The Origin and Costs of the American Opioid Crisis

Hydrocodone is a popular prescription semi-synthetic opioid that is used to treat moderate to severe pain. Hydrocodone is said to be one of the most common recreational prescription drugs in America. Image from the National Institute of Drug Abuse

A silent epidemic still affecting millions of people in the United States is the opioid crisis, primarily caused by the predatory actions of US pharmaceutical companies. The Department of Health and Human Services reported that more than 47,000 Americans in 2018 died of an opioid overdose, while an estimated 10.3 million people reported abusing opioids of some sort. Though the Trump Administration has called for an increased effort to combat this epidemic, many people throughout the United States are still suffering from the fallout caused by the over prescription of addictive opioids. This article will take a look at the foremost role pharmaceutical companies played in creating this crisis as well as solutions we can take to help and get justice for all that have been affected. 

The use of opioids as a medicinal remedy dates back to the ancient world, as a variety of cultures found the opium poppy useful as a pain-relieving narcotic and a panacea for maladies ranging from headaches to dysentery. The addictive qualities of opium were quickly discovered and caused a ban by the Catholic Church, but by the 1600s A.D opium remedies became increasingly popular due to growing trade and would be a major cash crop for European colonists. As international drug trafficking and pharmacology became more advanced in the 1800s, more potent and addictive medicines such as morphine were created, which many lauded was a cure-all for severe pain. By the 1900s however, western attitudes towards opiate use had changed, as rampant addiction became more prevalent and known. 

Opium was imported in great quantities to China in the 1800s as the British Empire tried to correct their trade imbalance with the Qing Dynasty. The addictive qualities’ of the drug were quickly noted by Chinese authorities and were banned, causing the British to invade China in order to continue to sell their opium. Image from Getty: Adoc-Photos

In an effort to combat the rising crisis of drug abuse, American lawmakers in 1915 passed the Harrison Act, which in effect banned many pharmacies from selling opiates without a license. Though the dangers of opiate abuse were widely known since the start of the 20th century, this did not stop pharmaceutical companies from widely advertising new opiate derived drugs as a treatment for chronic pain, which brought about the modern U.S opiate crisis. 

From 1996 to 2001, Purdue Pharma along with other pharmaceutical companies began aggressively pushing doctors to prescribe opiate-based medications such as Oxycontin and Vicodin for treating moderate to severe pain. They would invite doctors to all expenses paid seminars to promote their drugs, which they touted as having very little risk for addiction. Through misleading marketing campaigns and incentives for sales representatives to promote the drugs, opiates flooded the U.S market and became one of the most commonly prescribed drugs in America, with 219 million prescriptions filled in 2011. During this time, doctors were unaware of the ineffectiveness of these drugs to treat chronic pain and their addictive qualities, which the pharma companies hid from the general public. 

What followed this period of mass opioid prescriptions was increased heroin use and overdoses, as those who used opiates to treat chronic pain found themselves heavily addicted. As demand increased, cheaper and more potent alternatives such as fentanyl entered the black-market drug trade, causing another spike of drug overdoses in the United States. Since recognizing the addictive potential of opiate drugs, doctors have begun prescribing fewer opiates, but this has not stopped the crisis from ravaging the American people.

A sculpture of a drug spoon placed outside of Purdue Pharma’s headquarters in Connecticut by artist Domenic Esposito. The sculpture was inspired by Domenic’s brother’s 14 year long battle with opioid addiction. Image from USA Today

After the effects of the opioid crisis became more widely known, states began to implement services using federal funding such as methadone clinics and opioid recovery centers. Though these have helped provide essential services to those impacted by opioid addiction, there is still work to be done to improve the lives and get justice for those who are affected by the epidemic. One recent victory aimed at holding pharmaceutical companies accountable was a $8.3 billion dollar settlement from Purdue Pharma, which pleaded guilty to giving kickbacks to those who promoted their highly addictive drug Oxycontin, though the Sackler Family who owns the company has yet to face any criminal charges. For there to be restorative justice for those affected by the crisis, those who profited from creating the crisis should be held accountable and provide for the treatment of those who cannot afford it. 

Lawmakers could do a number of things from both a legal and a public health perspective to help mitigate the human disaster that addiction has caused. The first step is to destigmatize and decriminalize drug use in this country by treating addiction as a public health issue rather than a criminal one. Countries such as Spain and Portugal have already found success with this method, as they have seen both a decrease in hard drug use and an increase in those seeking treatment. Rather than throwing people who possess small amounts of drugs in jail, treating the underlying condition of addiction which has been ravaging the country is a much better solution than perpetuating a cycle that inhibits those who lack the resources to get clean. Lawmakers should also review the lobbying practices of the pharmaceutical industries which led to this crisis in the first place, along with redistributing the money from these class action lawsuits to those who have been hit the hardest. 

Activists protesting against the War on Drugs, which many leading doctors and intellectuals believe to be a failed policy. The War on Drugs has been especially discriminatory to blacks and people of color, whom made up the majority of simply drug arrests. Image from the CT mirror

Besides legislation, there’s also been a move towards providing social services to solve endemic problems related to drug abuse such as poverty and homelessness, which studies have found greatly contributes to relapse. Today, the opioid crisis is still causing a significant amount of both social and economic damage, which these holistic approaches to treatment can improve. The economic impact can be seen in the increased cost of medical treatment, premature death, and criminal justice intervention, as well as an increase in crime and poverty. Instead of throwing drug users in jail for crimes such as simple possession we should reorient our focus to solving the root of the problem, which involves providing greater access to rehab clinics and treatment opportunities. Entering the criminal justice system also hurts an individual’s ability to find future employment, which only furthers the societal damage caused by opioid addiction. Aside from legislation, we should also focus on underlying problems within society which leads to greater drug use, such as loneliness and joblessness caused by the Covid-19 pandemic. By providing social benefits to people suffering from drug addiction we can start treating a number of issues that have arisen from this crisis, both on an individual and human level as well as from a societal perspective. 

Many medical professionals support the idea of creating a safe injections sites such as this one in Vancouver, Canada. Safe injection sites provide users with clean needles as well as medical supervision to prevent overdoses. Image from USC Nursing

Accessibility to affordable and adequate treatments to addiction is one of the main roadblocks that many addicts face in their journey to get clean. Although the drug rehabilitation industry is worth an estimated $42 billion dollars, many programs are run through expensive and private clinics which less wealthy patients cannot afford. Out of 57 million American’s reported to use illicit drugs, only 11% sought treatment in 2018. For this crisis to get better we have to expand treatment opportunities to those who don’t have the resources to go into treatment. One of the first steps that were taken on the legislative level was the Affordable Care Act, which provided insurance for individuals seeking treatment for drug addiction. Many in the medical community are now calling for an expansion of the programs on the state level as many states have a limited Medicaid program. For the nation to curb its ever growing opioid epidemic, legislators must find a way to cover those who are unable to afford expensive rehab programs, either through our current insurance system or by creating new clinics to meet the increasing demand for treatment.  

What we can do as individuals is to support initiatives which seek to provide treatment and treat those who are drug dependent not as having a moral failing but suffering from a disease which can be treated. We should be educated on the history of why the crisis emerged and take a more sympathetic view to those who are suffering. Through raising awareness of the issue and being an ally for those harmed by the opioid epidemic, we can slowly begin the process of restorative justice and healing for the victims of the human rights abuse caused by greed of pharmaceutical giants. What I want people to take away from reading this article is the fact that many addicts are actually victims of the predatory behaviors of pharmaceutical companies who dangerously pushed their addictive drug. We should try to be more compassionate to those currently harmed by the opioid crisis and strive for a future where addiction isn’t a part of our everyday life. From calling for legislative reform to being a compassionate ally, we as a society can overcome this crisis which has plagued us for so long.

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