Opioid epidemic

The opioid epidemic refers the large number of people who have overdosed on prescription opioids. Pharmaeutical companies manufactured and marketed these highly addictive medicationsoriginally prescribed as pain medicationto physicians and the public as having a low potential for addiction. They continued these practices even after many people became addicted to and died from the drugs. While many types of opioids exist, the most common are Vicodin, OxyContin, fentanyl, and heroin. These are all synthetic opioids, which means they are manufactured. In this respect, they are unlike morphinea natural substance used for pain relief.

Over 700,000 people died from opioid overdoses in the United States and Canada between 1999 and 2024. In the US during the twenty-first century, many years saw an annual increase in the number of opioid deaths per yearccording to the National Center for Health Statistics (NCHS), more than 100,000 people died from opioid overdoses in the twelve-month period ending in September 2021, an increase of nearly 30 percent from the previous year. Over 81,000 opioid related deaths were reported in the US in 2023, a slight decrease over the previous year and the first time since 2018 that annual opioid deaths in the US decreased instead of increased.

While prescription opioids became difficult to obtain via prescription by the 2020s because physicians became aware of their high potential for addiction, addicts illegally purchase or steal the drugs or resort to using heroin, an illegal drug. To enhance their product, drug dealers cut their heroin with illicitly made fentanyl, a much more powerful drug that causes some users to overdose and die. By the 2020s fentanyl had become responsible for a large share of opioid deaths in the US.

In the 2020s, thousands of lawsuits have been filed against pharmaceutical and distribution companies who became aware of the dangers of using opioids but continued to profit from their manufacture and distribution. Some of these companies, such as Purdue Pharma and Johnson & Johnson, have agreed to pay billions of dollars to help end the opioid epidemic and treat those affected by it.

Overview

The term opioid describes a broad classification of drugs that work in the brain to produce a variety of effects, including pain release. Natural opioidssuch as morphineare made from poppy plants, which are grown in the mountains of southern Asia. Synthesized opioidssuch as fentanylare made in a laboratory.

Opioids travel through the blood and attach to receptors in brain cells that release endorphins. This gives people a sense of pleasure, suppressing their pain perception. Side effects of opioid use include slowed breathing, nausea, constipation, drowsiness, and confusion. To maintain the good feelings over time, higher and more frequent doses of opioids are needed.

Addiction

Many people who take opioids become addicted. This occurs when a drug that initially produces a pleasurable feeling becomes something users cannot live without. Experts describe drug addiction as an irresistible craving for a drug and a compulsion to seek it out even after becoming aware of its dangers. Opioids trigger the release of endorphins, hormones that make people feel good. This pleasurable feeling overcomes the perception of pain, which is why the drugs were prescribed. This desirable feeling ends, however, when the opioid wears off. To feel good again, a user must take more opioid pills. This is the first step to developing an addiction.

Regular consumption of opioids causes the body to produce fewer endorphins, making the experience less pleasurable for users. This is referred to as developing a tolerance to the opioidhe drug's dosage must be increased to regain the same pleasurable feeling.

Physicians in the 2020s are aware of the dangers of taking opioids and are reluctant to prescribe them, though they may prescribe opiods for patients in severe pain. However, even when they do prescribe opioids, they will not refill prescriptions or increase dosages. Patients who have become addicted may begin purchasing the opioids illegally or using heroin. Drugs purchased illegally may be combined with more powerful drugs. This compbination can be deadly, depending on the person’s body size and tolerancemany people have died after using heroin combined with fentanyl, which is at least eighty times stronger than morphine.

Risk Factors

Those who use opioids in a way other than what was prescribed are at a high risk of addiction. For example, some users crush pills so that opioid power can be snorted or injected. Others take more than an authorized dose or take an opioid more often than prescribed. The longer people take opioids, the higher their risk of addiction. Researchers believe those who take opioids for five consecutive days are likely to become addicted.

Other risk factors include past substance abusea family history of substance abuse, poverty and unemployment, mental illnesses such as severe depression or anxiety, and young age.

Further Insights

The opioid epidemic in the United States consists of three waves, or phases. The first wave started in the 1990s when pharmaceutical companies began researching new medications to treat pain. Concurrently, states began passing laws to make it easier for physicians to routinely prescribe medications to patients. In the United States, physicians’ salaries are determined by the number of patient visits. Writing a prescription for pain was an easy way to shorten visits and increase the number of patients seen each day. It was also cost-effective for patients because most health insurance plans covered pain medications but not nonpharmaceutical techniques such as physical therapy.

By the mid-1990s, pharmaceutical companies developed new opioid-based products, such as OxyContin, to relieve pain. These companies insisted that their synthetic opioids were safe and effective. They lobbied lawmakers, advertised heavily, and donated money to prestigious organizations to promote their products. They also sent pharmaceutical representatives to visit physicians. These individuals claimed that their new products were less addictive than morphine, a natural opioid that had been used to treat pain for decades.

First Wave

Many patients became addicted to opioids during the first wave, which lasted until 2010. Because laws regarding prescription medication were more lenient in some states than in others, people traveled to states with lax laws, accumulating many prescriptions and selling excess pills. By 2010, deaths from opioid overdoses had surpassed twenty thousand. In response, US federal and state agencies changed their policies to make it more difficult to obtain prescriptions. Purdue Pharma, the manufacturer of OxyContin, made the drug more difficult to crush and inhale. However, compolicateing the problem was the introduction of extended-released, long-lasting (ERLA) OxyContin. Users soon learned that they could receive the effects of a capsule all at once by crushing it and snorting or injecting the powder. The ERLA capsules have been blamed with facilitating users’ transition to heroin because they became accustomed to taking a higher dose and injecting the powder.

Second Wave

The second wave of the opioid epidemic began after 2010, when a significant increase in the supply of heroin decreased its price. The first and second waves are referred to as “intertwined epidemics” because those with a growing dependance on opioids easily transitioned to using heroin, which eased withdrawal symptoms and achieved the same high as opioids. According to the National Institute on Drug Abuse (NIDA), about 80 percent of heroin users first used opioids.

As people began using heroin, overdoses from this drug increased. From 2011, The start of the second wave began in 2011 as deaths from heroin overdoses began increasing. By 2015 heroin was responsible for the highest number of overdose deaths. According to the Centers for Disease Control and Prevention (CDC), deaths from heroin overdoses tripled during these four years.

Third Wave

The third wave began in 2013 when heroin dealers started cutting their product with illicitly manufactured fentanyl, a drug that is extremely powerful even in low doses. Legally manufactured fentanyl is rarely ever prescribed by physicians and only used in hospital settings to treat patients with late-stage cancer. The third wave is considered to have been the most dangerous because those who did not know that they were using fentanyl were at an extremely high risk of overdosing. According to the CDC, between 2013 and 2016, overdose deaths from fentanyl increased by 88 percent per year. By 2022, illicit fentanyl was frequently mixed with heroin and was also used in counterfeit pills and cocaine.

COVID-19 Pandemic

The COVID-19 global pandemic, which began in the United States in 2020, was linked to an increase in opioid overdoses and deaths. From 2019 to 2020, the number of deaths from opioids increased by more than 30 percent in the US. Researchers believed that people turned to opioids as well as alcohol and other drugs to help cope with the stress of the pandemic. Broken supply chains during the pandemic caused by illness posed an increased danger for opioid users. Buying opioids from new sources increased the risk of overdosing because the drugs may have been cut with fentanyl.

However, this inability to purchase drugs during the pandemic led some users to seek treatment. Furthermore, treatment was easier to acquire because remote services such as telehealth became available.

Viewpoints

Many states, municipalities, families, and individuals affected by the opioid epidemic filed lawsuits against pharmaceutical and distribution companies to recover damages. These lawsuits alleged that these companies caused the opioid epidemic by claiming that the drugs had a low risk of addiction. They also marketed the benefits of opioids without disclosing the risks. According to the lawsuits, pharmaceutical companies aggressively marketed their products directly to physicians without revealing their potential for addiction. They also failed to monitor, investigate, and report suspicious orders.

Purdue Pharma

Some of the first lawsuits were filed against Purdue Pharmabased in Stamford, Connecticut. Purdue Pharma is the manufacturer of OxyContin and owned by the billionaire Sackler family. While the Sacklers admitted no wrong-doing, Purdue Pharma and some of its executives pled guilty in 2007 and again in 2020 to federal charges relating to its salespersons lying about OxyContin’s potential for addiction. Members of the Sackler family were on the company’s board at the time and allegedly urged executives to increase sales of OxyContin even though it was responsible for many overdoses and deaths.

In March 2022 during a virtual Zoom bankruptcy hearing, families of victims of the opioid epidemic were allowed to confront members of the Sackler family. These included seventy-seven-year-old Dr. Richard Sackler, a former president and chair of the board. Also in attendance was forty-one-year-old David Sackler, a former board member, and seventy-seven-year-old Dame Theresa Sackler, the widow of founder Dr. Mortimer Sackler. Among the family members who addressed the Sacklers was a mother whose son was prescribed OxyContin in high school for a knee injury and told by his doctor to take it every four hours regardless of whether he was in pain. Her son was also told to take the drug for months after the injury. He became addicted and died of an overdose ten years later. Others shared similar stories.

Earlier in the month, the Sacklers reached a deal with states in which they agreed to pay $6 billion to help communities address the opioid crisis. In return, they would not have to face current and future civil claims although they may still be criminally charged. Purdue Pharma was ordered to pay $1.5 billion by 2024. The company was also expected to be renamed and overseen by a public board.

However, in late June 2024, the United States Supreme Court, in a 5–4 decision, struck down this agreement. This Supreme Court decision removed the immunity offered to individual members of the Sackler family under the earlier plea deal, though it also created uncertainty about the financial compensation offered to victims of the opioid crisis by placing on hold the financial settlement the Sacklers and Purdue Pharma had previously agreed to pay.

Other Companies

In 2021, three major drug distributors and a pharmaceutical company agreed to pay $26 billion to settle thousands of civil claims related to the opioid epidemic. The distributors McKesson, Cardinal Health, and Amerisource Bergen agreed to pay a combined $21 billion over eighteen years. The companies were accused of being aware that the opioids they were distributing were being sold illegally. Johnson & Johnson, a pharmaceutical company, agreed to pay $5 billion over five years in damages for selling its prescription opioid medications. At least 85 percent of the money collected will be used for addiction treatment and prevention services.

Pharmacies

In October 2021, a federal jury found three of the country’s largest pharmacies liable for playing a role in the opioid crisis. Jurors concluded that CVS, Walgreens, and Walmart dispensed enormous quantities of prescription opioids in two counties in Ohio. This decision is expected to set precedence for thousands of other lawsuits throughout the United States. The pharmacies claimed to have done nothing wrong because the drugs they dispensed were legally prescribed. Attorneys for the counties in Ohio believe that the pharmacies were aware that at least some of the medications they dispensed were being sold on the black market. A future legal proceeding will take place to determine how much money the companies will be ordered to pay to help remedy the crisis.

The Future

Most experts contend that deaths from fentanyl will continue to rise unless lawmakers take action to reduce both supply and demand. Most fentanyl is trafficked into the United States by Mexican drug cartels, but chemicals needed to manufacture it come from China. This illicit fentanyl is either sold pure or mixed with other drugs. The US Drug Enforcement Agency must make it more difficult for dealers to get this drug into the country, which is no easy task. The Mexican government has little power of the cartels manufacturing the drug, and because the demand opioids in the United States is high, many people are employed by the cartels. From 2019 to 2021, US law enforcement seized 7,710 pounds of fentanyl—but this is only a portion of the amount trafficked into the country.

Reducing drug demand is key since the drug will not be trafficked into the United States unless a market exists for it. The CDC recommends implementing educational programs to make all people, young and old, aware of the dangers of opioids. The CDC also stresses the importance of naloxone in fighting the war against opioid addiction. Naloxone is a non-addictive opioid-reversing drug that can help people who are overdosing. Naloxone manufacturers need to make the product accessible and affordable.

The government and health insurance companies also need to ensure that everyone who needs treatment for opioid addiction receives it quickly. According to the American Medical Association (AMA), more than 90 percent of doctors reported delays in treatment for patients waiting for approval from health insurance companies. Many said that patients whose treatment is delayed forego receiving treatment altogether. The AMA also contends that courts, jails, and prisons must treat those with opioid addictions, or they are at risk of overdosing while incarcerated.

Measures to reduce opioid addiction began to show positive effects. According to the National Center for Health Statistics, 2023 deaths from drug overdoses totaled 107,500. Although this represented a high number of fatalities, it remained a decline of 4 percent and the first such decrease since 2018. The smaller number of overdoses was attributed to a slight downturn in fentanyl consumption. In addition, law enforcement efforts resulted in the seizure of 115 million illegal pills containing fentanyl. This was an increase of 44 million pills from the previous year. These results were nuanced as overdose deaths were still double their number from 2019. In addition, deaths from cocaine in 2023 rose 5 percent and those from methamphetamines an additional 2 percent.

About the Author

Adrienne Kennedy holds bachelor’s degrees in communications and secondary education from King’s College and a master’s degree in English from the University of Scranton. She is a former college instructor and has worked in educational publishing for more than twenty years. She is also a published author of both nonfiction and fiction.

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