A Nation in Crisis: Causes and Effects of the Ongoing Opioid Epidemic

August 27, 2018

On October 26, 2017, the President declared the opioid crisis a national public health emergency under federal law. Six short months later, the bipartisan Senate health committee unanimously approved the Opioid Crisis Response Act of 2018.

How did the opioid crisis become a public health emergency? How did we get to the point where one person dies from an opioid overdose every 13 minutes?

The crisis didn’t emerge overnight. The seeds for the epidemic were planted decades ago—more than 150 years, in fact, on the battlefields of the U.S. Civil War. At that time, the widespread use of morphine as a painkiller caused an estimated 400,000 soldiers to become addicted. In the 1890s, German pharmaceutical company Bayer promoted heroin as a substitute for morphine and as a cough suppressant. By the early 1900s, heroin addiction in the United States and western Europe had escalated, partly due to these medical treatments.

Fast forward to the 1970s when short-acting, combination opioid drugs such as Percocet and Vicodin were introduced. A five-sentence letter published in the New England Journal of Medicine in 1980 stated that addiction was rare in patients treated with narcotics. Researchers recently noted that this letter was “heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy,” which they believe contributed to the North American opioid crisis.

Over the next 25 to 30 years, new drugs such as OxyContin and Fentanyl appeared on the market, and overprescribing became rampant. Purdue Pharma fueled the opioid epidemic with widespread claims that because of its time-released formulation,  OxyContin posed a lower risk of abuse and addiction than Percocet, Vicodin, or other shorter-acting painkillers.


The heavy costs of the opioid crisis

And the crisis continues, to the point that opioid-related overdose deaths are higher than car accident fatalities, and 80% of illicit opioid drug users report starting out on prescription opioids. The financial impact is also severe—the Council of Economic Advisers estimated that the economic cost of the opioid epidemic was $504 billion in 2015. That’s 2.8% of the GDP that year and six times greater than the most recently estimated cost of the epidemic.

For employers, the opioid crisis is costly by impacting productivity and absenteeism. Pain medication use disorder caused affected employees to miss 29 days of work in the past year, compared to 14 days for alcohol use disorder and 10 days for the general workforce.

Employees under the influence of opioids may experience sedation and dizziness—two dangerous side effects that put them, as well as others, at risk. This is especially concerning for employees where safety is an issue, from big-equipment operators to restaurant workers responsible for food safety. And even though opioid prescription use among people with large employer insurance coverage has declined, the cost for treatments has skyrocketed to $2.6 billion, according to new research by Peterson-Kaiser Health System Tracker.


Making sense of the numbers

A long history of misinformation and overprescribing culminated in more than 42,000 deaths from opioid overdoses in 2016; that’s 115 Americans a day. It’s a problem that does not discriminate by age, race, or gender. Sadly, the social stigma of addiction or fear of job loss causes many people to not seek help when they need it most.

If we can change the social stigma and create awareness surrounding addiction prevention and multiple avenues for individuals to ask for help, we can turn the crisis around and save lives. It’s up to all of us.


In our next blog post in this series, I’ll discuss strategies that have been implemented by employers to address the opioid epidemic and assist their members who have been affected by this crisis.