The Fentanyl Crisis: How Did We Get Here?
Yesterday, Portland’s City Council voted to ban public consumption of controlled substances like fentanyl, and to advocate for changes to state law that make such a ban illegal and unenforceable. You can watch testimony from Systemic Change Director, Lauren Armony, here and read written testimony from Executive Director, Kat Mahoney, here, to learn more about why we oppose this ordinance. We also thought this was an opportune moment to reflect on how we got to this point of crisis.
Fentanyl has now solidified its position as the foremost cause of death among Americans ages 18-49, surpassing even guns, COVID-19, car accidents, and cancer.
Chances are many readers have already encountered the chilling reach of the fentanyl crisis in headlines or witnessed its devastating consequences first-hand. But to truly understand how we got here, we need to take a closer look at the history of opioids in America.
The Birth of OxyContin
In 1996, Purdue Pharma introduced OxyContin, marketed as a revolutionary and “non-addictive” pain relief medication. Purdue preached the gospel of this new wonder drug to thousands of doctors, and by 2000, OxyContin sales had soared to nearly $1.1 billion.
This aggressive marketing campaign set the stage for a crisis that would grip the nation for years to come.
From 2006 to 2012, 76 billion oxycodone and hydrocodone pills flooded American communities. While many prescriptions were prescribed to legitimate patients, the DEA’s pain pill database shows a disturbing trend of excessive prescribing. For example, in small regions such as Mingo County, West Virginia, the database shows 200 pills per person per year were distributed.
As opioid prescriptions flooded communities, the consequences of overuse and addiction began to emerge. This era also was marked by disenfranchisement, loneliness, lack of purpose, multigenerational job loss, hopelessness, and an uncertain future. Physician-researcher Dan Ciccarone asserts that these factors created fertile ground for addiction.
The societal factors underlying addiction began to intertwine with the pharmaceutical industry's greed.
Unleashed Epidemic
By 2013 Americans found themselves grappling with an escalating epidemic of opioid abuse and overdose deaths.
Meanwhile, pharmaceutical manufacturers continued to produce more and more opioids and distributors shipped those pills to pharmacies all over the country, while drug companies saw record profits and America’s overdose death rate soared off the charts— all under the DEA’s watch.
As the crisis grew, the pharmaceutical industry and regulatory agencies were slow to respond.
By 2014, local governments began filing lawsuits against Purdue Pharma and the Sackler family. In September 2019, Purdue filed for bankruptcy, facing 2,900 lawsuits. These legal actions finally brought attention to the role of pharmaceutical companies in perpetuating the crisis.
In 2016, the CDC finally took action by issuing directives to reduce the flow of oxy prescriptions. Cutting people off from an addictive substance does not address the root causes of those addictions, nor does it help individuals recover from addiction. Tragically, this led many addicted Americans to turn to heroin, which in turn gave rise to a new, much deadlier substance.
Dan Ciccarone, a physician-researcher at UC San Francisco who studies heroin use, says the crisis unfolded in three waves: Prescription painkillers gave way to old-fashioned heroin, which gave way to illicit fentanyl.
Fentanyl's Deadly Ascent
Fentanyl, a synthetic opioid developed in 1959 as an intravenous anesthetic, gained notoriety for its potency and affordability. It is 50 times more potent than heroin.
In just a few years, fentanyl overdoses skyrocketed from 700 deaths in 2014 to almost 20,000 in 2016, marking a tragic turning point in the opioid crisis.
In the last decade, fentanyl has become the leading cause of a fourfold increase in U.S. overdose deaths.
The crisis further entangles individuals already struggling with poverty and housing instability. Studies indicate a heightened risk of opioid use and overdose among people who are houseless.
Addressing the opioid crisis requires confronting the deep-seated inequalities and systemic failures within American society. Even robust enforcement strategies may struggle to combat the physical, emotional, and existential ravages caused by these structural deficiencies.
