The Opioid Epidemic So Far

When Oxycontin was introduced to physicians across the country, it was almost too hard to believe — and for good reason. Purdue Pharma, the company behind the drug, promoted Oxycontin as the world’s first “non-addictive” opioid that could be used for severe and moderate pain. Physicians weren’t normally used to prescribing opioids for moderate pain, so it was a tough sell. Opioids were usually prescribed to help with pain after surgery or for patients with terminal illnesses, like cancer. 

With the release of Oxycontin, the label on the pill bottle read, “Delayed absorption, as provided by OxyContin tablets, is believed to reduce the abuse liability of a drug.” Essentially, the label claimed that because the drug released its effects over a 12-hour period, it had less of a potential to be abused by someone. Armed with their claim, Purdue Pharma enlisted sales representatives to visit physicians across the country, enticing them with kickbacks and false promises about addiction risks. 

As prescriptions for Oxycontin soared, so did its overdose rates. As early as 2003, the Food and Drug Administration (FDA) warned Purdue Pharma about their misleading advertising.1 The company continued to market the drug so aggressively that even federal prosecutors started to take notice. In 2007, the company was finally brought to court in a trial that focused on their shifty marketing tactics, revealing how its sales team convinced physicians to prescribe the drug by downplaying its addiction risks. For example, the main selling point of Oxycontin at the time was that it was “less than one percent addictive” than other opioids, but Purdue didn’t have many studies to back up its claims.2 Purdue Pharma plead guilty with an intent to defraud and mislead and agreed to pay over $634 million in fines.3 

While the lawsuit was important in putting spotlight on Purdue Pharma, the crisis that began with Oxycontin soon turned into an epidemic that cost the lives of hundreds of thousands in the United States alone. Even after the guilty verdict, prescriptions for opioids continued to rise at an alarming rate, and overdoses for heroin began to peak around 2011. Fentanyl, a fully synthetic opioid that is more powerful than morphine, surpassed heroin overdoses in 2016.4 While fentanyl can be prescribed by a doctor and is not illegal (unlike heroin), its strong potency can easily lead to abuse. It’s been commonly laced with street/black market drugs, causing fatal overdoses in people who take the drugs unknowingly.

By the time that it was acknowledged as a public health emergency in 2017, over 140 Americans were dying of an opioid overdose every day.5 Purdue Pharma finally took responsibility for the opioid epidemic in 2020 after filing for bankruptcy a year prior. They plead guilty to three felonies and agreed to a settlement where they would have to pay over $8 billion in fines. Among the charges, Purdue Pharma admitted to violating an anti-kickback agreement from 2009 to at least 2017, paying doctors to write prescriptions for their opioid products. The company also admitted to impeding the efforts to combat the opioid epidemic by knowingly marketing their drugs to healthcare providers that sold their drugs on the black market.6

In 2020, during the COVID-19 pandemic, over 48,006 people overdosed on opioids.7 It is too early to say if the pandemic has led to an increase in overdoses, but closing of resources and social distancing measures likely impacted treatment access by limiting face-to-face visits for many individuals. Steps taken to counter these challenges have positively changed how individuals receive addiction treatment. Methadone, for instance, used to only be administered through federally-certified opioid treatment programs and often required frequent in-person visits. Because stay-at-home ordinances disrupted treatment for many individuals, the rules for methadone have relaxed during the pandemic: individuals are now free to take home their dose of methadone unsupervised, freeing them from constant visits to a treatment facility.8 Easing such restrictions allows greater access to these life-saving medications that can stop the death tolls associated with the opioid epidemic.

1 Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse and Abuse | FDA
2 The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy
3 OxyContin Addiction Case Yields Millions in Fines : NPR 
4 Drug Overdose Death Statistics [2021]: Opioids, Fentanyl & More
5 Trump Administration Declares Opioid Crisis A Public Health Emergency : NPR 
6 Justice Department Announces Global Resolution of Criminal and Civil Investigations with Opioid Manufacturer Purdue Pharma and Civil Settlement with Members of the Sackler Family | OPA | Department of Justice 
7 Opioid Crisis Statistics [2021]: Prescription Opioid Abuse
8 The Opioid Epidemic During the COVID-19 Pandemic | Addiction Medicine