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Who's To Blame For The Opioid Epidemic?

If you haven't heard by now, the nation is facing one of its worst modern day public health epidemics it has ever encountered relating to the abuse and misuse of both prescription pain pills and non-prescription opioids such as heroin which started in the late 1990's. You can't go a day without reading about headlines in the news such as "Oklahoma wins case against drugmaker in historic opioid trial" in which a judge ordered Johnson & Johnson to pay $572 million for their role in the opioid crisis or "Sackler family backs $11.5-billion Purdue opioid settlement" which talks about how the Sackler family which owns Purdue Pharma, the makers of OxyContin, want to settle their more than 2,000 lawsuits against them with a $10-12 billion pay out. Regardless of the current legal settlements, experts agree that litigation alone is not going to fix the problem and has been criticized by some as not going far enough. And patients are the ones that continue to suffer with an average of over 130 people dying a day from overdoses leading to more than 400,000 needless deaths over the past 2 decades since the opioid epidemic began.

How It Began

Starting in the last 1990's pharmaceutical companies such as Purdue Pharma began heavily marketing opioid pain relievers as a safe and effective means to control pain from all causes that had no abuse or addictive potential. As a result of their aggressive push, healthcare providers started prescribing opioids at an increasingly greater rate often for conditions that did not warrant these types of medications.

Since we are now all aware of the highly addictive properties of opioid pain relievers many patients either knowingly or unknowingly became victims of opioid dependence. As their tolerance built, patients needed higher and higher doses or stronger opioids to maintain their habit often leading to fatal doses especially when mixed with other drugs such as benzodiazepines.

As the public and government became aware of the dangers of opioids they started instituting policies regarding the prescription of opioid pain relievers making them more difficult for patients to obtain, even in appropriate circumstances. As a result, patients were forced to turn to other means and many started obtaining heroin which accounts for the increase in heroin overdose deaths beginning in 2010. More recently, synthetic opioids such as illicitly-manufactured Fentanyl and Carfentanil started to flood the US market in 2013 and account for the majority of overdose deaths we see today due to their much stronger potency.

Given the magnitude of the opioid crisis and the lackluster response to address it thus far, many seek to find a scapegoat to blame. While the pharmaceutical companies are an easy target there are likely many other players that have contributed to where we are today. Some like to blame the doctors for prescribing the opioids in the first place although many claim they believed the advertising campaigns about opioids being safe and non-addictive and they were also under pressure at the time by many advocacy groups, medical associations, and government agencies to take pain management more seriously even going so far as making it a 5th vital sign. One could just as easily blame the pharmacies and pharmacists for allowing the opioid prescriptions to be filled even when red flags were raised. In some towns it has been reported that there were more bottles of pain pills being dispensed than there were citizens in the population. Insurance companies surely could see the trends in opioids being filled and put a hold on them. Public health officials also must have noticed the increase in overdose deaths over this time period and could have sound the alarm bell much sooner. Regardless of the cause, we must now turn our attention towards healing and recovery and work towards getting patients into treatment since currently it is reported that only less than 10% of all those suffering from opioid use disorder are getting help. Luckily, more and more legislation is coming out to address this ever growing epidemic and will likely continue to do so in the near future.

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