The U.S. Opioid Epidemic: Causes, Statistics, and Solutions

Introduction

It is hard to believe that a pretty flower could be responsible for ruining so many lives, but in fact the opioid crisis can indirectly be traced to the story of the opium poppy. This remarkable plant provides one of the world's most — arguably the most — effective pain relievers. The opium poppy has been used for therapeutic and recreational purposes for thousands of years, and has even led to major global conflicts like the Opium Wars. Since the advent of modern chemistry, scientists have been able to synthesize the compounds found in the opium plant and to develop related compounds for pain relief. Those compounds are collectively referred to as opioids, to differentiate them from naturally derived opium. Opioids do, however, include the most notorious member of their class: heroin.

As many lives as heroin itself has destroyed, even more people have died from overdoses of other opioids. Unlike heroin, the opioids fueling the recent epidemic are legal drugs — drugs prescribed each and every day by doctors across the country and around the world, without adequate regard for the fact that opioids are narcotics. Narcotics are powerful drugs with tremendous benefits, but they are also among the most addictive substances on the planet. The story of heroin seems far less sinister compared with the current opioid crisis, which involves deceit and hypocrisy at institutional levels. As more information surfaces about the ways pharmaceutical companies and doctors have liberally prescribed opioids, it is likely that major lawsuits and public policy initiatives will follow — much as they did with the tobacco industry.

The current opioid crisis has been officially defined as a public health epidemic by major organizations such as the National Institutes of Health and the Centers for Disease Control and Prevention. Pharmaceutical companies and the healthcare system shoulder the majority of the burden for this crisis; drug-related overdoses are now the leading cause of death in the United States. Responding to the opioid crisis requires a multifaceted approach, and may need to follow a trajectory similar to the one used to reduce the prevalence of smoking-related illnesses.

What Are Opioids?

Opioids refer to a class of drugs derived from the chemical compounds originally found in the opium poppy. Synthetic opioids include everything from illegal heroin to a wide range of legal prescription medications. All opioids are effective for pain relief, and opiate compounds may also appear in other prescription drugs such as Imodium. Many compounds in opioids are also manufactured endogenously by the human body, albeit in far lower quantities than would be consumed when taking prescription opioids (Case-Lo, 2017).

Some of the most commonly prescribed opioids include codeine, oxycodone, morphine, methadone, hydrocodone (Vicodin), fentanyl, and meperidine (Demerol). Collectively, this class of drugs is also referred to as narcotics. Both heroin and fentanyl are frequently manufactured illegally, contributing significantly to the opioid epidemic (CDC, 2019). Opioids are legal drugs, which illustrates how the war on drugs is not an effective framework for harm reduction. Because opioids are essential for treating severe short-term pain, they will remain legal. However, they should not be used in situations involving chronic pain or in patients with a history or predisposition to addiction. Many alternatives to opioids exist and can be incorporated into a broader harm reduction strategy.

Causes of the Current Opioid Crisis

Addiction to opioids is far from a new phenomenon. Humans have consumed opioids in some form for millennia, but the ability to synthesize these compounds has led to a proliferation of drugs in this category. Many, if not most, opioids do have genuine clinical benefits — most notably the alleviation of pain. The cause of the opioid crisis is not the drug itself, which remains necessary in many contexts. Rather, the crisis can be traced to unethical practices in both the healthcare and pharmaceutical industries.

According to the U.S. Department of Health and Human Services (2019), pharmaceutical companies must take responsibility for creating the current opioid crisis. Especially since the 1990s, pharmaceutical companies "reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates" (U.S. Department of Health and Human Services, 2019, p. 1). Much as tobacco companies had knowingly lied about the dangers of tobacco, pharmaceutical companies have systematically avoided full disclosure about the potentially disastrous public health outcomes of opioid overuse. Physicians and other healthcare workers must also shoulder some of the blame, given that the addictive nature of opioids has been recognized for centuries.

Only recently has the culpability of major pharmaceutical companies come to light in the courts. An Oklahoma judge ruled in 2019 that Johnson & Johnson "has blood on its hands for driving America's opioid epidemic" (McGreal, 2019, p. 1). Johnson & Johnson, predictably, deflected responsibility, casting blame on "Mexicans, doctors, and inevitably, the victims themselves" (McGreal, 2019, p. 1). Physicians do bear some responsibility, given that it is their duty to review the science, published literature, and all available evidence concerning the risks of any substance they prescribe. Both doctors and the pharmaceutical industry are primarily responsible for the current crisis. During the 2000s, there was a notable "surge" in the "prescribing of narcotic painkillers as a long-term treatment for even minor pain" (McGreal, 2019, p. 1). There is no defensible logic in prescribing a powerful narcotic for minor pain when low-cost and non-addictive alternatives exist. The fact that legally manufactured prescription drugs, prescribed by trained physicians, are the leading cause of drug-related mortality in the United States seriously undermines the credibility of the war on drugs — in short, legal drugs have become the leading drug-related public health problem.

Conclusion

Finally, responding to the opioid crisis requires effective, immediately implemented harm reduction strategies to reduce overdose deaths. Naloxone and other overdose reversal options should be available over the counter. Naloxone could even be proactively provided to anyone currently taking prescription or illicit opioids, enabling friends and family members to intervene in an emergency. The WHO (2018) recommends that anyone who knows a person at risk for overdose have access to naloxone.

The opioid epidemic represents a failure of the American healthcare system. It is largely a preventable problem that can be addressed through effective public policy. Framed in financial terms alone, the opioid crisis is unsustainable — it drains both human and financial resources. It is also a profound humanitarian crisis. Responding to it will take time. Banning opioids outright is not a viable solution, as they remain critical for pain relief in many clinical contexts. The most effective response will be to restructure the healthcare system so that greater legal responsibility is placed on pharmaceutical companies and healthcare institutions.

The first step in reducing opioid-related deaths is to comprehensively raise awareness and improve knowledge about how to identify early warning signs of addiction, how to wean patients off opioids using proven interventions, and how to respond to an overdose in order to prevent death. The second step is to thoroughly re-educate healthcare professionals. Physicians and others who are legally authorized to prescribe opioids must take responsibility for their complicity in the crisis. Physicians and nurses need to collaborate in screening patients for addiction risk factors and in determining when opioids are truly necessary versus when alternative methods of pain relief would suffice.