The Roots of the Opioid Crisis

How The Opioid Epidemic Began

The opioid epidemic’s beginnings can be traced back to the late 1990s when pharmaceutical companies reassured healthcare providers that opioid pain relievers were not addictive. As a result, healthcare professionals prescribed opioids at an extremely high rate, inadvertently leading to widespread misuse and addiction.

By the 2010s, it became apparent that opioids were highly addictive, and prescription rates began to decline slightly. However, it was too late for the many who had already become dependent on prescription opioids. Many turned to cheaper, highly potent options like heroin or the extremely dangerous synthetic opioids like fentanyl, which now accounts for a rising number of overdose deaths.

Beyond the addiction itself, the opioid epidemic has far-reaching consequences on public health, the economy, and the legal system. Overdose fatalities strain first responders and healthcare systems, while arrests and legal expenses for substance abuse related crimes add to the country’s economic burden. Lost wages and productivity as a result of addiction and death also contribute to this economic strain.

How are Opioids Made?
Derived from the poppy plant

Opioids are a class of drugs that act on the nervous system to relieve pain. Originally, most opioids were derived from the opium poppy plant. However, as modern medicine evolved, pharmaceutical companies started creating synthetic opioids in laboratories. These artificially created opioids, such as fentanyl and methadone, have a chemical structure that is modified from natural opioids but maintains similar pain-relieving effects.

Top Opioids in the US
5 drugs

Over the years, opioids have emerged as a class of drugs that have both immense therapeutic potential and a high risk of misuse. Some of the most commonly used opioids in The United States include the following

In a healthy brain, this system motivates people to eat good food, exercise regularly, engage in social activities, and pursue achievements at work or school. But when a person begins using addictive substances, these rewards begin to pale in comparison to the rewards that drugs can bring.

Brain changes in this region make it extremely difficult for people to break free from addiction on their own. While the brain can recover from these changes, it often requires prolonged abstinence and the help of a team of addiction professionals.

This is a semi-synthetic prescription opioid with high potential for abuse that is used to treat moderate to severe pain. It should only be used after careful consideration and with doctor supervision.
Hydrocodone, another semi-synthetic opioid medication prescribed to alleviate pain, shares similar properties to Oxycodone in terms of potential abuse and addiction risks.
This is a natural opioid derived from opium poppy plants and used as a painkiller.
This is an extremely potent synthetic opioid up to 100 times stronger than morphine, has long been a staple in surgical settings or for chronic pain management. Due to its strength and ease of incorporation into other substances, fentanyl has emerged as one of the primary players in today's opioid crisis.
Heroin, an illegal and extremely potent opioid, can quickly produce feelings of euphoria, which often lead to addiction and overdose.
How Do Opioid Overdoses Compare To Non-opioid Overdoses In The US?
2021 statistics

In the United States, opioid drug overdoses are a significant problem, and there is a clear correlation between opioid use and overdose.

Opioid Epidemic Timeline
3 major waves

The opioid crisis has significantly impacted The United States. Here’s a brief overview of its emergence: 

1st Wave: The Surge of Prescription Opioids (Around 1990s)

In the 1990s, doctors increasingly prescribed opioids for pain management due to pharmaceutical company marketing campaigns such as that of OxyContin. Approved by the FDA as nonaddictive pain relief in 1995, OxyContin quickly gained popularity during this era due to misleading “pain as the fifth vital sign” campaigns promoted by pharmaceutical companies, leading doctors to prescribe more liberally for various forms of discomfort.

2nd Wave: The Rise of Heroin (Around Early 2000s)

The second wave of the opioid epidemic saw a shift toward heroin, as pills were too expensive for many. The Obama administration started targeting “pill mills” and other sources of Oxycontin. As a result, opioid prescriptions were reduced, making it more difficult for individuals to access them. Due to an unmet demand for opioids, many users turned to heroin as an alternative. Heroin is also often laced with other dangerous substances, making it more potent and cheaper than pills.

3rd Wave: The Emergence of Fentanyl (Around 2013)

The third wave of the opioid epidemic began in 2013, primarily driven by the synthetic opioid fentanyl. Fentanyl is around 50 times more potent than heroin and 100 times more potent than morphine, and is typically used to treat severe cancer-related pain. Unfortunately, fentanyl managed to find its way into the hands of drug dealers.

Drug dealers often mix fentanyl with other drugs to enhance their effects without the users’ knowledge, significantly increasing the risk of overdose. This development made the third wave more lethal than the previous ones, with many people unknowingly consuming fentanyl-laced drugs.

Fentanyl Statistics

To understand the onset of the opioid epidemic you can look at charts or graphs. One particularly helpful one comes from the Center for Disease Control and Prevention (CDC) website.

All Opioid, Synthetic Opioid, and Common Opioids Overdose Trends In The US

Another helpful chart comes from the National Institute on Drug Abuse (NIDA) chart.

Male And Female Opioid Overdose Deaths In the US (1999-2021) -
Where Fentanyl is Being Sourced
National and international suppliers

Most of the illegal fentanyl found in the United States can be traced back to clandestine labs in foreign countries. These illicit labs operate in the shadows and are often difficult to pinpoint, but they are primarily located in China and Mexico, with some smaller-scale production hubs across other countries and in The United States.

San Diego and Imperial Counties: Major Hubs for Fentanyl Seizures

In the United States, California has become a major hotspot for fentanyl trafficking and seizures. In just the first nine months of FY 2022 (October – June), San Diego County and Imperial County reported fentanyl seizures totaling 5,091 pounds, a sizable chunk (60%) of all fentanyl seizures in the US during that time. The alarming trends in San Diego and Imperial Counties clearly illustrate the escalating problem at hand.

Precursors Imported from China and Other Countries

Fentanyl’s precursors are the chemicals required to produce the illicit drug, and a sizable share of these chemicals are imported from China. Examples include 1-boc-4-AP and 1-boc-4-piperidone. Some of these precursors are also sourced from other countries, such as India and Mexico.

Once procured, these precursors are used to create fentanyl in illicit labs. These labs can be small and amateur or operate on an industrial scale with advanced equipment. The fentanyl produced in these labs is often pressed into pills, turned into powder, or mixed with other drugs to be sold on the market.

What is Being Done to Combat the Opioid Epidemic?
DEA and national acts

In recent years, the opioid crisis has emerged as a significant public health concern, affecting millions of lives and causing thousands of deaths. Across the United States, various public and private sector initiatives have been and are being launched to tackle this growing problem.

President Barack Obama’s Prescription Drug Abuse Prevention Plan

President Barack Obama unveiled the Prescription Drug Abuse Prevention Plan in 2010, intended to curb prescription drug abuse by creating an efficient strategy and plan. It focused on four areas that included:

  1. Education: Encouraging prescribers and patients alike to increase their understanding of prescription drugs and opioid addiction. 
  2. Monitoring: Establishing prescription drug monitoring programs (PDMPs) that track prescribing and dispensing data.
  3. Medication Disposal: Providing safe and convenient ways of disposing of prescription drugs safely. 
  4. Enforcement: Targeting “pill mills” and individuals who facilitate opioid abuse.

HHS Grant Program for Medication-Assisted Treatment (MAT)

Another significant effort made towards combating the opioid crisis came in the form of the Department of Health and Human Services (HHS) grant program, designed to support medication-assisted treatment (MAT). MAT uses medicines such as methadone, buprenorphine, and naltrexone in conjunction with counseling or behavioral therapies in order to treat substance use disorders.

Initially, 11 states were given access to funding worth $12 million to help those battling addiction. The program has since expanded, with more states receiving additional funding to provide the necessary resources and support to people in need.

The Affordable Care Act and Substance Abuse Treatment

The Affordable Care Act (ACA) played a pivotal role in combating the opioid crisis. It did so by making substance abuse treatment one of the 10 essential health benefits that marketplace insurance plans are required to cover. The ACA also expanded Medicaid coverage, which consequently increased access to substance abuse treatment services for millions of Americans.

Additionally, the ACA recognized substance use disorders as a crucial public health issue and emphasized the importance of early intervention, screening, and proper treatment. This reformed outlook on addiction prevention and treatment has greatly contributed to the ongoing fight against the opioid epidemic.

The HEAL Initiative: A Holistic Approach to Addressing Opioid Addiction

In 2018, the National Institutes of Health (NIH) launched the Helping to End Addiction Long-term Initiative (HEAL Initiative) to address the opioid epidemic. As of July 2022, NIH has invested $2 billion in HEAL, funding over 600 research projects nationwide. This effort tackles the concurrent issues of chronic pain and addiction.

The DEA is Cracking Down on Fentanyl

The Drug Enforcement Administration (DEA) has made fentanyl trafficking one of its top priorities – in 2022, they seized double the amount of fentanyl laced pills compared to 2021.

The DEA also issued a public warning about counterfeit prescription drugs laced with fentanyl. Shockingly, 60% of these pills contain enough fentanyl to cause fatal overdoses, so awareness campaigns must continue.

President Biden’s National Drug Control Strategy

In 2022, the Biden administration unveiled their National Drug Control Strategy that prioritizes expanding access to evidence-based treatments and harm-reduction initiatives. Key parts of the strategy include the following:

Opioid abuse is an intricate problem which must be approached from all directions in order to find solutions. Pharmaceutical companies, doctors, and other healthcare professionals must acknowledge their role in the opioids epidemic and take steps to combat it. At the same time society as a whole must address its causes — poverty, trauma, and mental health concerns, to name a few.

Treatment and support for individuals struggling with addiction must be both accessible and affordable, while stigma must be dismantled to allow those seeking assistance to do so without judgment. The opioid crisis has claimed far too many lives. Adopting an approach rooted in kindness and care could contribute to creating a brighter future for us all.

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