The Opioid Crisis: WHY is it so devastating?
Three waves of opioids washing up to today.
In Part I, we saw that over 79,000 people have died from opioid-related causes in 2022, double the death toll from COVID-19 last year. The crisis didn’t start this big; so how did it reach its disastrous levels today?
1. Three waves crashing harder each time
The first wave began after the rise of prescription opioids, such as OxyContin, approved by the FDA in 1995. By 1999, the CDC reported the first wave of opioid-related deaths. These deaths tended to be among older and non-urban individuals, a group employed in more manual labor and accompanying pain. As more people became addicted to opioids through prescription channels, addicts sought out cheaper, more available sources of opioids and pushed into the illegal drug market. The second wave of the crisis began with the rise of heroin use and grew into younger demographics and urban areas.
The most destructive wave of the opioid epidemic began in 2013, as new, synthetic opioids, especially fentanyl, entered the market to replace heroin. Fentanyl is incredibly potent, making it much deadlier than other opioids. Illicitly manufactured fentanyl is highly dangerous precisely because there is no ability for users to verify its quality or safety, and it is often laced in combination with heroine, cocaine, and other counterfeit pills. This wave has affected a wide range of demographics, including teenagers and young adults, more minorities, and spans the whole of the U.S.
2. A major crisis mixed in with a pandemic
From 1999–2020, more than 564,000 people died in the U.S. from an overdose involving any opioid, including prescription and illicit opioids.[1] Then along came the pandemic…In 2020, the number of deaths had increased by nearly 30 percent from 2019 and nearly 75 percent of the 91,799 drug overdose deaths in 2020 involved an opioid.
The pandemic’s economic uncertainty combined with social isolation and increased mental health distress caused a surge in opioid related deaths. There was also disruption in access to addiction programs and medical treatments that needed face-to-face visits. Nearly 200,000 people died from opioids during 2020 and 2021.
3. Fanning the flames
The economic drivers of the epidemic have their roots in the structure of the medical system and industrial change in the U.S. On the demand side of the medical system, these prescription opioids were made very cheap through insurance. The out-of-pocket price for opioids fell by 80 percent between 2001 and 2010.[2] For example, a 2007 Council of Economic Advisors estimate showed that, without insurance, 1 gram of OxyCotin cost $144, putting a year’s supply at a largely unreachable $26,280-$52,560. However, with Medicare coverage, the price was merely $9.78 per gram, and yearly costs were only $1,785-$3,570.
Several factors on the supply side of healthcare made a bad situation worse. We already discussed the lack of transparency from pharmaceutical developers and the role of physician detailing, but another exacerbating policy was the importance of “management of pain” in Value Based Care. Hospitals were evaluated in several quality categories, and prescribing opioids improved pain management scores as well as patient satisfaction. There was also a lack of standardization for pain management among health professionals, in recognizing addiction and the availability of alternative pain treatments.
Finally, the crisis emerged from a pre-existing struggle of changes in U.S. economic drivers. The first wave of the crisis took root in the economically depressed areas of the “Rust Belt”, where poor economic opportunities, mental health struggles, and despair, merged with this newly accessible drug.
As always, keep me updated on what you’re up to or reach out to chat with me about these issues. Next month, we’ll have a more positive discussion- how can we create better solutions for this fight?
Best,
TMD
[1] Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at http://wonder.cdc.gov.
[2] The Council of Economic Advisors. “The Role of Opioid Prices in the Evolving Opioid Crisis,” April 2019. https://trumpwhitehouse.archives.gov/wp-content/uploads/2019/04/The-Role-of-Opioid-Prices-in-the-Evolving-Opioid-Crisis.pdf