What Are the Origins of the US Opioid Crisis, and How to Fix It

The opioid epidemic in the US is gaining ground. Also referred to as the opioid crisis, it is “one of the most devastating public health catastrophes of our time,” according to Professor Howard Koh, of the Stanford-Lancet Commission on the North American Opioid Crisis. The year 2021 was a bleak year for drug overdose statistics, with overdose-related deaths reaching an unprecedented100,000 – a 15% increasefrom the previous year. Judging by the current tendencies, a report issued in February by the same Stanford-Lancet Commission, estimates that if nothing is done, 1.2 million North Americans will die of opioid overdose before the decade is out.To make matters worse, only 11 percent of Americans with an addiction end up seeking treatment at rehab or a luxury addiction treatment center.

The situation is so dire that in December 2021, President Biden changed the status of the opioid crisis from a public health emergency to full-on national emergency. This drastic measure begs the question: how did opioids end up wreaking such havoc right across the United States, that they are deemed a threat to the entire nation? To answer this question, we must go right back to whenpotentially addictive, and highly habit-forming opioid medications, appeared on the prescription drug landscape in the mid-1990s.

Prescription Opioid Painkillers

The first opiate to be used medically as a painkiller was morphine, a naturally occurring substance contained in opium, the brown resin found in poppies. It was widely employed by doctors in the American Civil War, then again in WWI, and was still in use as late as WWII. While extremely effective, morphine was found to be highly addictive, which prompted pharmaceutical research to focus on developing opioids that could be used safely for pain relief, without this potential for misuse as a side-effect.

In the 1990s, modern pharmaceutical companies were producing large quantities of opioid pain-relief medications, which they claimed – misleadingly, as it turns out – were indeed safe for patients to take without risking becoming addicted. Thus reassured, healthcare providers began happily prescribing these medications with increasing frequency. This led to what is often known as the first wave of the opioid epidemic – a surge in widespread misuse of prescription opioids.

Feeding an opioid use disorder (OUD) from prescription opioids is complicated – for a start, opioid painkillers are not available without a medical prescription. Many people struggling with addiction to prescription meds began to join the ranks of other non-medical opioid users, and to take substances like heroin – to which many became addicted as well. This expansion of the heroin market marked the second wave of the crisis, and paved the way for the third.

Growing Availability of Fentanyl

With significant numbers of Americans already regular consumers of illegal drugs, all it took was the introduction of new and more potent substances on the street drug market for the opioid epidemic to enter its third, most lethal, and most sizable wave. Powerful and synthetic opioids, such as the deadly drug fentanyl, which is 50 times more powerful than heroin, began to circulate. Most fentanyl and similar illicit opioids are produced by Mexican cartels, who source the basic chemicals required for their manufacture from countries such as China and, to a lesser extent, India.

Around 2013, the use of fentanyl started growing, and besides being dangerous to use, it’s much cheaper to produce. Increasing use of fentanyl marked the start of the most threatening phase in the opioid epidemic. The drug has caused a rapid increase in the number of overdose-related deaths and undermined efforts to end the decades-long opioid addiction crisis. The number of opioid-related deaths grew to a large extent until 2018, after which there was a decline for the first time.

The pandemic, which struck towards the end of 2019, led to the rise of fentanyl use. With Americans spending more time at home, feelings of isolation and boredom drove them to use illegal drugs. In 2021, the rate of fentanyl-related deaths was at its highest. There were 80,000 cases of opioid overdoses in this year, and 88 percent of these could be attributed to fentanyl.

And the lethal drug isn’t just affecting people struggling with opiate addiction, but marijuana, methamphetamine, and cocaine users as well. In fact, any person who takes illicit substances is at risk of fentanyl exposure. Initially, pharmaceutical fentanyl was developed for use as a painkiller during surgeries. Now, illicitly manufactured fentanyl is a commonly available and cheap street drug.

It’s becoming common to mix fentanyl with other illicit drugs to strengthen their effects. Meanwhile, some manufacturers use it to make counterfeits of common prescription opioids. Now that it’s so abundant in the market for illicit street drugs, unsuspecting cocaine or marijuana users are at risk of experiencing a fatal overdose due to the drugs they take.

HHS 5-Point Strategy to Combat the Opioid Crisis

In 2017, after it declared a health emergency, the US Department of Health and Human Services announced a 5-point strategy to try and address the situation. However,the COVID-19 pandemic,which struck towards the end of 2019, created an unexpected and impactful aggravating factor. Substance abuse and opioid-related fatalities rose abruptly during the first months of the pandemic, and stemming the tide of ever-increasing overdose deaths has become one of the most urgent objectives of any strategy to fight the epidemic.

Measures to help protect the drug-using community, as well as vulnerable and underprivileged sections of society, from further harm focus mainly on the following:

● Primary prevention: this begins by spreading awareness – not only of the dangers of synthetic opioids (few people know, for example, that an amount of fentanyl equivalent to a few grains of salt could kill them), but also of where and who to turn to when in need of help.

● Harm-reduction: this is aimed at those currently actively taking drugs, and includes facilitating access to clean syringes (and safely disposing of used needles), and providing fentanyl strips to test whether drugs purchased contain this dangerous substance. At a wider level, it involves helping de-stigmatize drug misuse, which is a recognized medical condition, and not a moral failing.

● Evidence-based treatment: appropriate treatment needs to be rapidly accessible to those in need. An important point that has come to light is that the best addiction treatment outcomes are associated with longer treatment. It is important that patients be able to see their treatment through to completion.

● Recovery support: this includes anything from halfway houses to clinical aftercare. Peer support groups are also of the utmost importance.

Alongside improving access to the above services, drugs such as naloxone, which can reverse the effects of opioid overdose, must be made more widely available. The HHS also wants to support research into other, non-opioid medications and treatment modalities that can be used to manage severe pain.

From the Individual to the Collective

For long-term success in curbing opioid misuse, and preventing the loss of further lives through overdose, prevention must begin with children and the younger generations, on an individual and family level. The public health community and educational establishments can work together to support a generation of more informed, resilient young citizens.

On a more collective level, comprehensive substance use disorder treatment needs to become fully integrated into mainstream healthcare.

By replacing opioid painkillers with other, non-addictive types of medication – as well as supporting treatment modalities that do not rely primarily on meds (many exist already) – legal prescriptions would no longer risk leading people down the path of addiction. Once circulation of illegal opioids is effectively kept under control, reasons for optimism, of which there are, in fact, many, will continue to increase.