Problem Spotlight: The opioid crisis

Problem Spotlight: The opioid crisis

More than 100 people die from opioid overdoses each day in the United States. Just this week, the National Safety Council’s analysis of preventable deaths identified opioid overdose as the No. 1 cause of unintentional death; for the first time, Americans are more likely to die from an opioid overdose than a vehicle crash.

What are opioids?

“Opioids are drugs formulated to replicate the pain-reducing properties of opium. They include both legal painkillers like morphine, oxycodone, or hydrocodone prescribed by doctors for acute or chronic pain, as well as illegal drugs like heroin or illicitly made fentanyl.” (CNN)

How we got here

The history of pain management is relatively recent, and until the late 20th century, pain was severely undertreated. Early discoveries of pain management treatments for postoperative cancer in the 1990s led to new applications and strict standards of management for a wide spectrum of acute and chronic pain. As it turns out, opioids are good at getting rid of all kinds of pain — almost too good. This newfound desire to eliminate pain — instead of manage it — led to overprescription and widespread misuse of opioids.

“In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.” (National Institute on Drug Abuse)

Prosecutors and investigative journalists are still uncovering details of how Purdue Pharma, makers of the prescription painkiller OxyContin, deceptively marketed the drug and concealed knowledge of growing abuse. A number of states have filed lawsuits against Purdue Pharma, as well as other drugmakers and distributors.

Chart showing increasing U.S. drug overdose deaths from opioids 2010-2017

This increasing pressure — along with better awareness of the value of pain and the options for managing it — has led to a declining number of opioid prescriptions and supported attempts to reduce the number of new drug users. But suppliers of illicit drugs — heroin and black-market fentanyl — have rushed in to fill the void for those who already use opioids. Fentanyl, a synthetic opioid that’s 100 times more powerful than morphine, is driving dramatic increases in overdose deaths.

“Overdose deaths are higher than deaths from H.I.V., car crashes, or gun violence at their peaks. The data also show that the increased deaths correspond strongly with the use of synthetic opioids known as fentanyls. Since 2013, the number of overdose deaths associated with fentanyls and similar drugs has grown to more than 28,000, from 3,000. Deaths involving fentanyls increased more than 45 percent in 2017 alone.” (The New York Times)

Illegal drug dealers are increasingly selling opioids laced with fentanyl. The unpredictable potency makes these drugs even more dangerous, and first responders say it’s increasingly difficult to reverse overdoses. Illicit fentanyl is often purchased online and shipped directly to buyers; China is the largest source, but packages can come from anywhere, and the small parcels are difficult to detect.

What’s at stake

The number of deaths, though staggering, is not the only result of the crisis. More than 4 million people are “nonmedical users” of painkillers and an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers.

Opioid addiction is impacting millions of families — and their extended communities — across the country. Children and teens are increasingly at risk of accidental exposure and overdose. The steep increase in overdose deaths has led to an unprecedented decline in American life expectancy.

In 2015, nearly 1 million people were absent from the workforce due to opioids, and over the past two decades, lost productivity has cost the U.S. economy more than $700 billion.

Potential solutions

If you ask 30 experts, you’ll get 30 different ideas for how to approach the problem. And with a crisis this big, it makes sense to identify multiple angles and pursue many possible solutions.

The federal government’s Initiative to Stop Opioid Abuse is focusing on three areas: reducing demand and overprescription, cutting off the supply of illicit drugs, and supporting addiction treatment and recovery. The SUPPORT for Patients and Communities Act, a bipartisan bill signed into law in 2018, approaches the problem in “hundreds of ways,” from tracking and testing international packages for drugs to allowing health care providers to prescribe addiction treatment medication.

One way to think about the problem and its possible solutions is to divide it into two issues: supply and demand.

Supply

Initiatives that decrease access to opioids are tackling prescription and trafficking. Recently, we’ve noticed:

Demand

Solutions for reducing demand are finding new ways to treat pain, addiction, and overdose. A few collaborations, launches, and stories we’re tracking:

Are you studying this problem or working on a solution? We’d love to hear your thoughts — send a message to editor@luminary-labs.com.


Photo by rawpixel on Unsplash.

Authors

Jessica Hibbard
Managing Editor, Thought Leadership