What is the Opioid Crisis?

BACKGROUND

Opioid abuse has become an epidemic across the U.S., with rates of addiction climbing and overdoses becoming a tragically common cause of death. The substances, which are often used in medical settings as painkillers, are highly addictive which has caused many people to use them illegally after their prescriptions run out. The opioid crisis has led the federal government to pass several significant pieces of legislation to provide resources for addiction prevention & treatment.

OVERVIEW

The group of substances known collectively as opioids or opiates are derived from the opium plant. Opioids range from pharmaceutical painkillers including morphine, hydrocodone, and oxycodone, to street drugs like heroin. They are highly addictive and vary in terms of their potency, but when used in excess can cause the user to overdose. 

The rise in overdose deaths attributable to opioids has led to a decline in Americans’ life expectancy. Opioid overdoses kill roughly 130 Americans per day and outpace overdose deaths from non-opioids, and the gap between the two has widened although both have tragically increased. Overdose deaths from opioids have outnumbered those from non-opioids each year since 2000, when there were 6,026 overdose deaths from non-opioids and 5,848 deaths from opioid overdoses. By 2017, there were 46,394 opioid overdose deaths versus 25,201 non-opioid overdose deaths, as this chart from USAFacts shows:

Part of the reason for the increase in opioid deaths has been the increased use of fentanyl, a synthetic opioid that is 50-100 times more potent than morphine and up to 50 times more potent than heroin. Fentanyl is used medically, but because it’s relatively cheap for drug traffickers to obtain, it has become more prevalent as a standalone substance or cut with heroin with much of it manufactured in China and smuggled into the U.S. from Mexico. This USAFacts chart shows the tragic result, as overdose deaths attributable to fentanyl increased 800% between 2013 and 2017:

One of the drivers of the opioid crisis has been the overprescription of pill forms of hydrocodone and oxycodone as painkillers. Prescriptions for high potency forms of the opioids & large amounts of doses given to patients in prescriptions led to an explosion of addiction. The manufacturers of opioids have also been accused of responsibility, as several have lost or settled lawsuits with substantial sums paid to plaintiffs on the grounds that they misled the public about the addictive nature of the drugs. 

As the opioid crisis has escalated in recent years, the opioid prescription rate has declined due to measures taken by the federal government & state governments, the healthcare & pharmaceutical industries, and increased awareness of the risks of opioids among the general public. This USAFacts chart shows how the opioid prescription rate declined from a high of 81.3 prescriptions per 100 people in 2012 to 51.4 prescriptions per 100 people in 2018:

HOW IS THE FEDERAL GOVERNMENT RESPONDING TO THE OPIOID CRISIS?

Congress and the executive branch have come together in a bipartisan manner on several occasions in recent years to address the opioid crisis, and to this day there continues to be a bipartisan sense of resolve to deal with the issue. 

In 2016, the Comprehensive Addiction & Recovery Act (CARA) was enacted by President Barack Obama after the bill passed the House 407-5 and the Senate approved it 92-2. CARA created grant programs for medication assisted treatment (MAT) programs, which aim to gradually wean an addict off of opioids while minimizing withdrawal symptoms by giving them safer drugs in the process. It also funded prescription medication disposal sites & programs; offered grants to states, localities, & non-profits that treat addiction as a disease while promoting treatment & recovery instead of incarceration; and created education programs about prescription pain medications and addiction to them.

Later that year, the 21st Century Cures Act was enacted with similar bipartisan support. The bill dealt with a wide range of research & development & delivery (RD&D) initiatives related to innovative medical treatments, and included new programs & revisions to those in CARA that aimed to prevent drug abuse.

In 2018, the SUPPORT for Patients and Communities Act was signed into law by President Donald Trump after the bill passed the House 396-14 and the Senate 99-1. The package included more than 70 individual bipartisan proposals aimed at increasing detection of illegal drugs at the border (including synthetic opioids like fentanyl), reducing overprescription of opioids, and developing alternatives to opioids (ALTO).

RESOURCES

• USAFacts - Opioid Addiction, Deaths, and Treatment
• USAFacts Table Topics - Opioids
• Countable - Comprehensive Addiction & Recovery Act
• Countable - SUPPORT for Patients and Communities Act

— Eric Revell

(Photo Credit: iStock.com / Stuart Ritchie)