 Since the 2000s, and especially in the last few years, the use of opioids has exploded. Whenever we hear about the opioid crisis and make no mistake, it is a crisis. It's always in the context of the last few years. But opioids aren't some new drug that was whipped up in a lab, like amphetamines or LSD. To truly understand the crisis, we'll have to go back. Back to the past. Opioids are actually one of the world's oldest known drugs. There's archaeological evidence of humans using Popover somniferum, a seed that can be used to produce opium in the Italian and Iberian peninsulas dating back more than 7,000 years. An opium was used medically in Sumeria and Egypt during the 4th century BC. Even Hippocrates was a fan, enjoying its sleep-inducing properties. Our modern understanding of opioids stems from India and China in the early part of the 1500s, when it was reintroduced to Western Europe after it had been used in the Far East for at least several hundred years. After the British East India Company saw the opium trade as a worthwhile investment, they expanded production and, through secret importation into China, started the opium wars. In the 19th century, two major scientific advances were made that had far-reaching effects. The first, around 1804, the German pharmacist Friedrich Sirdener isolated morphine from opium. This would allow doctors to administer the drug to treat pain. And the second, nearly 50 years later, was the refinement of the hypodermic needle by Alexander Wood and others. Development of the syringe with the subcutaneous needle made it possible to easily administer controlled, measurable doses directly into the bloodstream. With these inventions, morphine was initially hailed as a wonder drug for its ability to ease pain, and its side effects could help people sleep and control coughing and diarrhea. In the 60s, the 1860s, doctors began widely prescribing morphine and pharmacists would dispense it without restriction. The American Civil War saw extensive use of the drug to treat injured soldiers and began to normalize its regular use. After further research into its side effects and addictive capabilities, the United States criminalized non-clinical use of opium in 1914. Yeah, before that you could use it non-clinically. The use of opioids was stigmatized in society, and it was seen as a dangerous substance to be prescribed only as a last resort for dying patients. After that, use drastically declined. It was actually so difficult to get that many people who needed it for severe pain couldn't get a prescription. Recognizing its oversip and changing course, in 1970, the US government passed the Controlled Substances Act, which relaxed some of the controls surrounding opioids and made their prescription easier. And in 1966, OxyContin was released, accompanied by an aggressive marketing campaign promoting the use of opioids for pain relief. The marketing campaign, coupled with now relaxed regulations, led to an explosion in opioid prescriptions. And as patients prescriptions ran out and they found themselves addicted, they were pushed into a growing black market for heroin. And in the 1990s, the crisis only continued as misrepresented research and big pharma pushed doctors into prescribing more aggressive painkillers like Oxycodone and Hydrocodone to try to treat pain. Nowadays, around 130 Americans die from opioid overdoses every day. That's 50% more than those who die in car crashes on all U.S. roadways combined. So what's the problem with opioids? Well, they're actually really good at fighting pain, maybe a little too good. Opioids work by attaching themselves to opioid receptors on nerve cells in parts of your body like the brain and spinal cord. When this happens, the opioids block pain messages sent from the body through the spinal cord to the brain. This is great for patients in extreme pain, like after a car crash or with extreme burns. The problem is your body builds tolerance to them pretty quickly, so you need more of the drug to control the same amount of pain. On top of that, opioids are very addictive. This is because neurons get used to the opioids blocking your opioid receptors and so they become more active to compensate for the drug-suppressing signals. Think of it like if you cover a sink faucet with your finger. The pressure starts to build as the path of the water is blocked, but once you move your finger, the floodgates come pouring open. So once you stop taking opioids, the cells can stay way more active than normal, causing you to be hypersensitive to pain and be easily agitated and anxious. Naturally, this pushes many people back onto opioids, legally or illegally, and it's a big part of why the risks of opioid use are supposed to be taken into consideration before they're prescribed and should only be used in extreme circumstances. But lately, many stories have come to light that have highlighted that doctors haven't been showing restraint in giving prescriptions, and pharma companies have had nearly no checks or balances in place to prevent abuse like in the case of the 21 million painkillers that were shipped to a town of 3,000 over the course of seven years. That's nearly three pills for every person in the town every day. And that story isn't unique. As these stories have come to light, regulators have started coming down harder on the companies that have allowed the opioid crisis to grow out of control, and is showing some signs of working. Use of prescription opioids such as OxyContin and Vicodin fell at a record rate last year. Individual opioid prescriptions in the United States peaked at 255 million in 2012. After that, the numbers have been falling steadily to 199 million by 2017. And prescription opioid use in the US was down 17% in 2018, marking the largest annual decline ever recorded. But while that sounds like a positive, it isn't really. As prescription numbers have dropped, drug deaths haven't because the epidemic just evolved. When government restrictions cut off tens of thousands from pills, people who were already addicted to the opioid high, many turned to street heroin. A surge of heroin into the United States was followed by an even deadlier arrival of fentanyl, an opioid 80 to 100 times stronger than morphine. As a result, in the United States in 2017, 47,000 people died of opioid overdoses, more than the death toll from traffic accidents or gun deaths. Normally, this is the part of the video where I tell you the positive, or how things are getting better. But as it stands, it's hard to see the path forward. As the government continues to crack down on prescription opioids, it's likely that fewer people will get addicted. But that doesn't do much to address the hundreds of thousands already addicted. Hopefully in a few years, we can make an update video on how the crisis was solved and things turned around. Until then, stay safe. And remember, there's always more to learn.