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As noted in SHADAC’s most recent brief, the opioid crisis is widely considered to have its roots in the mid-to late-1990s, when a confluence of factors—including the beginning of the “Pain as the 5th Vital Sign” campaign and the U.S. Food and Drug Administration’s approval of Purdue Pharma’s blockbuster OxyContin—led the U.S. health care system to greatly increase prescribing of opioid painkillers.
[4]
For more than a decade, the steadily increasing rate of overdose deaths involving prescription opioids continued with little notice. But that changed around 2011 when the CDC declared deaths from prescription painkillers an “epidemic.” In the years that followed, the U.S. health care and public health systems took steps to rein in prescribing of opioid painkillers. The CDC developed guidelines aimed at reducing risky prescribing patterns, and many states implemented legal restrictions in addition to the voluntary, well-meaning attempts made by many health care providers to be more cautious in prescribing opioid painkillers. The leveling-off of prescription opioid overdose deaths after 2011 suggest some degree of success, though it was limited, and rates never declined in any large or durable way.
Around the same time that prescription opioid deaths peaked, data on drug overdose deaths show that the opioid crisis made a distinct shift. Deaths began to climb first from heroin, an illegal opioid that has been trafficked for decades by criminal enterprises, then from fentanyl and similar synthetic opioids that criminal enterprises also began to traffic.
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Heroin rose in popularity as individuals who were addicted to prescription opioids suddenly found themselves cut off from a substance on which they had become chemically dependent and sought out a substitute. Seeking to exploit a growing market for illicitly trafficked opioids, drug traffickers eventually turned instead to fentanyl as it is easier to produce in large quantities than heroin, has a higher potency, and is easier and cheaper to smuggle than its counterpart. Resultantly, death rates from heroin began to recede, while those from fentanyl have only continued to surge.
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