Today, nearly every adult in the U.S. has been affected in some way by the opioid epidemic.
Almost everyone knows someone — a friend, a family member, an acquaintance — who has struggled with an opioid addiction or even died of an overdose. Many have seen opioid addiction ravage their community, tear families apart, and turn kind people on a road to desperation, addiction, and despair.
The widespread impact of the opioid problem has shattered some aspects of the stigma attached to drug addiction and substance use. No longer can those struggling with addiction be cast aside as nameless “addicts” or criminals on the outer edges of society. They are sons and daughters, parents, and neighbors — proof that addiction knows no bounds and can affect people of all ages, upbringings, and socioeconomic levels.
This has allowed for a further understanding of — and a more honest discussion about — addiction and recovery. Rather than hide their child or spouse’s substance problem, people may be more likely to seek help and support from others in similar situations or from a treatment center.
As more people recognize the seriousness of the problem and try to put an end to the epidemic, offering support to individuals and families dealing with an opioid addiction, many in communities across the country are left wondering how we got here.
When it comes to who is to blame for the opioid crisis, the public is often split. Some think the big pharmaceutical companies who pushed their opioid drugs bear the blame, while others blame the doctors who prescribed these drugs to patients looking for relief.
The U.S. has experienced many drug epidemics in its time — a heroin epidemic in the 1980s, a cocaine and crack epidemic in the 1980s and 1990s, and a methamphetamine epidemic that began in the 1990s and is now perhaps getting worse.
The U.S. is currently experiencing an ongoing opioid epidemic. In the late 19th century, it’s estimated that over 300,000 people were addicted to injected morphine or smoked opium.
The country has never experienced anything quite like the current opioid crisis. It is already the deadliest drug epidemic in American history, killing tens of thousands of people every year.
Opioids are a class of drug that produces a variety of effects in the brain. They are believed to block pain signals from the brain to the body.
Opioids can be prescription drugs (usually called painkillers) or street drugs, like heroin. In addition to affecting pain signals, opioids makes users feel high and relaxed. Users quickly develop a tolerance to and physical dependence on opioids, making them highly addictive.
The most commonly used opioids are prescription opioids (painkillers like Oxycontin and Vicodin), the street drug heroin, and fentanyl (an incredibly strong and dangerous illegal synthetic drug that’s 50 to 100 times more potent than morphine).
The opioid problem in America is huge and complex. There were many factors that contributed to it becoming the deadliest drug epidemic in American history. Some events surely shaped the crisis and help to explain how the situation spiraled out of control.
Purdue Pharma receives FDA approval for OxyContin, a potent opioid prescription painkiller.
Prescriptions for opioid painkillers triple in this time period, likely in part due to doctors overprescribing these drugs and addicted patients “doctor shopping” (getting multiple prescriptions from different doctors).
The number of people who admit to using OxyContin for nonmedical purposes rose dramatically during this time period, from 400,000 in 1999 to 1.9 million in 2002. It spiked to up to 2.8 million in 2003.
Purdue Pharma pays a $634 million dollar fine for “misbranding” OxyContin and falsely marketing it as a safer and less abuse-prone painkiller option, as well as misleading doctors, regulators, and patients about its high abuse potential and risk of addiction.
During this year, approximately 1.2 million hospital emergency room visits were related to misuse or abuse of pharmaceutical drugs. This number is larger than the number of hospital emergency room visits related to illicit street drugs, and it reflects a 98 percent increase since 2004. The most prominent drugs involved in the emergency room visits were opioid painkillers, particularly OxyContin.
Purdue Pharma releases a more abuse-resistant form of Oxycontin. If a user tries to inject or snort the drug, it becomes a gummy hard-to-use substance.
The FDA supports the The White House Office of National Drug Control Policy’s report “Epidemic: Responding to America’s Prescription Drug Abuse Crisis,” which outlines comprehensive plans to battle the ongoing opioid prescription drug epidemic.
Opioid prescriptions fall 18 percent from a 2010 peak, according to the Centers for Disease Control and Prevention.
A Washington University School of Medicine study that involved opioid users over a seven-year period found that the number of those who used only prescription medications declined by 6.1 percent, while the number of those who used prescription opioids and heroin increased by 10.3 percent. The number of those who began using only heroin rose by 14.1 percent.
Despite a reduction in opioid prescription drug prescriptions, the number of opioid-related deaths continues to rise. Many opioid prescription drug users have switched to more accessible street drugs, including heroin and fentanyl.
To date, 48 states have sued Purdue Pharma in relation to OxyContin. Accusations include lying about the drug, exaggerating its benefits and safety, and downplaying its dangers and high addiction rate.
According to a 2019 AP-NORC poll, approximately 46 percent of participants blame doctors and dentists for the current opioid crisis.
Of course, many doctors dispute this logic, insisting that they were also unaware of the dangers of prescription opioid painkillers like OxyContin. They claim that they were misled by the pharmaceutical companies, particularly Purdue Pharma who marketed OxyContin as a safer alternative to many other types of painkillers.
Some doctors also point to the pain-related patient advocacy movement in the 1990s that called for more aggressive pain treatment and pain relief standards. The advocates for this movement — which perhaps began with a 1990 editorial in Annals of Editorial Medicine by Dr. Mitchell Max, the President of the American Pain Society — expressed disappointment in the medical community’s lack of progress or focus on pain management. Advocates for aggressive pain management asked that pain be treated as a “fifth vital sign.”
Within a year, the American Pain Society had issued guidelines for pain management and related bills passed in Congress. By 2000 (well after OxyContin’s release), mandatory pain scales were used in certain areas of health care, sometimes requiring an “acceptable” pain score for release. The standards suggested using a numerical scale based on patients’ self-reported pain.
Many doctors claim this movement put them in conflict. Some feared their patients would become too dependent on opioids, but they were at risk of violating pain guidelines or patients’ rights if they were to try to limit access to painkillers.
While these explanations may sound reasonable, there are other aspects and statistics relating to doctors’ roles in the opioid crisis that raise more questions.
The 2019 AP-NORC poll found that a majority of Americans (63 percent) placed blame on the pharmaceutical companies for the opioid epidemic. According to a 2019 poll from National Public Radio (NPR), about 70 percent of respondents feel that pharmaceutical companies should cover the cost of addiction treatment as well as the costs for the drug naloxone, which is used to revive individuals after an opioid overdose.
It’s not hard to see why. As discussed above, drug companies — particularly Purdue Pharma, makers of OxyContin — have paid out millions in “marketing” to doctors. Purdue Pharma has already paid hundreds of millions for fines relating to lying and misleading the public, patients, and doctors about their drug. In 2007, the company and its top executives pleaded guilty to a felony related to the false marketing of OxyContin, even confessing to directing their sales team to tell doctors that the drug was less addictive than other opioids.
There is further evidence of the pharmaceutical company’s role in the opioid epidemic.
There is overwhelming evidence that drug companies, particularly Purdue Pharma, repeatedly and knowingly lied to doctors, patients, and the public about the dangers of their most profitable drugs in order to boost sales, even as it became clear that a deadly epidemic was underway. Because of this, it’s hard not to conclude that these pharmaceutical companies are perhaps more to blame that anyone for today’s deadly opioid epidemic.
However, when looking at the amount of money doctors received from these drug companies — and the direct connection between the number of opioid prescriptions written by a doctor and the amount of “marketing” payments received from the opioid manufacturers — it’s clear that some doctors also bear a large portion of the blame.
It’s particularly bleak when considering the trust many have in their doctors, who have taken an oath to serve their patients, not their bank accounts or a drug company. Even if they were misled by the drug companies, could they not see the levels of addiction rising? One has to wonder whether their marketing payments from drug companies helped them to turn a blind eye.
Perhaps the larger question here is, why are drug companies like Purdue Pharma allowed to market dangerous drugs to doctors using payments? Are payments really marketing? Or are they payoffs? Should a doctor be deciding what drugs to prescribe based on marketing payments from a drug company?
Based on what we’ve seen during the devastating opioid epidemic, there needs to be a reassessment of how opioids are prescribed and how pharmaceutical companies motivate doctors to choose their meds.
(August 2018) A Brief History of The Opioid Epidemic. American Council on Science and Health. Retrieved August 2019 from https://www.acsh.org/news/2018/08/22/brief-history-opioid-epidemic-13346
(April 2018) An Opioid Crisis Foretold. The New York Times. Retrieved August 2019 from https://www.nytimes.com/2018/04/21/opinion/an-opioid-crisis-foretold.html
(February 2018) Meth, the Forgotten Killer, Is Back. And It’s Everywhere. The New York Times. Retrieved August 2019 from https://www.nytimes.com/2018/02/13/us/meth-crystal-drug.html
What are Opioids? John Hopkins Medicine. Retrieved August 2019 from https://www.hopkinsmedicine.org/opioids/what-are-opioids.html
(May 2007) In Guilty Plea, OxyContin Maker to Pay $600 Million. The New York Times. Retrieved August 2019 from https://www.nytimes.com/2007/05/10/business/11drug-web.html
(2011) Epidemic: Responding to America’s Prescription Drug Abuse Crisis. White House Office of National Drug Control Policy. Retrieved August 2019 from http://publications.iowa.gov/12965/1/NationalRxAbusePlan2011.pdf
(2018) Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse. Food and Drug Administration (FDA). Retrieved August 2019 from https://www.fda.gov/media/106638/download
(April 2018) Opioid Crackdown Has Patients Struggling to Get Their Meds. The Wall Street Journal. Retrieved August 2019 from https://www.wsj.com/articles/opioid-crackdown-has-patients-struggling-to-get-their-meds-1524744001
(April 2019) Painkiller Addicts Shifting to Heroin. Verywell Mind. Retrieved August 2019 from https://www.verywellmind.com/painkiller-addicts-shifting-to-heroin-67840
(June 2019) Nearly Every U.S. State is Now Suing OxyContin Maker Purdue Pharma. CNBC. Retrieved August 2019 from https://www.cnbc.com/2019/06/04/nearly-every-us-state-is-now-suing-oxycontin-maker-purdue-pharma.html
(March 2017) The Opioid Epidemic: It’s Time to Place Blame Where It Belongs. Missouri Medicine. Retrieved August 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140023/
(August 2018) Purdue Pharma’s Sales Pitch Downplayed Risks of Opioid Addiction. Kaiser Health News. Retrieved August 2019 from https://www.healthleadersmedia.com/clinical-care/purdue-pharmas-sales-pitch-downplayed-risks-opioid-addiction
(May 2017) The Joint Commission’s Pain Standards: Origins and Evolution. Joint Commission. Retrieved August 2019 from https://www.jointcommission.org/assets/1/6/Pain_Std_History_Web_Version_05122017.pdf
(April 2019) AP-NORC Poll: Many Blame Drug Firms for Opioid Crisis. AP News. Retrieved August 2019 from https://www.apnews.com/103530ad684f4941999e99467121b5d6
(January 2019) Drug Company Payments to Doctors May Influence Opioid Overdose Deaths, Study Finds. Washington Post. Retrieved August 2019 from https://www.washingtonpost.com/national/health-science/drug-company-payments-to-doctors-may-influence-opioid-overdose-deaths/2019/01/18/f265ade0-1aa0-11e9-9ebf-c5fed1b7a081_story.html?noredirect=on
(January 2019) Association of Pharmaceutical Industry Marketing of Opioid Products With Mortality From Opioid-Related Overdoses. JAMA Network Open. Retrieved August 2019 from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2720914?guestAccessKey=630f38c9-ac45-406f-8764-b04eef425ce7
(October 2013) Is Pain Really the 5th Vital Sign? Physicians Weekly. Retrieved August 2019 from https://www.physiciansweekly.com/pain-5th-vital-sign/
(June 2015) The Prescription Opioid Addiction and Abuse Epidemic: How it Happened and What We Can Do About It. The Pharmaceutical Journal. Retrieved August 2019 from https://www.pharmaceutical-journal.com/opinion/comment/the-prescription-opioid-addiction-and-abuse-epidemic-how-it-happened-and-what-we-can-do-about-it/20068579.article?firstPass=false
(February 2019) Sackler Embraced Plan to Conceal OxyContin’s Strength from Doctors, Sealed Testimony Shows. ProPublica/ Stat News. Retrieved August 2019 from https://www.propublica.org/article/richard-sackler-oxycontin-oxycodone-strength-conceal-from-doctors-sealed-testimony
(February 2019) Here’s One Billionaire Who Really Might be a Policy Failure. Washington Post. Retrieved August 2019 from https://www.washingtonpost.com/opinions/the-oxycontin-catastrophe-highlights-a-big-failure-in-policy/2019/02/25/b72dc184-391a-11e9-aaae-69364b2ed137_story.html
(December 2016) An L.A. Times Investigation: OxyContin goes global — “We’re only just getting started.” Los Angeles Times. Retrieved August 2019 from https://www.latimes.com/projects/la-me-oxycontin-part3/
(June 2018) How America Got Hooked On A Deadly Drug. Kaiser Health News. Retrieved August 2019 from https://khn.org/news/how-america-got-hooked-on-a-deadly-drug/
(February 2019) Lawsuit Claims Sackler Family Disregarded Safety, Opioid Addiction in Purdue Push to Profit from OxyContin. Washington Post. Retrieved August 2019 from https://www.washingtonpost.com/national/lawsuit-claims-sackler-family-disregarded-safety-opioid-addiction-in-purdue-push-to-profit-from-oxycontin/2019/02/01/5d29e072-2660-11e9-90cd-dedb0c92dc17_story.html
(May 2019) News Release – Complaint for the Violation of the New Jersey Fraud Act. Attorney General of the State of New Jersey. Retrieved August 2019 from https://www.nj.gov/oag/newsreleases19/Sackler-Complaint-Redacted.pdf
(October 2018) 5 NY Doctors Charged with Illegally Prescribing Oxycodone. Modern Healthcare. Retrieved August 2019 from https://www.modernhealthcare.com/article/20181012/NEWS/181019954/5-ny-doctors-charged-with-illegally-prescribing-oxycodone
(March 2018) CNN Exclusive: The More Opioids Doctors Prescribe, the More Money They Make. CNN Health. Retrieved August 2019 from https://www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html
(May 2018) Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused. The New York Times. Retrieved August 2019 from https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxycontin.html
(April 2019) Majority Of Americans Say Drug Companies Should Be Held Responsible For Opioid Crisis. National Public Radio (NPR). Retrieved August 2019 from https://www.npr.org/2019/04/25/716691823/majority-of-americans-say-drug-companies-should-be-held-responsible-for-opioid-c
(February 2018) Senate Report Probes Purdue Pharma Donations to Nonprofits. Stamford Advocate. Retrieved August 2019 from https://www.stamfordadvocate.com/business/article/Senate-report-probes-Purdue-Pharma-donations-to-12703659.php