The Opioid Epidemic

Written by Vinh Le, MS 4, Larner College of Medicine

The opioid epidemic is a national crisis that claims more than 130 lives daily and has contributed to a majority of the one million drug overdose deaths in the US since 1999.^1-3

The progression of the crisis can be described in three waves, the first of which started in 1995 when the FDA approved OxyContin, believing that it would be less addictive than other prescription opioids. However, widespread prescription of OxyContin gave way to the practice of tablet crushing, which quickly released high levels of the drug and caused overdose rates to skyrocket.^4-5 This phenomenon had an especially harsh impact on non-Hispanic white, American Indian, and Alaska Native populations.^5-7 The second wave arose around 2010, when patients who had been on prescription opioids began using heroin to achieve similar effects.^5-8 The third wave began around 2014 with the rise of synthetic opioids such as fentanyl and its analogs, causing rapidly escalating mortality rates among Black Americans.^9-10

Any effective national response strategy must take into account the serious nature and scope of the crisis. Currently, over fifty million US adults live with chronic pain and half of them endure pain that interferes with their daily lives, correlating with the national increase in opioid marketing and prescription rates.^11-12

Meaningful change will have to come from the community level as well as the individual level.

Influence leveraged by the pharmaceutical industry on regulators, prescribers, and politicians – particularly in the realm of opioid use – must be diminished at the policy level.^5,13,14 Plans that achieve a balance between reduction of unnecessary opioid prescription and compassionate care for patients in pain must be developed. Campaigns and programs destigmatizing high quality treatment for individuals with opioid use disorder (OUD) must be pursued.¹⁵ And the criminal justice policies of incarceration for non-violent crimes of personal illicit opioid use, which have been shown to disproportionately impact minority populations and contribute to post-release mortality, must be replaced with initiatives and environments that reduce risk of addiction, including educational programs, real-time risk tracking, and safer ways to dispense excess medications.^5,16,17

The opioid crisis has been framed historically (and inaccurately) as a crisis of personal and moral failings that can be remedied through sheer willpower. Reframing it as a treatable public health issue – one grounded in personal experience, genetics, neurobiology, and environment – can go a long way in changing attitudes, increasing public support for compassionate public health policies, and getting people the help they need.^18-26

Medication-assisted therapies – methadone, buprenorphine, and naltrexone – are gold-standard treatments for OUD and have been proven to be safe, cost-effective, and integral to recovery.²⁷ However, they are greatly under-prescribed; in fact, according to a recent study, barely more than 20% of patients with OUD had received buprenorphine.²⁸

On an individual level, there is much we can do. It is important for all of us to do our research, remain aware of the resources available to care for ourselves and each other, and work towards destigmatizing discussion and treatment. If you or someone you know is struggling with OUD, it is important to seek help and enter a treatment program that can provide essential therapies. In emergency situations, call 911, and consider carrying naloxone, which can be lifesaving for emergency opioid reversal.²⁹ For additional information on OUD treatment, the Substance Abuse and Mental Health Services Administration (SAMHSA) is a good resource – you can visit www.samhsa.gov or call the hotline at 800-662-4357.

The opioid epidemic is a serious challenge, but it is not insurmountable. Together, let’s work to advocate for relief, bring lifesaving care and treatment to those who need it the most, and end this crisis.

Learn more from these high-quality sources of information on the opioid epidemic:

• The Lancet
• Centers for Disease Control and Prevention
• US Department of Health and Human Services

About Vinh Le

I’m a senior medical student at the UVM Larner College of Medicine. I am so grateful for the opportunities across my medical education to engage in public health research and advocacy, and I appreciate this chance to share more about the opioid epidemic and ways that we can work together to end it.

References

1.       Opioid Crisis. Health Resources & Services Administration

2.       Opioid Facts and Statistics. U.S. Department of Health and Human Services

3.       The Drug Overdose Epidemic: Behind the Numbers. Centers for Disease Control and Prevention

4.       Timeline of Selected FDA Activities and Significant Events Addressing Substance Use and Overdose Prevention. U.S. Food & Drug Administration

5.       Humphreys, K. et al. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford–Lancet Commission. The Lancet 399, 555–604 (2022).

6.       Carioti, R. As opioids flooded tribal lands across the U.S., overdose deaths skyrocketed. The Washington Post (2020).

7.       McGranahan, D. & Parker, T. The Opioid Epidemic: A Geography in Two Phases.

8.       Muhuri, P. K., Gfroerer, J. C. & Davies, M. C. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. SAMHSA

9.       Frank, R. G. & Pollack, H. A. Addressing the Fentanyl Threat to Public Health. N. Engl. J. Med. 376, 605–607 (2017).

10.   Spencer, M. R., Warner, M., Bastian, B. A., Trinidad, J. P. & Hedegaard, H. Drug Overdose Deaths Involving Fentanyl, 2011-2016. Natl. Vital Stat. Rep. 68, 1–18 (2019).

11.   The Opioid Crisis. NIH HEAL Initiative

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13.   Cuéllar, M.-F. & Humphreys, K. N. The Political Economy of the Opioid Epidemic. SSRN

14. Meier, B. Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused. The New York Times (2018).

15.   Cheetham, A., Picco, L., Barnett, A., Lubman, D. I. & Nielsen, S. The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy. Subst. Abuse Rehabil. 13, 1 (2022).

16.   Overdose Deaths and Jail Incarceration – National trends and racial disparities. Vera Institute of Justice

17.   Merrall, E. L. C. et al. Meta-analysis of drug-related deaths soon after release from prison. Addiction 105, 1545–1554 (2010).

18.   Saloner, B. et al. A Public Health Strategy for the Opioid Crisis. Public Health Rep. 133, 24S-34S (2018).

19.   McGinty, E. E., Goldman, H. H., Pescosolido, B. & Barry, C. L. Portraying mental illness and drug addiction as treatable health conditions: effects of a randomized experiment on stigma and discrimination. Soc. Sci. Med. 126, 73–85 (2015).

20.   Kennedy-Hendricks, A. et al. Social Stigma Toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health-Oriented Policies. Psychiatr. Serv. 68, 462–469 (2017).

21.   Cardoso, F. H. The World Drug Perception Problem – Countering Prejudices About People Who Use Drugs.

22.   Compton, W. M. & Jones, C. M. Epidemiology of the U.S. opioid crisis: the importance of the vector. Ann. N. Y. Acad. Sci. 1451, 130–143 (2019).

23.   Mistry, C. J., Bawor, M., Desai, D., Marsh, D. C. & Samaan, Z. Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence. Curr. Psychiatry Rev. 10, 156–167 (2014).

24.   Jones, C. M. & McCance-Katz, E. F. Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug Alcohol Depend. 197, 78–82 (2019).

25.   Dasgupta, N., Beletsky, L. & Ciccarone, D. Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. Am. J. Public Health 108, 182–186 (2018).

26.   Volkow, N. D. & Blanco, C. The changing opioid crisis: development, challenges and opportunities. Mol. Psychiatry 26, 218–233 (2021).

27.   Volkow, N. D., Frieden, T. R., Hyde, P. S. & Cha, S. S. Medication-Assisted Therapies — Tackling the Opioid-Overdose Epidemic. N. Engl. J. Med. 370, 2063–2066 (2014).

28.   Barnett, M. L. et al. Racial Inequality in Receipt of Medications for Opioid Use Disorder. N. Engl. J. Med. 388, 1779–1789 (2023).

29.   Lifesaving Naloxone. Centers for Disease Control and Prevention