Introduction
The United States is grappling with one of its worst-ever drug crises. More than a thousand people a week die from opioid-related overdoses, and some experts say the death toll may not peak for years. Meanwhile, millions more Americans suffer from opioid addiction.
The crisis has reached such a scale that, beyond the risks it poses to public health, it is becoming a drag on the economy and a threat to national security. Analysts say the problem started with the overprescription of legal pain medications, like oxycodone, but note that it has intensified in recent years with an influx of cheap heroin and synthetic opioids, like fentanyl, supplied by foreign-based drug cartels.
In recent years, the U.S. government has ramped up efforts to cut both the foreign and domestic supply of opioids, limiting the number of prescriptions in the United States while providing counternarcotics assistance to countries including Mexico and China. Meanwhile, federal and state officials have attempted to reduce demand by focusing less on punishing drug users and more on treating them. Other countries where opioid use has also spiked, such as Canada and Australia, are experimenting with different policies.
What drugs are contributing to the crisis?
Opioids, a class of drugs derived from the opium poppy plant, can be divided into two broad categories: legally manufactured medications and illicit narcotics.
Opioid medications, including oxycodone, hydrocodone, and morphine, are commonly prescribed to treat pain, while methadone is primarily used in addiction treatment centers to reduce patients’ dependence on opioids. Opioids gained popularity among doctors in the 1990s for treating patients who had undergone surgery or cancer treatment, but in the last fifteen years physicians have increasingly prescribed them for chronic conditions, such as back or joint pain, despite concerns about their safety and effectiveness.
We didn’t develop an opioid epidemic until there was a huge surplus of opioids, which started with pharmaceutical drugs.
Bridget G. Brennan, New York Special Narcotics Prosecutor
Heroin has for decades been the most commonly used illegal opioid. Over the last several years the heroin supply in the United States has soared, and the drug can now be obtained for a third of the price it was in the early 1990s.
People in the last few years have increasingly turned to synthetic opioids, such as fentanyl, which is especially lethal. Some law enforcement officials have labeled the drug “manufactured death” because it is cheaper and up to fifty times more potent than heroin. Fentanyl-related deaths are largely caused by the drug’s illegal use, though it can also be prescribed as a painkiller. The Centers for Disease Control and Prevention (CDC) notes that heroin and fentanyl are most often used in combination with other drugs, such as cocaine, or alcohol, which increases the risk of overdose.
What is the scale of the epidemic?
Overdose deaths involving opioids have increased sevenfold since 1999. In 2016, opioid overdoses killed more than fifty-three thousand people, or nearly eight times the number of U.S. military servicemembers killed in the post-9/11 wars in Iraq and Afghanistan.
Many health experts attribute the rising death toll to what they say has been years of overprescribing by physicians. Doctors began prescribing more opioids amid a growing concern that pain was going undertreated, and also because pharmaceutical companies began marketing them more aggressively while claiming they posed little risk. Health-care providers have reported feeling pressure to prescribe opioid medications rather than alternatives, such as physical therapy or acupuncture, because patients request them and other treatments are often more costly or less accessible.
Opioid-related deaths have grown in lockstep with the volume of opioids prescribed. A spike in the use of illegal opioids in the United States followed the rise in prescriptions, as many users turn to heroin and other illegal drugs once they can no longer obtain enough of their prescribed drug to keep pace with what may be a developing addiction. “We didn’t develop an opioid epidemic until there was a huge surplus of opioids, which started with pharmaceutical drugs distributed legally,” says New York Special Narcotics Prosecutor Bridget G. Brennan.
What are the demographics of the opioid crisis?
The vast majority of those who overdose on opioids are non-Hispanic white Americans, who make up more than 80 percent of the annual total. Non-Hispanic black Americans and Hispanic Americans each account for about 10 percent of cases. Economists Anne Case and Angus Deaton have argued that the rise in what they call “deaths of despair,” which include drug overdoses, particularly among white Americans without college degrees, are primarily the result of wages stagnating over the last four decades and a decline in available jobs.
U.S. military veterans, many of whom suffer from chronic pain as a result of their service, account for a disproportionately high number of opioid-related deaths. Veterans are twice as likely as the general population to die from an opioid overdose, according to a study commissioned by the National Institutes of Health.
What have been the socioeconomic consequences?
The opioid epidemic is having devastating consequences on public health, causing high rates of hepatitis C, HIV, and other diseases, mainly due to shared syringes. Meanwhile, mothers may pass an opioid dependency on to their children if they use while pregnant. Incidences of neonatal abstinence syndrome almost quadrupled from 2000 to 2012. The opioid crisis may also have contributed to an uptick in the number of children in foster care.
Opioids have also begun to take a toll on the economy. Testifying before the U.S. Senate, Federal Reserve chief Janet Yellen linked the opioid epidemic to declining labor-force participation among “prime-age workers.” Princeton University economist Alan Krueger says it could account for 20 percent of the decline in participation among men and 25 percent among women from 1999 to 2015. As one example of this, a boiler manufacturing company in Ohio, the state with the second-largest number of opioid-related deaths, reported that at least a quarter of its job applicants failed drug tests. The firm says the workforce shortage costs it roughly $800,000 in orders a year, which end up going to foreign competitors.
This is part one of a report published by the Council on Foreign Relations. You can read part 2 here.