By German Lopez

2015 was the worst year for drug overdose deaths. Then 2016 came along.

If nothing is done, we can expect a lot of people to die: A forecast by STAT concluded that as many as 650,000 people will die over the next 10 years from opioid overdoses — more than the entire city of Baltimore. The US risks losing the equivalent of a whole American city in just one decade.

That would be on top of all the death that America has already seen in the course of the ongoing opioid epidemic. In 2016, nearly 64,000 people died of drug overdoses in America — with synthetic opioids (such as fentanyl), heroin, and traditional painkillers (like Percocet and OxyContin) topping other causes of overdose, according to new data from the Centers for Disease Control and Prevention. That’s a higher death toll than guns, car crashes, and HIV/AIDS ever killed in one year in the US, and a higher death toll than the entirety of US military casualties in the Vietnam and Iraq wars combined.

If you want to understand how we got here, there’s one simple explanation: It’s much easier in America to get high than it is to get help.

In talking about this, Brandeis University opioid policy expert Andrew Kolodny draws a comparison to New York City’s fight against tobacco. In his telling, the city took a two-prong approach: It made tobacco less accessible — by banning smoking in public spaces and raising taxes to make cigarettes much more expensive. But it also made alternatives to tobacco more accessible — by opening a phone line that people can use to get in touch with a clinic or obtain free nicotine patches or free nicotine gum. It has seen its smoking rate steadily drop, from 21.5 percent in 2002 to 14.3 percent in 2015.

Essentially the opposite has happened with opioids. Over the past couple of decades, the health care system, bolstered by pharmaceutical companies, flooded the US with painkillers. Then illicit drug traffickers followed suit, inundating the country with heroin and other illegally produced opioids, particularly fentanyl, that people could use once they ran out of painkillers or wanted something stronger. All of this made it very easy to obtain and misuse drugs.

Meanwhile, there has been little attention to getting people into treatment. According to the surgeon general’s 2016 report on addiction, only 10 percent of people suffering from a drug use disorder get specialty treatment. The report attributed the low rate to shortages in the supply of care, with some areas of the country lacking affordable options for treatment — which can lead to waiting periods of weeks or even months just to get help.

When you put these two issues together, you get the recipe for a disaster — one that has been only further accentuated by the socioeconomic and mental health issues that have plagued the US for years.

This is the story of the opioid epidemic: a crisis that has already taken hundreds of thousands of lives, and is likely to kill hundreds of thousands more over at least the next decade if nothing is done.

How America’s opioid epidemic began

The opioid epidemic began in the 1990s, when doctors became increasingly aware of the burdens of pain. Pharmaceutical companies saw an opportunity, and pushed doctors — with misleading marketing about the safety and efficacy of the drugs — to prescribe opioids to treat all sorts of pain. Doctors, many exhausted by dealing with difficult-to-treat pain patients, complied — in some states, writing enough prescriptions to fill a bottle of pills for each resident.

The drugs proliferated, making America the world’s leader in opioid prescriptions. As Stanford drug policy expert Keith Humphreys previously noted, “Consider the amount of standard daily doses of opioids consumed in Japan. And then double it. And then double it again. And then double it again. And then double it again. And then double it a fifth time. That would make Japan No. 2 in the world, behind the United States.”

The statistics really do back this up. Japan is one of the lowest prescribers of opioids in the developed world (for reasons outlined by Ella Nilsen for Vox). And the US absolutely dwarfs anyone else in terms of opioid prescriptions, with Japan not even showing up in the top 25:

Chart showing that Americans by and far consume more opioids than the rest of the world.

Several key factors contributed to this.

First, there were the pharmaceutical companies. Wanting to make as much money as possible, these companies marketed their drugs as safe and effective for treating pain — even though the evidence for opioids shows that, particularly for chronic pain, the risks outweigh the benefits in most, but not all, cases. Many doctors and patients were convinced by this campaign. (Purdue Pharma, the maker of OxyContin, and some of its higher-ups later paid more than $600 million in fines for their misleading marketing claims, and opioid makers and distributors are now facing many more lawsuits on similar grounds.)

Then there were doctors. On one hand, doctors were under a lot of pressure from advocacy groups (some pharma-backed), medical associations, and government agencies to treat pain more seriously. On the other hand, doctors faced increasing pressure to see and treat patients quickly and efficiently.

The latter is a result of what Stanford addiction specialist Anna Lembke, author of Drug Dealer, MD, describes as “the Toyotazation of medicine — tremendous pressure on doctors within these large integrated health care centers to practice medicine in a certain way and get patients out in a timely fashion to be able to bill insurers at the highest possible level and to make sure that their patients were satisfied customers.”

Opioids provided an answer to these two problems. Doctors didn’t know how to deal with many of the complex pain …read more

Read more here: The opioid epidemic, explained

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