More than 3,000 years ago, a flower began to appear in remedies in Ancient Egyptian medical texts.
Across the Mediterranean, the ancient Minoans likely found ways to use the same plant for its high.
Both ancient civilizations were on to something— opium, an extract of the poppy in question, can both induce pleasure and reduce pain.
Though opium has remained in use ever since, it wasn’t until the 19th century that one of its chemical compounds, morphine, was identified and isolated for medical use.
Morphine, codeine, and other substances made directly from the poppy are called opiates.
In the 20th century, drug companies created a slew of synthetic substances similar to these opiates, including heroin, hydrocodone, oxycodone, and fentanyl.
Whether synthetic or derived from opium, these compounds are collectively known as opioids.
Synthetic or natural, legal or illicit, opioid drugs are very effective painkillers, but they are also highly addictive.
In the 1980s and 90s, pharmaceutical companies began to market opioid painkillers aggressively, actively downplaying their addictive potential to both the medical community and the public.
The number of opioid painkillers prescriptions skyrocketed, and so did cases of opioid addiction, beginning a crisis that continues today.
To understand why opioids are so addictive, it helps to trace how these drugs affect the human body from the first dose, through repeated use, to what happens when long-term use stops.
Each of these drugs has slightly different chemistry, but all act on the body’s opioid system by binding to opioid receptors in the brain.
The body’s endorphins temper pain signals by binding to these receptors, and opioid drugs bind much more strongly, for longer.
So opioid drugs can manage much more severe pain than endorphins can.
Opioid receptors also influence everything from mood to normal bodily functions.
With these functions, too, opioids’ binding strength and durability mean their effects are more pronounced and widespread than those of the body’s natural signaling molecules.
When a drug binds to opioid receptors, it triggers the release of dopamine, which is linked to feelings of pleasure and may be responsible for the sense of euphoria that characterizes an opioid high.
At the same time, opioids suppress the release of noradrenaline, which influences wakefulness, breathing, digestion, and blood pressure.
A therapeutic dose decreases noradrenaline enough to cause side effects like constipation.
At higher doses opioids can decrease heart and breathing rates to dangerous levels, causing loss of consciousness and even death.
Over time, the body starts to develop a tolerance for opioids.
It may decrease its number of opioid receptors, or the receptors may become less responsive.
To experience the same release of dopamine and resulting mood effects as before, people have to take larger and larger doses— a cycle that leads to physical dependence and addiction.
As people take more opioids to compensate for tolerance, noradrenaline levels become lower and lower, to a point that could impact basic bodily functions.
The body compensates by increasing its number of noradrenaline receptors so it can detect much smaller amounts of noradrenaline.
This increased sensitivity to noradrenaline allows the body to continue functioning normally— in fact, it becomes dependent on opioids to maintain the new balance.
When someone who is physically dependent on opioids stops taking them abruptly, that balance is disrupted.
Noradrenaline levels can increase within a day of ceasing opioid use.
But the body takes much longer to get rid of all the extra noradrenaline receptors it made.
That means there’s a period of time when the body is too sensitive to noradrenaline.
This oversensitivity causes withdrawal symptoms, including muscle aches, stomach pains, fever, and vomiting.
Though temporary, opioid withdrawal can be incredibly debilitating.
In serious cases, someone in withdrawal can be violently ill for days or even weeks.
People who are addicted to opioids aren't necessarily using the drugs to get high anymore, but rather to avoid being sick.
Many risk losing wages or even jobs while in withdrawal, or may not have anyone to take care of them during withdrawal.
If someone goes back to using opioids later, they can be at particularly high risk for overdose, because what would have been a standard dose while their tolerance was high, can now be lethal.
Since 1980, accidental deaths from opioid overdose have grown exponentially in the United States, and opioid addictions have also exploded around the world.
While opioid painkiller prescriptions are becoming more closely regulated, cases of overdose and addiction are still increasing, especially among younger people.
Many of the early cases of addiction were middle-aged people who became addicted to painkillers they had been prescribed, or received from friends and family members with prescriptions.
Today, young people are often introduced to prescription opioid drugs in those ways but move on to heroin or illicit synthetic opioids that are cheaper and easier to come by.
Beyond tighter regulation of opioid painkillers, what can we do to reverse the growing rates of addiction and overdose?
A drug called naloxone is currently our best defense against overdose.
Naloxone binds to opioid receptors but doesn’t activate them.
It blocks other opioids from binding to the receptors, and even knocks them off the receptors to reverse an overdose.
Opioid addiction is rarely a stand-alone illness; frequently, people with opioid dependence are also struggling with a mental health condition.
There are both inpatient and outpatient programs that combine medication, health services, and psychotherapy.
But many of these programs are very expensive, and the more affordable options can have long waiting lists.
They also often require complete detoxification from opioids before beginning treatment.
Both the withdrawal period and the common months-long stay in a facility can be impossible for people who risk losing jobs and housing in that timeframe.
Opioid maintenance programs aim to address some of these obstacles and eliminate opioid abuse using a combination of medication and behavior therapy.
These programs avoid withdrawal symptoms with drugs that bind to opioid receptors but don’t have the psychoactive effects of painkillers, heroin, and other commonly abused opioids.
Methadone and buprenorphine are the primary opioid maintenance drugs available today, but doctors need a special waiver to prescribe them— even though no specific training or certification is required to prescribe opioid painkillers.
Buprenorphine can be so scarce that there’s even a growing black market for it.
There’s still a long way to go with combating opioid addiction, but there are great resources for making sense of the treatment options.
If you or someone you know is struggling with opioid use in the United States, the Department of Health and Human Services operates a helpline: +1-630-534-0510 and a database of more than 14,000 substance abuse facilities in the US: www.hhs.gov/opioids
In Kenya, 1984 is known as the year of the cup, or the goro goro.
The goro goro is a cup used to measure two kilograms of maize flower on the market, and the maize flower is used to make ugali, a polenta-like cake that is eaten together with vegetables.
Both the maize and the vegetables are grown on most Kenyan farms, which means that most families can feed themselves from their own farm.
One goro goro can feed three meals for an average family, and in 1984, the whole harvest could fit in one goro goro.
It was and still is one of the worst droughts in living memory.
Now today, I insure farmers against droughts like those in the year of the cup, or to be more specific, I insure the rains.
I come from a family of missionaries who built hospitals in Indonesia, and my father built a psychiatric hospital in Tanzania.
This is me, age five, in front of that hospital.
I don't think they thought I'd grow up to sell insurance.
(Laughter) So let me tell you how that happened.
In 2008, I was working for the Ministry of Agriculture of Rwanda, and my boss had just been promoted to become the minister.
She launched an ambitious plan to start a green revolution in her country, and before we knew it, we were importing tons of fertilizer and seed and telling farmers how to apply that fertilizer and plant.
A couple of weeks later, the International Monetary Fund visited us, and asked my minister, "Minister, it's great that you want to help farmers reach food security, but what if it doesn't rain?"
My minister answered proudly and somewhat defiantly, "I am going to pray for rain."
That ended the discussion.
On the way back to the ministry in the car, she turned around to me and said, "Rose, you've always been interested in finance.
Go find us some insurance."
It's been six years since, and last year I was fortunate enough to be part of a team that insured over 185,000 farmers in Kenya and Rwanda against drought.
They owned an average of half an acre and paid on average two Euros in premium.
It's microinsurance.
Now, traditional insurance doesn't work with two to three Euros of premium, because traditional insurance relies on farm visits.
A farmer here in Germany would be visited for the start of the season, halfway through, and at the end, and again if there was a loss, to estimate the damages.
For a small-scale farmer in the middle of Africa, the maths of doing those visits simply don't add up.
So instead, we rely on technology and data.
This satellite measures whether there were clouds or not, because think about it: If there are clouds, then you might have some rain, but if there are no clouds, then it's actually impossible for it to rain.
These images show the onset of the rains this season in Kenya.
You see that around March 6, the clouds move in and then disappear, and then around the March 11, the clouds really move in.
That, and those clouds, were the onset of the rains this year.
This satellite covers the whole of Africa and goes back as far as 1984, and that's important, because if you know how many times a place has had a drought in the last 30 years, you can make a pretty good estimate what the chances are of drought in the future, and that means that you can put a price tag on the risk of drought.
The data alone isn't enough.
We devise agronomic algorithms which tell us how much rainfall a crop needs and when.
For example, for maize at planting, you need to have two days of rain for farmers to plant, and then it needs to rain once every two weeks for the crop to properly germinate.
After that, you need rain every three weeks for the crop to form its leaves, whereas at flowering, you need it to rain more frequently, about once every 10 days for the crop to form its cob.
At the end of the season, you actually don't want it to rain, because rains then can damage the crop.
Devising such a cover is difficult, but it turned out the real challenge was selling insurance.
We set ourselves a modest target of 500 farmers insured after our first season.
After a couple of months' intense marketing, we had signed up the grand total of 185 farmers.
I was disappointed and confounded.
Everybody kept telling me that farmers wanted insurance, but our prime customers simply weren't buying.
They were waiting to see what would happen, didn't trust insurance companies, or thought, "I've managed for so many years.
Why would I buy insurance now?"
Now many of you know microcredit, the method of providing small loans to poor people pioneered by Muhammad Yunus, who won the Nobel Peace Prize for his work with the Grameen Bank.
Turns out, selling microcredit isn't the same as selling insurance.
For credit, a farmer needs to earn the trust of a bank, and if it succeeds, the bank will advance him money.
That's an attractive proposition.
For insurance, the farmer needs to trust the insurance company, and needs to advance the insurance company money.
It's a very different value proposition.
And so the uptick of insurance has been slow, with so far only 4.4 percent of Africans taking up insurance in 2012, and half of that number is in one country, South Africa.
We tried for some years selling insurance directly to farmers, with very high marketing cost and very limited success.
Then we realized that there were many organizations working with farmers: seed companies, microfinance institutions, mobile phone companies, government agencies.
They were all providing loans to farmers, and often, just before they'd finalize the loan, the farmer would say, "But what if it doesn't rain?
How do you expect me to repay my loan?"
Many of these organizations were taking on the risk themselves, simply hoping that that year, the worst wouldn't happen.
Most of the organizations, however, were limiting their growth in agriculture.
They couldn't take on this kind of risk.
These organizations became our customers, and when combining credit and insurance, interesting things can happen.
Let me tell you one more story.
At the start of February 2012 in western Kenya, the rains started, and they started early, and when rains start early, farmers are encouraged, because it usually means that the season is going to be good.
So they took out loans and planted.
For the next three weeks, there wasn't a single drop of rain, and the crops that had germinated so well shriveled and died.
We'd insured the loans of a microfinance institution that had provided those loans to about 6,000 farmers in that area, and we called them up and said, "Look, we know about the drought.
We've got you.
We'll give you 200,000 Euros at the end of the season."
They said, "Wow, that's great, but that'll be late.
Could you give us the money now?
Then these farmers can still replant and can get a harvest this season."
So we convinced our insurance partners, and later that April, these farmers replanted.
We took the idea of replanting to a seed company and convinced them to price the cost of insurance into every bag of seed, and in every bag, we packed a card that had a number on it, and when the farmers would open the card, they'd text in that number, and that number would actually help us to locate the farmer and allocate them to a satellite pixel.
A satellite would then measure the rainfall for the next three weeks, and if it didn't rain, we'd replace their seed.
One of the first — (Applause) — Hold on, I'm not there!
One of the first beneficiaries of this replanting guarantee was Bosco Mwinyi.
We visited his farm later that August, and I wish I could show you the smile on his face when he showed us his harvest, because it warmed my heart and it made me realize why selling insurance can be a good thing.
But you know, he insisted that we get his whole harvest in the picture, so we had to zoom out a lot.
Insurance secured his harvest that season, and I believe that today, we have all the tools to enable African farmers to take control of their own destiny.
No more years of the cup.
Instead, I am looking forward to, at least somehow, the year of the insurance, or the year of the great harvest.
Thank you.
(Applause)