Well-Being Prevention & Cures

US opioid crisis arose from weak laws and regulations, study says

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Story at a glance

  • Nearly 841,000 people have died since 1999 from drug overdose, according to the Centers for Disease Control and Prevention, and in 2019 about 70 percent of all drug overdoses involved opioids.
  • The Stanford-Lancet Commission on the North American Opioid Crisis published an in-depth analysis of how the U.S. can learn from its mistakes and solve the opioid crisis.
  • Reforming drug regulations and establishing stronger substance use prevention were among many recommendations made by the commission.

Over half a million people in the U.S. and Canada have died from opioid overdoses, and a new study estimates 1.2 million more could die by 2029 if drastic solutions aren’t enacted by the government to reform and regulate industries that administer and facilitate opioid use. 

Stanford University established the Standford-Lancet Commission on the North American Opioid Crisis in response to the soaring opioid-related death rates in the U.S. and Canada over the past 25 years. In a new analysis, the commission identified a series of problem areas that governments could act on, from reforming drug regulations, establishing stronger systems for substance use disorders, fostering healthier environments for substance use prevention and encouraging innovation within biomedical research for pain relievers. 

The commission argues that the North America opioid crisis began when “insufficient regulation of the pharmaceutical and health-care industries enabled a profit-driven quadrupling of opioid prescribing.” 

That’s been made clear in recent years, as Purdue Pharma, maker of opioid OxyContin, pleaded guilty to conspiring to impede the Drug Enforcement Administration (DEA) which also involved facilitating unlawful prescriptions of OxyContin. 

Pharmaceutical giant Johnson & Johnson faced a similar fate, with a judge ruling the company must pay out $572 million to abate the ongoing opioid epidemic in the state of Oklahoma. Evidence presented at trial revealed that Oklahoma doctors were targeted over 150,000 times by J&J sales representatives aggressively marketing and bombarding them with pseudoscience and misleading information that downplayed the risks of opioids.  


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The commission noted that under U.S. law, once a drug is approved, monitoring and educating prescribers about any risks it carries is largely at the manufacturer’s discretion, along with any post-marketing studies of approved opioid medications. That should change, as the commission recommended the government should step in and monitor post-approval risks or harms of medicines and be more willing to pull drugs from the market that are non-compliant. 

The commission also found that the U.S. doesn’t spend nearly enough on substance use disorder programs and that previous studies have found that fewer than half of treatment programs have a full-time physician or nurse on staff, which, “shows how poorly the treatment system for substance use disorder is integrated with mainstream medicine.” 

The federal government has historically funded substance use disorder programs by issuing short-term grants, but that’s created low and inconsistent financing. As a result, the commission argued this can reduce clinicians’ willingness to specialize in the care of substance use disorder and for educational institutions to provide training in this area. 

To fix this, the commission recommended integrating evidence-based, enduring systems for the care of substance use disorders, built and supported financially on a permanent basis. That also includes adapting the mentality around how to treat substance abuse, like the controversy around supervised drug consumption sites.  

New York City took a step in that direction last year when former mayor Bill de Blasio announced the first publicly recognized overdose prevention centers. The sites are considered safe place for those using drugs who can receive medical care and be connected to treatment and social services. The city’s Health Department conducted a feasibility study and found that opening overdose prevention centers would save up to 130 lives a year.  

Another recommendation the commission offered was stimulating innovation in response to addiction, writing that other chronic health problems like depression, asthma, hypertension and cardiovascular disease have seen improved treatment options over the past 25 years, but treatment of addiction has not. 

“Innovation is also needed in pain management, particularly in the development of effective medications that do not carry risk of addiction,” said the commission’s report. 

The bottom line of the commission’s report found that even in the era of COVID-19, “the opioid crisis stands out as one of the most devastating public health disasters of the 21st century in the U.S. and Canada.” It warned that addiction will remain an issue within the population, but in the future the main drugs of concern may not be opioids. 

“It took more than a generation of mistakes to create the North American opioid crisis. It might take a generation of wiser policies to resolve it. Such polices will have long-lasting gains if they curtail the power of health-care systems to cause addiction and maximize their ability to treat it,” said the commission.


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