Author: Kimran Gill
Editor: Altay Shaw
A drug prescribed to be the solution to America’s pain problem, ultimately ended up becoming one of their biggest public health concerns … So how did it get out of control? With increased opioid prescriptions and the availability of other non-prescription opioids, many individuals have developed an addiction, which has led to an increase in overdose deaths and triggered an epidemic. In order to understand why this is a prominent issue in America and not other countries, we need to examine the cause of the crisis, the agents responsible for its escalation, and future implications.
What Are Opioids?
Opioids are a class of drugs that originate from or mimic naturally occurring substances found in the poppy plant, Papaver somniferum, along with semi-synthetic and synthetic compounds that are able to interact with opioid receptors present in the brain. Through the activation of opioid receptors in the brain, these drugs provide pain relief by blocking pain signals between the brain and the body. In addition to generating the feeling of euphoria, opioids trigger endorphin release, which reduces pain. Doctors prescribe them for analgesic and sedative effects, which relax the body and alleviate pain from injuries, illnesses, or surgeries.
However, the same properties that make opioids effective pain relievers also make them highly addictive; therefore methadone and buprenorphine, both opioid medications, are used for the ongoing treatment of opioid dependence. As physical dependence sets in over time, the body may eventually become tolerant to the drug, which increases the risk of opioid use disorder (OUD), which can result in overdose and death; a higher and more frequent dose will need to be given to overcome this tolerance. Because of their pharmacological effects, opioid misuse can increase the risk of respiratory arrest. With such a strong addictive effect, how could a drug be widely available and easily prescribed to suffering patients?
How Did the Opioid Crisis Begin?
As a result of a campaign in the 1990s that recognised pain as the “fifth vital sign”, led to a cascade of events as prescriptions of opioids increased, spurred on by misleading marketing by pharmaceutical companies that downplayed addiction risks, leading to the opioid epidemic. It is estimated that the sales of prescription opioids quadrupled between 1990 and 2010. However, whilst an individual’s pain may have been treated, yet their addiction was not.
This crisis has been exacerbated by Purdue Pharma’s promotion of oxycontin, which was initially approved by the Food and Drug Administration despite concerns over its addictive nature. Since pain is a subjective measure, there were misleading pain scales, resulting in overmedication and an unintended consequence of death. To prevent the epidemic from escalating, there should have been greater pain education and training so that more appropriate measures could have been used to assess and manage pain. Were doctors solely responsible for prescribing this “dream drug” despite its addictive nature or did pharmaceutical companies exploit the asymmetric information that existed between doctors and pharmaceutical companies to strategically widen their profit margins?
The Role of Pharmaceutical Companies and the Black Market
As a result of regulatory failures across the board, Purdue Pharma took advantage of the FDA’s failure to enforce the Food, Drug and Cosmetic Act when its extended-release oxycodone application was approved in 1995. Therefore, the misrepresentation of the drug’s uses allowed the company to market it for conditions that caused more harm than good. This created a snowball effect as other pharmaceutical companies rushed to introduce their own opioids to reap greater rewards. With this dream drug now widely available, warnings about addiction risks were being ignored, creating a false reality that opioids were a safe and effective long-term solution for managing pain.
The unfolding of the crisis provided an opportunity to start selling this wonder drug on the black market. When regulations tightened, prescription opioids became less available, so out of desperation, people turned to illegal alternatives like heroin and fentanyl which are cheaper and more readily available. In recent years, there has been an increase in overdose deaths due to the shift from prescription opioids to illicit drugs. Approximately 75% of Americans who are addicted to street opioids initially were taking prescription opioids. With the rising availability of potent synthetic opioids, the situation has become even more of an issue, as these drugs are often mixed with other substances, increasing the risk of overdose, particularly among individuals from lower socioeconomic areas.
Impact on Communities
Communities from low socioeconomic backgrounds have been particularly hard hit by the opioid crisis, with some communities bearing a heavier burden than others. Studies have shown that the epidemic has led to a notable fall in Black and Hispanic American’s life expectancy. From 2013 and 2018, the death rate from opioid overdoses among Black Americans exceeded that of White Americans, highlighting racial disparities in access to healthcare and treatments.
The crisis has resulted in an increase in hospitalisations, which has put greater pressure on public health resources as well as a significant burden on law enforcement. The Covid-19 pandemic further exacerbated the crisis as there was a rise in overdose deaths due to isolation, stress, and disruptions in accessing treatment. Addiction can also create financial hardship, leading to unemployment, criminal activity, and family breakdown. This cycle of despair can be difficult to break without comprehensive intervention.
Will America Ever Overcome the Opioid Crisis?
Addressing the opioid crisis in the United States requires a multifaceted approach that tackles the issue from several angles. It is imperative for future interventions to focus on restricting opioid supply, improving prescribing practices, and reducing demand through education and treatment.While policymakers have taken steps to reduce unnecessary opioid prescriptions and close pill mills, efforts must also be focused on reducing the racial and socioeconomic disparities that have been further aggravated by this crisis. According to the Fundamental Cause Theory, new interventions tend to benefit the privileged first in unequal societies, thus potentially increasing existing inequalities. It is therefore crucial that interventions are designed to address these disparities directly if America is to truly be free of this deadly epidemic.
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