The (Human) Cost of Greed

The opioid crisis in the USA has claimed well over half a million lives – more than the num-ber of American soldiers killed in World War II. At its worst, the opioid crisis claimed more lives in a single year than the number of Americans killed during the entire Vietnam war. The scale of the crisis partially explains why average life expectancy in America declined in 2017 – a first for the developed world.

Issues of prescribing, dependence and misuse are complex and overlapping. When taken for a short time and as prescribed by a healthcare provider, opioids are generally safe: many Americans suffering with chronic pain take opioids for much-needed relief without misusing the drugs – indeed they are the majority (1). But opiates can cause changes in neurological pathways in just a few days, and many abuse the medicines they are prescribed by taking too much – in some cases, crushing pills to either inhale or inject the drug instead – or by seek-ing early repeat prescriptions. Others may become dependent on illicit drugs and then seek to replace them with prescribed medicines; while others may become dependent on pre-scribed medicines and then, when they are no longer accessible, seek alternatives from other sources (2).

Tragically, a sufficiently high dose can slow or stop a person’s breathing, which can result in death. No one knows the true number of deaths caused by prescription opioids, including diverted prescriptions or counterfeit medicines that have been imported illegally from other countries; toxicology testing cannot distinguish between some pharmaceutically- and illicitly-manufactured opioids, such as fentanyl. Furthermore, drugs are not specified on the death certificate in approximately 20 percent of overdose deaths. And in 2014, multiple drugs were involved in almost half of the drug overdose deaths that mentioned at least one specific drug on the death certificate (3).

But we do know that more than 50 percent of overdose deaths during the course of the USA opioid crisis were related to prescription opioids. Regardless of how they are taken, these are drugs manufactured by pharmaceutical companies, approved and licensed by regulatory authorities, distributed by wholesalers, and prescribed by medical professionals. And that raises some big questions. How could such harm come from legitimate attempts to treat pain? Why couldn’t the authorities prevent misuse? Will bad actors be brought to justice? What should be done to halt the situation and ensure it never happens again?