The U.S. Opioid Crisis and the Urgency of Now

For the past two years, we have rightfully been focused on navigating a once-in-a-century global pandemic; but COVID-19, unfortunately, is not the only public health crisis that demands our attention. Since 1999, the United States and Canada have lost more lives to opioid overdose than they did in World Wars I and II combined — 600,000 people — and opioid addiction continues to harm millions, triggering increases in disability, family breakdown, unemployment, and child neglect.?

Tragically, the problem is only worsening. Opioid overdoses reached a record high in the United States and Canada in 2020, an effect of pandemic-induced isolation and rising use of heroin and synthetic opioids, among other factors. If our approach to the crisis remains unchanged, we face a future that is similarly grim: statistical modeling predicts that 1.2 million more Americans and Canadians will die from opioid overdose between 2020 and 2029.

A Comprehensive Strategy for Addressing the Crisis

Avoiding this fate will not be easy. To right the course, we must gain a deep understanding of how we got to this point, build an effective system to care for people who have substance use disorders, and put safeguards in place to avert future epidemics of pharmaceutical addiction. At Stanford Medicine, our faculty felt so strongly about the need for progress on these fronts that we joined with the esteemed British medical journal?The Lancet?to form an 18-member multidisciplinary commission, charged with investigating the opioid crisis and producing a comprehensive strategy for ending it. Published in February after two years of study, the commission’s report provides a wide range of detailed, evidence-based recommendations, from reforming the pharmaceutical regulatory system to?nurturing innovation of alternate pain relievers.

Preventing a Global Opioid Crisis

Among the many areas of concern, the commission emphasizes the need to guard against exporting North America’s public health crisis to other nations – something that, regrettably, has happened in the past. When the United States tightened restrictions on the tobacco industry in the late 1990s, companies simply sought out new markets overseas, bolstering their profits and expanding the international reach of their harmful products without the public benefit of required health warnings. To avoid repeating this destructive history, the commission recommends that legal settlements against opioid manufacturers include prohibitions against fraudulent and dangerous practices beyond American borders. Addressing the problem from another angle, the commission also suggests that free, generic morphine be made available to hospitals and hospices in low-income countries. This step would support treatment of patients in pain, while avoiding creating a profit motive for over-prescribing opioids.

While by no means simple to implement, these measures are a start to fulfilling our moral obligation to help others avoid the agonies we have collectively endured from the opioid crisis in the United States and Canada. If the difficult lessons from our mistakes can save lives, there is no question that we should share our knowledge and take action for the global good.

Here are some resources for further reading about the opioid crisis.

Stanford-Lancet Report Calls for Sweeping Reforms to Mitigate Opioid Crisis?The results and recommendations of the Stanford-Lancet Commission’s research are outlined here.

A Rising Death Toll?This report from the?New York Times?summarizes the history and missteps that have led to this point in the U.S. opioid crisis.

The Potent Drug Mix Causing Unprecedented Rates of Black Americans to Overdose?In this article,?Timemagazine explores the reasons behind a dramatic increase among Black Americans in overdose deaths involving more than one substance.

Is ‘Dopesick’ a True Story? Experts and the Show’s Creators Sort Fact from Fiction?Dopesick?is a popular fictional mini-series, based on a nonfiction book by a reporter in rural Virginia, that explores America’s struggle with opioid addiction. This?NPR?piece examines which elements of the fictional series adhere closest to fact.