A report by The Council of Foreign Relations (CFR) shows that the United States is facing one of its worst crises in combating drug use in history. More than 1,500 people die each week from opioid overdoses, a number that has increased nationwide during the COVID-19 pandemic. Millions of Americans suffer from opioid addiction.
Analysts say the problem began with the over-prescription of legal painkillers but note that it has intensified in recent years with an influx of cheap heroin and synthetic opioids, particularly fentanyl, supplied by foreign drug cartels. The crisis has reached such a scale that it affects the economy: opioid misuse is costing the country tens of billions of dollars annually, not only in healthcare expenses but also in the form of a weakened workforce.What drugs are contributing to the crisis?
Opioids, a class of drugs derived from the poppy plant, can be divided into two main categories: legally manufactured medications and illicit narcotics.
Prescription opioids, including oxycodone, hydrocodone, and morphine, are commonly prescribed to treat pain, while methadone is primarily used in addiction treatment centers to reduce patients’ opioid dependence. Opioids gained popularity among doctors in the 1990s for treating patients who had undergone surgery or cancer treatment, but starting in the 2000s, doctors began prescribing them more frequently for chronic conditions, such as back or joint pain, despite concerns about their safety and efficacy in these cases.
For decades, heroin was the most commonly used illegal opioid, as the supply of the drug in the United States surged and its average retail price fell in the mid-2010s to about one-third of what it was in the early 1980s. However, by the end of the decade, heroin use and overdose deaths involving the drug appeared to be declining, according to the Centers for Disease Control and Prevention (CDC).
In recent years, people have increasingly turned to synthetic opioids, such as fentanyl. The U.S. Drug Enforcement Administration (DEA), the primary U.S. agency involved in combating narcotics, states that fentanyl is “the main driver of the current opioid crisis.” Some law enforcement officials have labeled the drug as “manufactured death” because it is cheaper and up to fifty times more potent than heroin. Fentanyl-related deaths are largely caused by the illegal use of the drug, although it can also be prescribed as a painkiller. The CDC notes that heroin and fentanyl are more often used in combination with other drugs, such as cocaine, or with alcohol, which increases the risk of overdose.What is the scale of the epidemic?
Opioid overdose deaths have increased more than sixfold since 1999. In 2019 – the most recent year for which complete data is available – opioid overdoses killed nearly fifty thousand people, or more than seven times the number of U.S. military personnel killed in the post-9/11 wars in Iraq and Afghanistan. According to CDC data, the number of opioid-related overdose deaths skyrocketed in 2020 to around seventy thousand and again in 2021 to eighty thousand. Since 2015, the opioid mortality rate has contributed to a historic decline in life expectancy in the United States.
Many health experts attribute the high death toll to what they say are years of excessive opioid prescribing. Doctors began prescribing more opioids amid growing concern that pain was being undertreated, and also because pharmaceutical companies began marketing the medications more aggressively, claiming they posed little risk. Healthcare professionals reported feeling pressure to prescribe opioid medications instead of alternatives, such as physical therapy or acupuncture, because patients requested them and other treatments are often more expensive or less accessible.
Opioid-related deaths have increased in sync with the volume of prescribed opioids. An increase in the use of illegal opioids in the United States followed the rise in prescriptions, as many users turn to heroin and other illegal drugs when they can no longer obtain enough of the prescribed medication to keep up with what can be a developing addiction. “We did not develop an opioid epidemic until there was a large surplus of opioids, which began with legally distributed pharmaceuticals,” said New York’s special narcotics prosecutor, Bridget G. Brennan, to CFR.
The COVID-19 pandemic has exacerbated the opioid epidemic. Supply chain disruptions forced people to turn to drugs they are less familiar with, and social distancing measures meant more people were using drugs alone, analysts say.What are the socioeconomic consequences?
The opioid epidemic is having devastating consequences on other aspects of public health, causing high rates of hepatitis C, HIV, and other diseases, primarily due to syringe sharing. Meanwhile, mothers can pass on opioid dependence to their children if they use opioids during pregnancy. Incidences of neonatal abstinence syndrome, or withdrawal symptoms experienced by newborns exposed to drugs in utero, increased by more than 80% between 2010 and 2017. The opioid crisis has likely also contributed to an increase in the number of children in foster care.
Opioids have also impacted the economy: the CDC estimates that opioid misuse costs the country about $78 billion per year, a figure that includes healthcare costs, lost productivity, treatment programs, and legal expenses. In 2017 alone, the cost of opioid misuse and fatal overdoses was estimated at around $1 trillion.Where do heroin and fentanyl come from?
Most of the heroin that enters the United States is grown on poppy farms in Mexico, with several large cartels controlling production and operating distribution centers in major U.S. cities. The Mexican cartels, which the DEA calls “the greatest drug trafficking threat to the United States,” typically smuggle narcotics across the U.S. southwest border in commercial and passenger vehicles and through underground tunnels. Large quantities of heroin are also produced in South American countries, particularly Colombia, and trafficked to the United States by air and sea. Although most of the world’s heroin comes from Afghanistan, only a small portion of the U.S. supply is produced there.
Most of the fentanyl in the United States is smuggled across the southern border, U.S. authorities say. Although fentanyl coming directly from China – previously the dominant source – has decreased significantly since 2019, experts note that many drug shipments from China are simply being redirected through Mexico. Mexican cartels “will almost certainly have the greatest direct impact” on the U.S. fentanyl market in the coming years, the DEA warns. Source: Council on Foreign Relations