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A Series on the Opioid Crisis – Part II: How Did We Get Here?

June 22 2018 | Blog
  • Just like any complex problem, the American opioid crisis stems from many different factors, each contributing to the current situation in a unique way. Understanding these factors may ultimately help to encounter a more permanent solution.

    According to a forecast by STAT, a health news website, “opioids could kill nearly half a million people across America over the next decade as the crisis of addiction and overdose accelerates”. In order to prevent this, it is essential to know from where this problem stems and what made it escalate to such a massive scale in a relatively short period. Experts point to at least three causes. Each of them is complex in its own right.

    The Role of Big Pharma

    The first cause is related to changes that occurred in the healthcare industry in the late 1990s. Doctors and medical providers were facing pressure to treat pain more effectively. This coincided with (and in the opinion of many was a direct consequence of) Big Pharma’s push for a wider distribution of opioid painkillers. Aggressive marketing campaigns, which included articles in respected medical journals, highlighted the benefits of opioids in treating pain. At the same time, pharmaceutical companies would either fail to mention the addictive potential of these drugs or even go as far as to assure users that such potential did not even exist. For example, in 1998, Purdue Pharma – a drug manufacturer – started a campaign to promote OxyContin, a pain-relief medicine which at the time was still relatively new and was being marketed as working wonders for all kinds of pain. Purdue Pharma distributed 15,000 copies of a promotional video of the drug to physician’s waiting rooms. A year later, the number of prescriptions for opioid painkillers surged by 11 million. OxyContin remains one of the most popular prescription pain-relief medications.

    Generational Dynamics

    The second cause has to do with to the generational characteristics of the demographics most often affected by opioid addiction. In last week’s article, we mentioned that virtually every classification of individuals are being affected by the epidemic. While this is true, Forbes magazine reports that overdose rates in the last two decades have risen the most among the second half of the Baby Boomer generation (those currently aged 55 to 65) while overall death rates are highest among early members of generation X (currently aged 45 to 54). Some experts see a direct connection between the Boomers current struggle with addiction to opioids and their youth, when experimenting with mind-altering substances was the norm and taking risks was viewed as somewhat of an ethos. In addition, the Boomers are now the aging generation which means that chronic pain is a part of their daily experience. This alone makes them prone to reach for ever stronger pain-relief medicine. And with aging comes a lower ability to metabolize the addictive agents found in the drugs. These factors may explain why the Boomers are more likely to become addicts and overdose on opioids.

    Illegal Drug Market

    A third cause of the escalation of this epidemic and the high mortality rate associated with it, is a booming illegal drug market. A number of studies1 suggest that many people who started out using prescription opioid drugs later moved on to stronger opioids such as heroin or fentanyl and its analogs.2 The most deadly analog of fentanyl, carfentanil, is chiefly used as an elephant tranquilizer. With a potency 5,000 times greater than that of heroin, the risk of overdose is high, yet drug traffickers use this drug to make counterfeits of prescription medications and add it to other drugs such as cocaine.

    This review of the recent history of the opioid crisis seems to indicate that considerable responsibility falls on pharmaceutical companies. In the next blog in the series, we will review the legal ramifications of this situation and the most recent legal developments related to it.


    1) See also: The Changing Face of Heroin Use in the United States, a study published in the JAMA Psychiatry medical journal as well as Today’s Heroin Epidemic by the Centers for Disease Control and Prevention (CDC)

    2) According to one dictionary, a drug analog is “a drug or other chemical compound that resembles another in structure or constituents but has different effects”.

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