How Should the U.S. Deal with its Opioid Crisis?

By: Shiny Han (Kellogg)

Opioids are substances that work in the body's nervous system or in specific receptors in the brain to reduce pain intensity. Since 1999, more than 932,000 in the U.S. have died from opioid addiction. However, Americans have been neglecting and stigmatizing individuals affected by opioid addiction, placing blame on individuals while overlooking institutional problems. As increased unemployment, homelessness, and a lack of interpersonal communication during COVID-19 exacerbated mental health issues, pandemic-induced stress surged drug usage over recent years. As a result, drug overdose deaths surged in the United States during the first year of the COVID-19 pandemic, increasing by 30.6% in just 12 months, with nearly 75% of drug overdose deaths in 2020 involving an opioid.

Harmful Health Industry Practices

The lobbying of pharmaceutical companies has been the root cause behind the unchecked opioid crisis. In 2021, annual donations from opioid manufacturers reached a record high of $361.13 million. Among the 1780 lobbyists in the Pharmaceutical/Health products industry, 1050 were ‘revolvers’: government regulators and Congress members who joined the private organizations and lobbying firms they used to oversee.

This institutional practice permitted drug distributors such as Purdue Pharma to prescribe OxyContin, a highly addictive pain medicine, since the mid-1990s. Since its inception, OxyContin sparked a wave of deaths from legally prescribed opioids, subsequent deaths from heroin, and more recent deaths from illegal synthetic opioids such as fentanyl. Most alarmingly, Purdue Pharma has employed deceptive strategies to increase the healthcare industry’s reliance on OxyContin. For example, while Purdue Pharma promoted the risk of addiction as less than 1%, studies reported the risk of addiction could be as high as 50% for patients with chronic non-cancer-related pain. In addition, Purdue Pharma trained their sales representatives to persuade pharmacists, physicians, and nurses to prescribe OxyContin for common pain relief and sponsored clinicians to attend symposiums promoting OxyContin.

Despite accusations of fraudulent marketing, Purdue Pharma’s institutional power shields them from legal consequences. Specifically, Purdue Pharma was provided legal protection from future opioid-related litigation with a settlement of $6 billion to local governments. However, this number is meager in comparison to the $1 trillion the opioid crisis costs the U.S. annually (CDC). Although Purdue Pharma is undergoing restructuring into a new company called Knoa Pharma LLC, it is uncertain how effectively funds will be distributed to opioid abatement programs. Furthermore, there is still an ongoing debate about whether the 80-milligram version of OxyContin, the drug’s highest strength, should remain on the market.

However, Purdue Pharma’s lawsuit is only the tip of the iceberg. Other large drug distributors such as Johnson & Johnson, Cardinal Health, CVS, and Walgreens were recently sued for mitigating the risks and exaggerating the benefits of drugs. Until policies effectively regulate harmful industry practices, both medical practitioners and patients will continuously overlook the risks of carelessly prescribed opioids.

De-stigmatization as Prevention

While no single panacea exists to remedy the opioid crisis, public awareness can be improved by combatting the stigma associated with those addicted and recovering from drug usage. Health professional education should emphasize training practitioners to evaluate and mitigate the risk of prescriptions accurately. Specifically, practitioners should receive training and demonstrate leadership in de-stigmatizing language during treatment and discussion of addiction. For instance, the term “addict” can be replaced by “person with substance use disorder,” “drug abuser” with “patient,” and “abuse” with “misuse.” If practitioners normalize more first-person language, the general public may gradually adopt a different framework for humanizing people with substance use disorder.

In addition, the public health community can also work with the criminal justice system to prioritize treatment over incarceration. In 2008, The Mental Health Parity and Addiction Equity Act required insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions. Unfortunately, such parity laws are not consistently adhered to. Rather than relying solely on short-term federal funding, addiction care should be accessible, de-stigmatized, and integrated into mainstream health care. It is imperative to ensure that public and private insurance covers the full range of addiction services with sustained funding.

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