As the 20th century came to a close, the United States faced many challenges, but a high rate of death from prescription opioid overdoses was not one of them. In 1999, 3,442 people died from taking excessive pain-killing substances such as oxycodone or hydromorphone. Each such death, of course, was a tragedy; but the country as a whole could not speak of a crisis. Only eight years later, the number of prescription opioid-related deaths had nearly quadrupled, reaching 12,796 in 2007 - and the United States was in the grip of an addiction crisis. It would ultimately morph into new epidemics of heroin and fentanyl use, leaving hundreds of thousands of people dead and families shattered all over America.
The latest news from the opioid addiction front, though, is encouraging. The Centers for Disease Control and Prevention reports that the total number of drug overdose deaths in the United States declined in 2018, by 5.1%, the first annual decline in nearly three decades. The raw numbers of deaths - 68,577 in 2018, vs. 72,224 in 2017 - are still unconscionably high. But the progress shows that the federal, state and local mobilization against drug addiction, which has emphasized treatment and availability of the life- saving opioid antidote naloxone, is producing results.
Particularly noteworthy was the fact that some 59 percent of the decline in overall drug deaths could be attributed exclusively to a reduction in those caused by prescription opioids. More cautious prescribing practices by doctors, partly because ofCDC guidelines issued in 2016, have curbed the once-rampant supply of these addictive medications, saving many lives.
As Drug Enforcement Administration data released in response to a Washington Post lawsuit demonstrate with astonishing clarity, the pharmaceutical industry - manufacturers, distributors and retailers - practically flooded the United States with opioids in the pre-guideline period. And of the 76 billion oxycodone and hydrocodone pills supplied between 2006 and the peak year of opioid prescriptions, 2012, a disproportionate number reached rural communities in Appalachia. Norton, Virginia, received 306 pills for each of its about 4,000 residents during those seven years. Not coincidentally, The Post’s reporting found that counties with the most pills distributed per person experienced more than three times the national death rate from opioid overdoses.
These data are critical, both to the ongoing effort to hold accountable those responsible and to help prevent a repetition. The main threat now is fentanyl, an illicit opioid that is imported from China and Mexico, as well as manufactured clandestinely in the United States, and that was implicated in nearly half of overdose deaths in 2018. With respect to presciption opioids, the challenge will be to continue reducing supply, and overdoses, without overcorrecting to the detriment of patients for whom opioids remain necessary and appropriate.
Historians may look back on the first two decades of the 21st century as a time of an avoidable public health crisis whose effects touched every aspect of national life, from medical practice to electoral politics. First, though, we must redouble efforts to insure that the epidemic does, indeed, become a thing of the past.