The Deadliest, Most Avoidable Public Health Crisis In Recent History

Drug overdose is now the leading cause of accidental death in the United States, with opioids driving this epidemic. In 2017, there were 72,000 reported overdose deaths, and opioids contributed to at least two-thirds of these deaths. While the opioid epidemic may have been sparked by prescription drugs, the advent of highly potent synthetic opioids over the last few years—estimated to be 50-10,000X more potent than morphine—has spiraled the opioid epidemic into a much deadlier crisis.

The opioid crisis evolved in three distinct waves. The epidemic was born in 1991 following a sharp increase in the prescribing of opioid analgesics for the treatment of pain. The increase in opioid prescribing was influenced by assurances by pharmaceutical companies that prescription opioids were non-addictive and safe for the treatment of chronic pain. Deaths involving prescription opioids reached epidemic proportions in 1999, marking the first wave of the death toll.

As legislative efforts to reduce opioid prescribing took effect in the early-to-mid 2000s, prescription opioid use declined, and heroin emerged as a cheaper, more potent alternative. The rapid rise in heroin-related deaths became apparent in 2010, marking the second wave of the opioid epidemic. Heroin-related deaths continued to dominate epidemic until 2013, when illicitly manufactured fentanyl (IMF) emerged. The rapid rise in deaths involving IMF and other synthetic opioids in 2013 marked the third and deadliest wave of the epidemic. In 2017, the opioid death toll reached shocking new heights, advancing the epidemic to a public health crisis.

One major, yet often overlooked contributor to the malignancy of the opioid crisis is our criminal justice system. Jails and prisons are notorious for forcing abstinence upon opioid addicts, despite the known dangers of doing so. Forced abstinence precipitates physical withdrawal, leading to severe and overwhelming cravings, while simultaneously reducing one’s physical tolerance for opioids. Lowered tolerance coupled with the rise of highly potent synthetic opioids make recently incarcerated opioid addicts 129X more likely to overdose compared with the general population.

The risk of overdose within the first few weeks of release cannot be emphasized enough. Experts in the field of addiction medicine have deemed incarceration as the most lethal and socially disruptive point of an overdose. Incarceration usually leads to prolonged periods of abstinence, and though drug use ceases during these periods, the addiction itself does not. Incarceration addresses the drug offense, not the underlying illness contributing to the drug offense. The inadequacy of forced abstinence is reflected in the statistics alone: 95% return to drug use following incarceration, and 60-80% reoffend within one year. Given the significantly higher risk of overdosing upon release, it should come as no surprise that recently incarcerated populations comprise a substantial proportion of the death toll.

Opioid addiction, like other chronic and relapsing diseases, responds to treatment and medication—not incarceration or punishment. Fortunately, advances in opioid addiction treatment in recent years have made opioid use disorders (OUD) much more manageable. Medications like buprenorphine and methadone can counteract the disruptive effects of opioid addiction on the brain and reduce up to 75% of overdoses in the weeks following incarceration,

Please visit our medication-assisted treatment page to learn more about ways to manage opioid addiction and prevent fatal overdoses.