Everything about the massive surge in opioid abuse cuts across traditional boundaries of drug use in the U.S. It’s hit white residents in the countryside as well as minorities in cities. It involves long-banned substances such as heroin, legally prescribed painkillers, including OxyContin and, increasingly, street drugs that mimic powerful synthetic opioids such as fentanyl. Their combined death toll now exceeds that of car crashes or firearms, and opioid abuse is seen as a prime factor in declining American longevity. 

The Situation

In October, Congress passed a bipartisan bill to increase grants for treatment programs and expand access to inpatient drug rehab services through Medicaid, the government’s health program for the poor. The bill also requires the U.S. Postal Service to screen packages coming from China and other countries for fentanyl. Almost a year earlier, U.S. President Donald Trump had declared the situation a national emergency. That cleared the way for temporary appointments of specialists under federal grants to crisis areas, but didn’t create additional funding. More than 200 states and localities have sued drugmakers and drug distributors, accusing them of creating a public-health crisis with their mishandling of opioids. Officials of Purdue Pharma Inc., the maker of OxyContin, and other drug makers are in seeking a global settlement of the claims. States and the federal government have made the opiate-antidote drug naloxone more readily available. Still, in 2016 fatal drug overdoses jumped by 21 percent, and the rate of deaths from synthetic opioids like fentanyl doubled.

The Background

Extracts of the poppy plant have been a source of trouble since the 19th century Opium Wars. Heroin, first produced in 1898 by Bayer, the German pharmaceutical company, was marketed as a non-addictive substitute for morphine. By the early 1900s, widespread heroin use led states like New York to open addiction centers in hospitals. Heroin’s latest wave arose from changes in prescription opiate use. Opioid painkillers gained in popularity in the 1990s, partly in response to what was seen as widespread undertreatment of chronic pain. In 1996, Purdue Pharma Inc. introduced OxyContin as an alternative to stronger opioids reserved mainly for the dying. Its annual sales surged to $1 billion. In 2007 Purdue paid $600 million in fines and its executives pleaded guilty to federal criminal charges for misbranding the product as less addictive than other painkillers. In 2010, it released a reformulated version that was harder to crush for snorting. A May 2015 study found that while the new version reduced illicit use of the painkiller, it led more people to take up heroin, whose price was dropping. Nearly 90 percent of new heroin users in the U.S. are now white, compared with an equal mix of whites and nonwhites before 1980. Globally, poppy cultivation has reached its highest level since the 1930s. 

The Argument

While Trump agreed to his commission’s call for a declaration of emergency, he said that the prime solutions should be telling people not to use the drugs and cutting off illegal supplies. But a commission he had appointed had instead stressed measures to help educate medical professionals about prescription abuse and to make treatment easier to obtain. Officials from hard-hit states have chided federal regulators for not doing more to restrict opioid prescriptions. In response, health officials are encouraging doctors to reserve the strongest painkillers for patients who don’t respond to milder drugs. Groups that advocate for patients in chronic pain worry that the rush to solve the addiction problem will lead to needless suffering.  Nearly every state has enacted laws related to opioid abuse, including measures targeting doctors and pharmacists who prescribe or dispense too many of the pills, and offered criminal immunity to patients seeking treatment for an overdose. But with limited action at the federal level and little new money available to fight addiction, many states are pinning their hopes on generating a Big Tobacco-style legal settlement. Cigarette makers agreed in 1999 to pay $246 billion to settle states’ suits that sought to recoup the costs of smoking to society.

To contact the writer of this QuickTake: Lauren Etter in Austin at letter1@bloomberg.net

To contact the editor responsible for this QuickTake: John O’Neil at joneil18@bloomberg.net

First published March 29, 2016

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