S.A.F.E.
Stop the Addiction Fatality Epidemic
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Public Awareness

Public Awareness

How Did the Opioid Epidemic Happen?

  • Rapid growth in opioid prescriptions in the 1990s, largely spurred by the pharmaceutical industry over-interpreting and exaggerating a 1980 one paragraph letter in The New England Journal of Medicine (known as “the Porter and Jick letter”) that suggested patients using opioids for pain were not likely to become addicted.
  • The industry (particularly Purdue Pharma, with the drug Oxycontin) heavily marketed opioids for routine treatment of pain.  Previously such drugs had been principally used for treatment of acute pain in terminal cancer patients.
  • A new wave emerged within the medical community in the 1990s that treated freedom from pain as a “right”, and treated pain as a fifth vital sign.  Doctors started being evaluated by patients regarding how well they treated their pain, which was important to hospitals and thus to doctors.  At the same time, pressure increased on doctors to see more patients, which resulted in less time allotted per patient, and prescribe larger dose lengths in order to minimize return visits.  These factors, combined with heavy marketing from Big Pharma led legitimate doctors to prescribe increasing amounts of opioids for individual patients.  A lack of reimbursement from insurance companies for other approaches to pain management, which are more costly than opioid prescriptions, contributed to this trend.
  • Big Pharma was beginning to look a lot like Big Tobacco in the late 20th Century.
  • Contrary to the perceptions created by contemporary medical and pharmaceutical literature, large numbers of patients became addicted, and a large market developed for both “legal” and illegal distribution of prescription painkillers.
  • Meanwhile, unethical doctors helped create “pill mills” that fed the ever-increasing appetite for prescription opioids among the addicted population.  Big Pharma benefitted from this trend, and encouraged it through its sales force. 
  • The proliferation of pills led to a sophisticated side market for those who would obtain them and re-sell them in order to either make money or feed their own opioid addiction.  In some areas, painkiller pills turned into a back-market side currency that was able to pay for almost any kind of retail product, which in turn led to a black market in stolen goods.
  • At the same time, Mexican producers revolutionized the model for heroin distribution in the U.S., using a new, far more potent, and cheaper type type known as “black tar.”  The distribution networks were highly fragmented rather than centrally controlled by a cartel.  Massive numbers of highly organized mini-networks spread throughout the U.S.  When prescription opioids became scarce or too expensive for an addict, it was easy to turn to heroin. 
  • The stigma of addiction and reluctance of insurance companies to pay for comprehensive treatment led to a paucity of resources for treatment.

“On the day of Operation Black Gold Rush . . . Hundreds of officers fanned out across fifteen U.S. cities gathering up Sanchez heroin crews: 138 people in all, drivers, telephone operators, suppliers, as well as numerous local addicts.  That day, federal court looked like a hospital ward.  Junkies were throwing up, sweating, and falling off their benches.  “If we didn’t arrest them, they were going to die,” Mabry said.  Marshals rushed doctors to court.  Several junkies had arraignments postponed because they weren’t fit to understand the judge.”  DreamLand, by Sam Quinones, p 262

 
 

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Why Must the Solution Be a Full-Spectrum Effort?

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