a newer phenomenon
beginning in the past decade, and it has recently spread from eastern states to
increasingly affect states in the western half of the country as well.
The COVID-19 pandemic strikes at a moment when our national response to the
opioid crisis was beginning to coalesce, with more persons gaining access to
treatment and more patients receiving effective medications COVID-19
threatens to dramatically overshadow and reverse this progress. Some
disruptions in the care of patients with opioid use disorder are inevitable during
the weeks and months to come.
Opioid misuse increased during the pandemic as people experienced worsened
mental health, more social isolation, greater job losses, and reduced access to
treatment. In addition, the use of more potent synthetic opioids led to a sharp
increase in overdose deaths.
III.2. What are the effects of the opioid crisis on children

Children, of course, are not

immune to the effects of what
may happen in their homes and
communities, and there is
ample evidence that negative
home or community factors can
be associated with lost learning
opportunities. Education can be
a pathway to economic and
social mobility, especially for
children from disadvantaged
backgrounds. The collateral
consequences associated with
the opioid epidemic—family members who suffer from substance-use disorder,

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parents lost to opioid overdose, diverted community resources, and the fraying
of neighborhood social connections—have the potential to negatively impact
the educational outcomes of children.

In conceptualizing the pathway linking a young person’s exposure to the opioid

epidemic to education outcomes, we draw upon work that models how a given
neighborhood context can impact the education outcomes of a child. The
neighborhood context under consideration is the opioid epidemic in the
community, and the route through which the epidemic can impact a child’s
education is via the interaction between the child’s level of exposure to the
epidemic and the child’s vulnerability to any given level of exposure.
Variation in exposure across children can arise from different sources,
experiences, and life situations. For example, a child who lives in a household
with an addicted parent may face a traumatic home life, maltreatment, or family
separation, all consequences of the child’s direct exposure to the epidemic via
their struggling parent.
Children and youth affected by familial opioid use disorders are more likely to
experience child maltreatment and neglect. They are also more likely to witness
familial overdoses, thus creating often-undiagnosed trauma reactions and a need
for therapeutic intervention.
In 2017, an estimated 2.2 million children and adolescents had a parent with
opioid use disorder (OUD) or had OUD themselves. If current trends continue,
an estimated 4.3 million children will have had OUD or a parent with OUD by
2030.
Despite promising signs that the opioid epidemic has hit an inflection point, it is
far from over. The number of children affected by the crisis will continue to
grow.

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 III.3. How did the US respond to the opioid crisis

Between 2016 and 2018,

three laws enacted in
response to the crisis
aimed to lower the
demand for and supply of
opioids and to reduce
their harm. The funding in
those laws complemented
annual appropriations to
agencies tasked with
responding to substance
use disorder, including
opioid use disorder.
To build on this progress
and save more lives, President Biden is calling for increased investments to
dramatically expand access to care for addiction and go after drug traffickers
harming the health and safety of communities.
In response to the opioid epidemic, naloxone distribution programs aim to
prevent overdose death by making naloxone available and training people to use
it. Peers of individuals at risk of opioid overdose are well-positioned to
administer naloxone and prevent overdose death.
Naloxone is a medication designed to rapidly reverse opioid overdose. It is an
opioid antagonist—meaning that it binds to opioid receptors and can reverse
and block the effects of other opioids, such as heroin, morphine, and
oxycodone.
For many years after naloxone, emergency treatment of opioid overdose was
restricted to use by emergency medical personnel such as hospital physicians
and paramedics. Over the past decade, as harm reduction efforts have focused
on making naloxone more accessible and available in overdose situations, first
responders like law enforcement have been equipped as well. Law enforcement
officers are frequently first to arrive on the scene of an emergency. When
officers have and are prepared to use naloxone, administration can occur before
other responders arrive, thus increasing the likelihood of effective overdose
reversal.

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In the US, naloxone was first distributed to people who use drugs in the 1990s
through underground programs in Chicago and San Francisco. Though various
initiatives were distributing the medication and access began increasing in 2010,
it was not until July of 2017 that all 50 states and the District of Columbia had
passed legislation to improve layperson access to naloxone.

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 FINAL CONSIDERATIONS
The opioid crisis is a current problem and will continue to be for
many years to come. We can hardly believe that something will
change or that someone will make a change to stop all overdoses and
the atrocities that people are transformed into after entering this world
of opioids.
However, these drugs do not only destroy the individuals involved,
but also their communities and families. Drugs cut them off from
everything that means reality, ending up not knowing who they really
are anymore, living only for the next line, pill or syringe. It distorts
their perception, distorts everything that could make them human and
turns them into opioid slaves.
When you choose to enter this world, getting out may seem
impossible. When money become the most important problem, you do
anything to be able to keep buying. You lose your house, your car,
your friends and even your family just for a few hours of euphoria.
The people you will bond with later, on the streets stained with traces
of opioids, will be your best friends and your most feared enemies in
equal measure. When the person next to you doesn't have drugs and
you do, he won't think of you as a friend but as a man who can satisfy
his need to have any kind of opioid in his blood, and then, even the
streets become bloody.

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 WEBLIOGRAPHY

https://www.asahq.org/madeforthismoment/pain-management/opioid-
treatment/what-are-opioids/#anchor5
https://n.neurology.org/content/92/15_Supplement/P4.9-055
https://www.washingtonpost.com/history/2021/12/01/opioid-crisis-civil-war-
addiction/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/opioid-use-
disorder
https://www.healthpartners.com/blog/a-full-time-job-in-hell-my-journey-in-and-
out-of-opioid-addiction/
https://sacopioidcoalition.org/personal-stories/
https://americanaddictioncenters.org/marijuana-rehab/mixing-weed-opioids
https://www.acpjournals.org/doi/full/10.7326/m20-1141

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