The epidemic surrounding opioid abuse in the United States is inescapable. On average, 140 Americans die everyday of drug overdoses, with over 90 of those deaths resulting from opioid abuse alone. Accidental drug overdoses recently became the leading cause of death by injury for Americans under 50, surpassing homicides and car accidents. Beyond the obvious impact on human life, the current opioid crisis has had massive economic effects. The Centers for Disease Control estimates that the economic costs of the opioid epidemic total around $78.5 billion every year, including “healthcare, lost productivity, addiction treatment, and criminal justice” costs. By this point, it is clear that the opioid epidemic is a colossal emergency our society faces. Much less clear, though, are the reasons behind this outbreak of substance abuse disorders and exactly what steps can be taken to combat it. 

The catastrophic level of opioid abuse has become increasingly common in recent years. As cases of addiction and overdose deaths reach new heights, many Americans are looking for the reasons behind the mounting crisis and where to place the blame. The obvious first place to look for many is the pharmaceutical industry. In terms of history, this is a logical place to start. The opioid crisis in its current form effectively began in the 1990s. In 1996, Purdue Pharma began manufacturing OxyContin, a narcotic used to manage moderate to severe pain. Prior to this point, doctors in the United States had demonstrated a long history of what was referred to as “opiophobia,” or an extreme resistance in prescribing opioids because of the possibility of addiction.

In order to combat this trend and, in effect, increase their drug sales, pharmaceutical companies began to aggressively market their products. Such companies also started to engage in misleading advertising techniques. For example, pharmaceutical company Endo International sponsored a website claiming that the notion of opioid painkillers causing addiction was a myth. As a result of such marketing, health care providers began to prescribe opioids at ever increasing rates. Since this point, opioids have become dangerously overprescribed, with prescription sales increasing alarmingly since 1999. Opioid use thus became more widespread, and opioid-related overdose deaths much more common.

The immoral acts of companies such as Purdue, Allergan, Johnson & Johnson and Endo in prioritizing their own profits over the lives of their consumers are clearly reprehensible. In fact, over 35 percent of all opioid-overdose related deaths are from prescribed opioids, demonstrating just how influential the actions of pharmaceutical companies were in creating the current epidemic. The guilt of the pharmaceutical industry is highlighted by the abundance of lawsuits against varying companies over their roles in manufacturing the crisis.

However, pharmaceutical companies do not stand alone in their guilt. The government officials who enabled the sales of opioid drugs to skyrocket are equally to blame in the opioid crisis. Agencies such as the Food and Drug Administration and the Drug Enforcement Administration were created to protect the American people from abuses and misuses of drug distribution such as this one. This past summer, a federal court ordered the release of DEA-collected data, revealing that the agency began collecting data on the manufacture, distribution, and sale of all opioid pills in 2006. Despite the documentation of data recording the astronomical surge in opioid sales and related overdose deaths, the DEA effectively did nothing to help save the lives of American people. In conjunction with the malicious marketing techniques employed by the pharmaceutical industry beginning in the 1990s, the inaction of the government in the face of clear misuse of opioid prescription implicates it in the current state of the opioid epidemic. 

It is difficult to deny that the disastrous effects of the opioid crisis clearly have their origins in abuses of power and governmental inaction. More difficult than determining the overall causes of the epidemic, though, is figuring out how to handle the effects. As hundreds of thousands of people die of drug overdoses annually, it is clear that the current methods of dealing with the crisis are not working. Many pharmaceutical companies are in the early stages of being held accountable for their own parts in the epidemic. Most recently, a $260 million settlement was reached between three major drug distributors and two Ohio counties, allowing them to avoid the first federal opioid trial. The government should begin to acknowledge their own guilt by vowing to combat the epidemic more aggressively.

They can first do this by portraying opioid addiction and related substance abuse issues as the mental health issues they are, instead of criminalizing them. The decriminalization is particularly necessary in Black communities or communities of lower socioeconomic status. The majority of the media attention on the opioid crisis has been on white Americans, and the reason for this may be the fact that opioid deaths among white individuals outnumber those among Black individuals. However, deaths from opioid overdoses are more rapidly increasing among Black Americans. Furthermore, Black drug addicts are more likely to be portrayed as criminals than their white counterparts, who are more often seen as requiring medical treatment. In the pursuit of combating the opioid epidemic through decriminalization, it is imperative to include all demographics in this process, especially those who have been hit hardest by the criminal justice system.

Beyond the total decriminalization of opioids, the federal government should fund and implement effective public education and awareness campaigns about the opioid crisis, including instructional information about where to find effective treatment options. Furthermore, the government should additionally develop, fund and implement more effective school and community-based prevention techniques. These techniques must be non-punitive in nature and address the often underlying mental health issues that contribute to opioid addiction.

Finally, the federal government must circle back to the origins of the crisis and be more stringent in holding the DEA accountable in their documentation of opioid sales. This can include requiring that the DEA uphold stricter standards in the issuance of registrations to doctors with the ability to prescribe opioid medications, as well as the prohibition of direct-to-consumer advertising of opioids. 

The complexity and magnitude of the current opioid crisis in the United States is overwhelming. It is important to avoid getting caught up in the intricacies and allow those responsible to account. By holding both the pharmaceutical companies and the federal government accountable for the epidemic, society can begin to more fully combat the crisis and prevent any further catastrophic loss of life. 

Alanna Berger can be reached at balanna@umich.edu.

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