OPIOID EPIDEMIC & FENTANYL CRISIS

THE OPIOID EPIDEMIC OCCURRED IN THREE WAVES:

1st Wave – Beginning in 1991 deaths involving opioids began to rise following a sharp increase in the prescribing of opioids for pain treatment.  The increase was influenced by reassurances given to physicians by pharmaceutical companies and medical societies claiming that the risk of addiction to prescription opioids was very low.  During this time, pharmaceutical companies also began to promote the use of opioids in patients with non-cancer related pain even though there was a lack of data regarding the risks and benefits to these patients.  

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In the mid-90’s Johnson & Johnson started a new venture, cultivating poppies in Tasmania. Its scientists genetically modified the poppy plants, engineering so-called “super poppies.”  These poppies were exported to the U.S. and refined by subsidiaries into oxycodone and hydrocodone powders that were shipped to U.S. pill makers such as Purdue Pharma.  Their products were marketed as being safe, effective, and without significant risk of addiction.

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In 1996, Purdue Pharma first released OxyContin and created a marketing campaign blitz presenting OxyContin as the next miracle drug. It falsely claimed that the pill’s extended release of painkiller medication would addict less than 1% of patients. Doctors were encouraged to liberally prescribe the medication for all sorts of conditions. Due to a combination of aggressive marketing and misleading information, the market was flooded with OxyContin. When tolerances increased, the company’s marketing response was “increase the dose”.  In 1997, there were approximately 670,000 prescriptions for OxyContin. In less than five years, that number ballooned to 6.2 million prescriptions.

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By 1999, 86% of patients using opioids were using them for non-cancer related pain like accident and sports injuries
as well as dental surgery.  Communities where opioids were readily available and liberally prescribed were the first places to experience increased opioid abuse and diversion (the illegal transfer of opioids from the individual for whom they were prescribed to others).  In its early years, the Opioid Crisis went relatively unnoticed by medical professionals and law enforcement agencies. By the time agencies took notice, the effects were catastrophic.
              

2nd Wave – The 2nd wave of the opioid epidemic started around 2010 with a rapid increase in deaths from heroin abuse.  As early efforts to decrease opioid prescribing began to take effect, prescription opioids became harder to obtain and the focus turned to heroin, a cheap, widely available, and potent illegal opioid. The use of heroin increased in both sexes, most age brackets, and all socioeconomic groups.  Deaths due to heroin-related overdose increased by 286% from 2002 to 2013, and approximately 80% of heroin users admit to having misused prescription opioids before turning to heroin.  When prescriptions were ‘cut off’ by doctors, many of those addicted turned to the streets to stave off severe withdrawals. The product was cheap and accessible…and thus, the downward spiral of the disease began. It also had the potential to be more contaminated or cut with other illicit drugs or synthetic ingredients increasing the risk of sickness or death.  Heroin is also commonly injected, which puts users at risk for injection related diseases like HIV/AIDS, Hep B and C, skin infections, bloodstream infections and infections of the heart.

3rd Wave – The 3rd wave began in 2013 with an increase in deaths related to synthetically manufactured opioids like fentanyl.  Fentanyl is 100x more potent than morphine and 50x more potent than heroin.  In 2016 alone there were over 20,000 deaths from fentanyl and other chemicals being deceptively added to many street drugs. As of October 16, 2017, the U.S. government declared the opioid epidemic a public health emergency.

Fentanyl and fentanyl precursors are mostly being produced in China and then distributed by Chinese transnationals to Mexican cartels who then transport throughout the U.S.  Compared to the start of the fentanyl crisis, the flow of fentanyl into the U.S. in 2019 became more diverse and complicated with new source countries globally manufacturing and shipping fentanyl, fentanyl-related substances and fentanyl precursors as well as new transit countries emerging as significant trafficking nodes. This highly challenges law enforcement operations and policy efforts to stem the flow. While Mexico and China are the primary source countries trafficking to the U.S., India is emerging as a source for finished fentanyl powder and fentanyl precursor chemicals.  Fentanyl production and precursor chemical sourcing may also expand beyond the currently identified countries as these substances lack the geographic source boundaries of heroin and cocaine which must be produced from plant-based materials.  Fentanyl deaths are now being labeled ‘poisonings’ or ‘murders’ by many.

Drug overdoses are now at record highs, largely due to synthetic opioids and have currently become the leading cause of death of Americans between the ages of 18 - 45. The overall life expectancy of Americans for the past several years has decreased, with young men disproportionately more affected.

• Over 289 people die from opioid overdose every day, according to some sources. 

• There were 100,000 overdose deaths in 2021, a. 28.5% increase from the prior year, according to the CDC.

• In 2021, 3,124 people in New Jersey died of overdoses. 

• This epidemic has been dramatically impacted by the Covid-19 pandemic due to social isolation, mental health issues, lack of in-person treatment, and economic stressors.

• Fentanyl 'poisoning' deaths occur on average every 5 minutes in the U.S.    

• Fentanyl contamination has been found in heroin, cocaine, methamphetamines, ecstasy, and even marijuana…and in  counterfeit pills made to look identical to prescription medication such as Oxycontin, Percocet, Xanax, Adderall, and others.

As soon as May 2022, thousands of U.S. communities will receive opioid recovery funds from $26 billion global settlements with pharmaceutical manufacturers.  The National Prescription Opiate Litigation Plaintiffs’ Executive Committee (nationalopioidsettlement.com) confirmed in February 2022 that over 90% of litigating local governments have confirmed participation in these global settlements approved by the “Big Three” drug distributors AmerisourceBergen, Cardinal Health, and McKesson, along with opioid manufacturer Johnson & Johnson Washington, D.C.  Additionally, on March 3, 2022, Purdue Pharma reached a nationwide settlement for $6 billion. The bottom line is that financial help is on the way for governments, first responders, and healthcare workers on the front lines of this public health crisis. Nothing can make whole what was lost in this country, but what we can do is ensure that thousands of communities nationwide have the tools they need to help prevent the opioid epidemic and fentanyl crisis from taking more lives. It is also important to remember that while this is a vital step, it is only one of many that are necessary to put an end to this crisis. The settlements are the first of their kind to administer resources directly to the state and local governments specifically for relief programs to help rebuild the devastation caused by the opioid epidemic.