It is well documented that opioid prescriptions rose dramatically in the 1990’s. Some of this was a well-intentioned culture shift, because of a growing recognition that doctors weren’t taking pain seriously and were stigmatizing patients with chronic pain. In 1995, the American Pain Society introduced a campaign:  “Pain is the fifth vital sign.”

Pharmaceutical manufacturers supported this change with marketing and education about the importance of proper pain control. Hospitals feared losing federal funding if they didn’t treat pain adequately. Many doctors started to use opiates (traditionally reserved for terminal cancer pain) for chronic pain, and they were encouraged by their health systems to err on the side of overprescribing. This exposed many more people to opioids who would never have come into contact with them previously.

A “disease of despair”

Since 2014, there has been a decrease in American life expectancy that has been called the “disease of despair”. The phrase points out the connection between a sense of increased hopelessness, depression, suicide/suicidal thoughts, alcohol misuse, and substance misuse. The source of the despair can be debated - is it loneliness, anxiety, a loss of faith in self, mankind or a higher power, loss of economic or educational opportunity, or a general feeling of lack - but the facts are not up for debate.

Corporate Greed played a part

New formulas and brands of opiates were marketed as “less addictive” by companies, some with household names, like Johnson & Johnson. Another company, Purdue Pharma, maker of OxyContin, profited from the opioid crisis as well as from treatments for the very problem the company had helped create. There are currently approximately 2,000 lawsuits pending around the country filed by states and cities against opioid makers. A federal judge in Cleveland overseeing the cases is working toward a “global settlement,” worth tens of billions of dollars.

Other factors

Lack of oversight of drug distributors (the “middlemen” between doctors and pharma companies), cheaply made synthetic opiates like Fentanyl that are easy to import and extremely toxic, a general stigma about opiate use that prevents access to treatment or harm reduction programs, increased pressure on young athletes to compete harder, resulting in more injuries, and mandated incarceration for drug-related offenses, rather than treatment, all have contributed to a “silent epidemic” of opiate addiction and overdose.

Reason for hope

Large settlements with drug companies are funding more research on treatment approaches and prevention. Awareness of the problem is more widespread, doctors are less likely to overprescribe, and there is less stigma for seeking treatment. States and cities are focusing collaborative community resources on the problem, including drug courts, mandated treatment and M.A.T. Harm-reduction strategies like needle exchange programs and medically supervised “safe injecting sites” allow for a smoother transition from street to treatment. The problem has become obvious, and people across the country are passionately pursuing answers.