The Problem
The opioid crisis is an acute social problem that began in the mid-2010s and continues to this day. It is related to the fact that from 1991 to 2010, large pharmaceutical companies aggressively marketed opioid painkillers, resulting in millions of people becoming addicted to this drug. After becoming addicted to these drugs, people started switching to heroin (Stoicea et al., 2019, p. 1). Consequently, the statistics are that 70,000 people died from opioid overdoses in 2020, and 75 percent of people who take heroin in the United States got addicted after being prescribed opioid painkillers (Stoicea et al., 2019, p. 1). Therefore, society is now at least outraged at the companies that were in any way involved in this experience.
The First Wave of the Opioid Epidemic
The first wave of the opioid crisis emerged in 1991 when patient mortality rapidly increased after a surge in prescriptions for opioid medications, including combination medications. Prescriptions were being issued for the treatment of even minor and non-chronic pain. Meanwhile, the expansion was primarily influenced by assurances from pharmaceutical manufacturers and even medical organizations that the risk of addiction resulting from using these drugs was “extremely low” (Stoicea et al., 2019, p. 3). Pharmaceutical companies also began promoting among doctors the use of opioids in patients with non-cancer pain. At this rate, by 1999, 86% of patients taking opioids as prescribed by a physician were using them to treat pain of non-oncological etiology (Stoicea et al., 2019, p. 3). The first targets of a large-scale epidemic were societies where access to such drugs was relatively straightforward.
The Second Wave of the Opioid Epidemic
The second wave of the opioid epidemic began around 2010 when the first efforts to decrease the number of prescriptions for opioid drugs had begun. Addicts switched to semi-synthetic opioids, that is, heroin (Stoicea et al., 2019, p. 7). The second wave of the opioid epidemic was marked by rapid growth in deaths due to heroin abuse. As access to prescription drugs became more restricted, interest in this cheap, affordable, and powerful street drug grew. In addition, heroin use escalated significantly among all demographic and socioeconomic groups. Between 2002 and 2013, heroin overdose deaths increased by 286% (Stoicea et al., 2019, p. 8). Consequently, heroin was the cause of the growing opioid crisis.
The Third Wave of the Opioid Epidemic
The third wave of the opioid crisis occurred in 2013, with an escalation of deaths. This was related to synthetic opioids, that is fentanyl and other drugs. The most significant drop occurred in 2016, with more than 20,000 deaths from fentanyl and related medications (Stoicea et al., 2019, p. 8). In an effort to reduce the risk of addiction and maximize the benefits of available pain treatment options, the U.S. Centers for Disease Control and Prevention (CDC) has issued new clinical guidelines. For instance, according to the new revisions of such documents, nonopioid medications should be preferred as first-line therapy for chronic pain (Stoicea et al., 2019, p. 8). Opioid medications, on the other hand, should be prescribed only after a thorough pain assessment and subsequent regular review of the need for them
Initial attempts to control the opioid epidemic were leveled by corruption. First and foremost, the indirect interference of the pharmaceutical industry through lobbying and advocacy groups. Attempts to prosecute prescribers of irrational pharmacotherapy and pharmaceutical companies agitating for opioid use were suppressed. Researchers from two universities found that noncompliance with CDC guidelines was much more widespread among organizations that received funding from opioid manufacturers (Stoicea et al., 2019, p. 7). In addition, an investigation by the U.S. Senate Committee on Homeland Security and Governmental Affairs revealed financial connections between opioid manufacturers and medical professional societies.
The Key Causes of the Problem
The United States is the world leader in opioid prescription. For every million Americans, there are about 50 thousand doses per day (Saloner et al., 2018, p. 24). The main reason for the social problem is that American doctors write a lot of prescriptions. Since many Americans’ insurance policies cover only pills, doctors do not prescribe different procedures but assign them opioid medications. Meanwhile, the USA and New Zealand are the only countries where T.V. advertising of prescription drugs is allowed (Saloner et al., 2018, p. 24). Thus, patients want to get the advertised drug because they consider it more effective. However, in the United States, it is considered standard practice for pharmaceutical companies to encourage physicians to promote their products to patients. This leads to doctors prescribing opioid drugs even if they are not necessary.
The Main Consequences of the Problem
In the United States, medical providers prescribe opioid-based medications to pain patients. Moreover, by 2011, three out of four (75%) opioid prescriptions worldwide were prescribed in the United States, where only 5% of the world’s population lives. From 1999 to 2017, more than 218,000 people in the U.S. died from opioid drug overdoses. About 200,000 more people died from abuse of illegal substances such as heroin (Saloner et al., 2018, p. 27). Since the publication of the CDC report, law enforcement agencies have been paying more attention to doctors and pharmacies prescribing suspiciously high amounts of analgesics. As a side effect of this attention, addicted patients have turned to illegal psychoactive substances (Saloner et al., 2018, p. 27). Therefore, prescriptions gradually declined, but overdose deaths continued to rise from 8,048 deaths in 1999 to 47,600 in 2017.
The Beginning of the Combat with the Problem
Overall, in three waves, the drop in opioid overdose deaths has been enormous. In 2016, the opioid crisis lowered Americans’ total life expectancy from 78.7 to 76.6 years (Saloner et al., 2018, p. 29). Additionally, drug overdoses were the leading cause of death for Americans under the age of 50, with opioids accounting for two-thirds of all overdoses. The official war against opioid drugs began when President Donald Trump came to power. This is because the president declared a public health emergency because of the opioid crisis (Saloner et al., 2018, p. 29). Since then, the statistics on non-medical opioid use have begun to demonstrate a declining trend.
The Reasons That Decelerate the Struggle
The U.S. government has started to work in all directions because there are many root causes of the substance abuse epidemic. Primary, there is a connection to widespread social disruptions. The last few decades have been characterized by rising unemployment, poverty, economic inequality, and the deterioration of the social safety net (Saloner et al., 2018, p. 32). Therefore, first and foremost, public servants need to improve Americans’ general standard of living. At the same time, when the government adopts new measures to restrict the circulation of drugs, alternatives appear on the black market (Saloner et al., 2018, p. 32). Therefore, it is also advisable to pay attention to official measures and hospitals and control the black market.
Modernization of the Legislation
For the struggle against the opioid crisis to be successful, first, the legislation had to be enhanced. In 2017, Donald Trump declared the opioid crisis in the United States an emergency. In 2018, the “Patient and Community Support Act” was enacted (Slater and Beverley, 2022). This law should produce public health reform, funding for substance abuse treatment, and prevention of addiction. The new law will improve the availability of special addiction programs under the federal low-income Medicaid health insurance program. In addition, there are measures to combat the mail-order shipment of prescription drugs, such as fentanyl (Slater and Beverley, 2022). The law also provides for new federal grants to combat opioid addiction.
The Court’s Review
It is essential to emphasize that an effective fight also requires fair decisions, which is why it is necessary to appeal to the courts. For example, the U.S. Department of Justice has sued Walmart Inc. (Slater and Beverley, 2022, p. 1303). Authorities accuse the world’s largest retailer of fomenting the opioid crisis in the country and issuing thousands of illegal prescriptions, but the company disagrees with the charges. The civil suit claims the retailer has been turning its pharmacy chain, which currently has about 5,000 locations, into a supplier of highly addictive painkillers since June 2013 (Slater and Beverley, 2022, p. 1303).
If the company is found guilty, it will probably have to pay fines: up to $68,000 for each illegal prescription and $16,000 for each unregistered suspicious order (Slater and Beverley, 2022, p. 1303). The exact number is not disclosed: the lawsuit lists thousands and thousands of unlawful medications for controlled substances. Thus, the fight against the opioid crisis is also being fought with the help of court proceedings.
Treatment of Opioid Addiction
In the United States, there is now a wide range of medications available to treat opioid dependence. For example, drugs such as Methadone or Buprenorphine, which work by inhibiting all or part of the opioid receptors, are approved in the country (Slater and Beverley, 2022). They are authorized to treat withdrawal symptoms and drug addiction. Other available therapies in this area are based on opioid receptor antagonists such as Naltrexone and Naloxone, commonly known as Narcan. In addition, experimental treatments range from psychedelics such as Ibogaine to treat addiction to Cannabidiol (CBD) or vaccines (Slater and Beverley, 2022). Thus, effective medications exist to treat opioid use disorder, but more drugs must be created to overcome the overdose problem further.
References
Habit vs. Addiction: What’s the difference, Alvernia University, 2019. Web.
Saloner, B., McGinty, E. E., Beletsky, L., Bluthenthal, R., Beyrer, C., Botticelli, M., & Sherman, S. G. (2018). A public health strategy for the opioid crisis. Public Health Reports, 133(1), 24-34. Web.
Slater, R. R., & Beverley, L. (2022). The opioid epidemic in America: Pandemic Impacts. Journal of the American Academy of Orthopaedic Surgeons, 30(20), 1302-1310. Web.
Stoicea, N., Costa, A., Periel, L., Uribe, A., Weaver, T., & Bergese, S. D. (2019). Current perspectives on the opioid crisis in the US healthcare system: A comprehensive literature review. Medicine, 98(20), 1-8. Web.
The opioid crisis, National Recreation and Park Association, 2018. Web.
US Department of Justice sues Walmart over opioid sales, Made for Minds, 2020. Web.
