The opioid epidemic: America’s deadliest drug overdose crisis

OxyContin maker Purdue Pharma has reached a supposedly $8 billion settlement with the federal government in which it pleads guilty in a criminal investigation over its role in the opioid epidemic, the US Department of Justice announced Wednesday.

As part of the settlement, Purdue will plead guilty to three counts related to its misleading marketing of opioid painkillers and faces a $3.5 billion criminal fine, $2 billion in criminal forfeitures, and a $2.8 billion civil settlement.

America’s Covid-19 epidemic is likely making its drug overdose epidemic even worse.

While there’s no good national data for the year yet, local and state jurisdictions have reported increases in overdose deaths. According to the American Medical Association, as of July 20, more than 35 states have reported increases in drug-related deaths and other concerns with drug use and mental illness. Some municipalities reported overdose deaths increasing by 20, 40, or 60 percent — or more.

Addiction treatment based on Alcoholics Anonymous works as well as or better than scientifically proven treatments for alcohol addiction, according to a new review of previous studies by Cochrane, an organization renowned for its analyses of scientific research.

The review does not mean that AA and treatments that use the 12 steps, which are derived from AA, work for everyone with alcohol addiction. But it shows that, at least for some people, AA and 12-step treatments work as well as alternative treatments like cognitive behavioral therapy, which has solid scientific evidence behind it.

Vice President Joe Biden this week released a plan to combat the opioid epidemic, the deadliest drug overdose crisis in US history.

The plan is the most detailed and expansive proposal on the opioid crisis released by any of the presidential campaigns, including Sen. Bernie Sanders, Biden’s current Democratic rival in the primary, or by President Donald Trump.

Brianna Jaynes wanted help for her addiction to painkillers and heroin. She ended up trapped in a cycle that focused on running up big insurance bills and landing profitable kickbacks — not addressing her drug problem.

In 2015, when Jaynes was 20, she started her rehab search by calling a number she found through Google. The person on the other end of the line promised to get her help: She’d be fine, and she’d get into one of the best addiction treatment facilities in the country. Jaynes had little experience with addiction treatment, and, in a moment of crisis, it was exactly what she wanted to hear.

The opioid epidemic remains one of the US’s worst public health crises — with 2018 ending up as the second-worst year for overdose deaths in US history, behind 2017. But you wouldn’t know that from listening to the Democratic presidential campaigns.

The omission is striking, especially given the importance of New Hampshire to the 2020 Democratic primaries. As recently as 2015, New Hampshire ranked second for overdose deaths in the US. It dropped to sixth by 2018, but mostly because overdoses in other states got much worse; New Hampshire’s overdose death rate in 2018, while 9 percent lower than it was at its peak in 2016, is actually higher than it was back in 2015. Nearly 500 people still die of overdoses in New Hampshire each year.

President Donald Trump used his State of the Union address in February to take credit for a recent drop in drug overdose deaths and a reversal in the opioid epidemic.

“With unyielding commitment, we are curbing the opioid epidemic,” Trump said. “Drug overdose deaths declined for the first time in nearly 30 years. Among the states hardest hit, Ohio is down 22 percent, Pennsylvania is down 18 percent, Wisconsin is down 10 percent — and we will not quit until we have beaten the opioid epidemic once and for all.

Melissa Godsey credits the medication Suboxone, also known as buprenorphine, for her recovery from a years-long struggle with opioid and meth addiction. As she told me, the medication has let her “live a normal life.”

But for a while, the 35-year-old from Seattle feared that she would be cut off from the treatment. This week, Godsey had to turn herself in to serve a two-year sentence in federal prison for identity theft — while she was using, she stole credit cards so she could afford drugs. The feds don’t typically offer medications for opioid addiction in prison, even though studies show the medications are the gold standard for opioid addiction treatment and save lives.

America’s drug overdose crisis is still largely dominated by opioid overdose deaths. But stimulants like cocaine and especially methamphetamine seem poised for a comeback.

New federal data shows national overdose deaths linked to psychostimulants like meth spiked by nearly 22 percent from 2017 to 2018. Overdose deaths linked to cocaine increased by almost 5 percent.

American drug overdose deaths fell for the first time in 28 years in 2018 but remain near record highs, according to a new report released by the Centers for Disease Control and Prevention on Thursday.

The report put total drug overdose deaths at more than 67,000 in 2018, down 4 percent from over 70,000 in 2017. That adds up 20.7 drug overdose deaths per 100,000 people in 2018, compared to 21.7 in 2017. It’s the first recorded fall in overdose deaths since America’s opioid epidemic began in the 1990s.

A federal court has sentenced former executives of Insys, including founder and ex-CEO John Kapoor, to years in prison for their role in irresponsibly marketing the painkiller Subsys and perpetuating the opioid epidemic.

On Thursday, US District Judge Allison Burroughs sentenced Kapoor to five-and-a-half years in prison — less than the 15 years requested by prosecutors but more than the one year requested by his defense. The other executives previously received sentences between one and three years.

An estimated 130 people die from opioid-related drug overdoses each day in the United States, and 2 million people had an opioid use disorder in 2018. This public health crisis has left officials scrambling for ways to cut down on illegal sales of these controlled substances, including online sales.

Now the National Institute on Drug Abuse, which is part of the US Department of Health and Human Services, is investing in an artificial intelligence-based tool to track how “digital drug dealers” and illegal internet pharmacies market and sell opioids (though online transactions are likely not a large share of overall illegal sales).

Megan King had long used drugs casually. But when her brother died of a drug overdose in 2010, her use of opioid painkillers, heroin, and benzodiazepines “just kind of spiraled out of control,” she said.

King, who is now 34 and lives in Oceanside, California, managed to keep her job in the video game industry through her addiction, but she felt like she was on the brink of collapsing under the weight of her drug use. At the peak, she could blow through $300 worth of opioid painkillers, heroin, or benzos in a day or two — leaving her finances, she said, in “a wreck.”

Obamacare’s Medicaid expansion, which gave millions of low-income adults access to health insurance, was linked to a 6 percent reduction in opioid overdose death rates — potentially preventing thousands of deaths — according to a new study in JAMA Network Open.

The study looked at what happened in counties in states that expanded Medicaid under the Affordable Care Act by 2017, compared to counties in states that didn’t expand Medicaid, accounting for variables like demographic and policy differences. The Medicaid expansion was made optional in a 2012 Supreme Court ruling, and only 32 states and Washington, DC, had opted to expand by the study period (with the total rising to 37 in the past few years).

Since September, I’ve asked Vox’s readers to tell me their stories about drug addiction treatment for our Rehab Racket project. In less than four months, we’ve gotten a lot of responses — now more than 1,000.

The responses range from tragic stories about overdoses and early deaths to more optimistic ones about recovery. They’ve come from all over the US, including every state and Washington, DC, and Canada, the United Kingdom, Germany, Switzerland, South Africa, and Australia. Most of the stories come from addiction patients, although parents, spouses, siblings, and other relatives and friends of patients have sent in their stories as well.

Ian McLoone was at his son’s first birthday party in 2011 when his drug addiction rehab center called him at his Minneapolis home, telling him he needed to come back early.

McLoone quickly realized he was in trouble. The day before, he had missed curfew while chaperoning another client’s family visit for the inpatient facility. After the call, McLoone told his family that he had to go, and left, embarrassed. Over the next few days, he would be forced to “sit on the bench.”

WARREN TOWNSHIP, New Jersey — When Ed Fahy agreed to go to addiction treatment in February 2016, he expected to get into recovery near his home and family in Warren Township, New Jersey.

Nearly seven months later, and a thousand miles away in Palm Beach County, Florida, he would overdose and die at the age of 28. After his health insurance plan repeatedly denied requests to cover inpatient treatment closer to home, he wound up in Florida — at a sober living house that was so bad it was eventually shut down by law enforcement.

The opioid epidemic cost the US $696 billion in 2018 and more than $2.5 trillion from 2015 to 2018, according to a new estimate by the White House Council of Economic Advisers.

The CEA last calculated the cost of the opioid epidemic in 2015, putting the price at more than $500 billion. Using similar methodology, the agency calculated new numbers for the ensuing years.

In 1983, Nan Warren’s first daughter died at the age of 2 of congenital anomalies. In 2005, Warren lost her first son to a heroin overdose.

In the decade and a half that followed, Warren has fought to prevent the same fate for her surviving daughter, Erin Kane, who was addicted to alcohol. But Warren struggled, constantly wrestling with insufficient health insurance coverage, and was unable to pay the amount treatment facilities charged, which could range in the tens of thousands of dollars.

America is in the middle of its deadliest drug overdose crisis in history, with the opioid epidemic now linked to tens of thousands of deaths every year and other types of drug overdoses steadily increasing in recent years.

In his nearly three years in office so far, President Donald Trump hasn’t done much to fight the crisis. He declared an emergency over the opioid epidemic, but a watchdog agency found the declaration didn’t lead to much actual policy change. And while Trump, with the support of Congress, has committed a few billion dollars to the opioid crisis here and there, the funding falls short of the tens of billions of dollars that experts claim is needed to fully confront the epidemic. Advocates have called Trump’s approach “a lot of talk, little action.”

Four drug companies on Monday reached a last-minute settlement with two Ohio counties that will let them avoid trial over their role in the opioid epidemic, but it doesn’t put an end just yet to the thousands of other lawsuits the four companies and others face.

The settlement will require drug distributors McKesson, AmerisourceBergen, and Cardinal Health as well as generic opioid painkiller maker Teva Pharmaceuticals to pay at least $260 million to Cuyahoga and Summit counties, according to the Washington Post and New York Times. The deal leaves Walgreens, which distributes opioids, as the lone defendant that has not settled, but its case was postponed after a trial was originally set to start Monday.

It’s impossible to talk about the causes of America’s opioid epidemic without pointing to the manufacturers and distributors that marketed and proliferated dangerous opioid painkillers. Yet for much of the crisis, these multibillion dollar opioid companies have avoided much in the way of serious accountability.

Until, perhaps, now.

At Tuesday’s Democratic debate, several presidential candidates agreed on one point: The pharmaceutical executives who helped create the opioid epidemic should go to prison.

Asked directly whether opioid executives should be locked up, Sen. Kamala Harris (D-CA) said:

The Sacklers, the family behind OxyContin maker Purdue Pharma, will likely pay billions of dollars for their role in causing the opioid epidemic. But when the cases are settled, they will walk away from the lawsuits — and the opioid epidemic they and Purdue helped cause — still billionaires.

Purdue, which is owned by the Sacklers, introduced and aggressively marketed the opioid painkiller OxyContin in 1996. Since then, more than 200,000 people have died of painkiller overdose deaths, with another roughly 200,000 dying from other opioids — in many cases, after using painkillers first.

Looking for drug rehab? It can be extremely difficult — and horribly expensive. In some cases, families spend years and thousands of dollars before they find treatment that works.

Michel Cote, whose two daughters are now in recovery from opioid and meth addictions, said it took his family 10 years and $200,000 to find a small clinic that finally helped.