THE OPIOID CRISIS AND THE WAR ON DRUGS
The opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain, and the rising toll of harms related to opioid use.
—National Academies of Sciences, Engineering, and Medicine, 2018.
Opioid addiction and related deaths increased at an alarming and unprecedented rate over the past 15 years in the United States. In fact, opioid overdoses have quadrupled since 1999.1 Pain medications such as methadone, oxycodone, and hydrocodone, and illicit opioids such as fentanyl, account for 1 in 6 drug overdose deaths in the United States.1 In 2016, nearly 43,000 people died from opioid-related deaths.2 Without strategic action and intervention, this number is projected to rise to nearly 100,000 per year by 2027.3 At the current rate, the crisis may result in more than 500,000 deaths over the next decade,3 largely due to the accessibility of synthetic variants such as fentanyl, and delays in addiction treatment. In addition to opioid overdose, misuse, addictions, and use disorders pose significant public health challenges, to say nothing of the suffering affecting families and communities nationwide.
At the forefront of the crisis is the supply of prescription opioids, in addition to the ready availability of heroin and fentanyl on the streets. In 2015 alone, more than 20,000 people died from overdoses involving prescription opioids.4 Sales of prescription opioids in the United States more than tripled from 1999 to 2014.5 Between 2007 and 2012, the rate of prescribing opioids increased among surgeons, pain management and emergency room physicians, and other specialists who manage pain regularly. Primary care providers accounted for nearly 50% of opioid pain medications prescribed.5
Fortunately, the rate began to decline in 2012 and hit a 10-year low in 2016.6 This decrease may be attributed to strong messaging doctors received about decreasing opioid prescriptions and added barriers to prescribing hydrocodone products. This occurred after the Drug Enforcement Administration (DEA) moved hydrocodone combination products from Schedule III to Schedule II in October 2014. Even so, the rate of prescribing opioids varies greatly by region in the United States. In 2016, the average rate of opioid prescriptions in U.S. counties was 66 per 1000 people. In areas most affected by the opioid crisis, such as Ohio, West Virginia, and Kentucky, the rate was up to seven times the average.6
In addition to prescription opioids, the crisis is fueled by illicit drugs such as heroin (Figure 247-1). From 2002 to 2013, heroin use and addiction increased among young people, which was attributed to heroin being cheaper and more accessible than prescription opioids.7 Heroin-related deaths more than doubled between 2010 and 2015, with more than 12,000 heroin-related deaths in 2015....