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Understanding the Opioid Epidemic: How Did We Get Here?

The opioid epidemic, which began in 1999, has resulted in over 550,000 lives lost due to prescription and illicit opioid overdoses. Efforts at both state and federal levels aim to combat the epidemic through prevention, treatment, and increased awareness.

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Over 180 people die every day due to prescription and illicit opioid overdose. [8]

The opioid epidemic in the United States began in 1999 with the first rise of opioid overdose deaths. Since then, an increase in the use of prescription opioids, heroin, and synthetic opioids has contributed to the epidemic that has claimed more than 550,000 lives since 1999.[8]

People of all demographics have been affected, and the government is attempting to respond to the national health crisis.

Who is Most Affected by the Opioid Crisis?

Quick Answer

Opioid overdose deaths are higher for men, people between 25 and 34, non-Hispanic white people, and people with mental health disorders.[1] However, other people are affected by the opioid epidemic as well.

Key Facts

  • More than 180 people die every day due to opioid overdoses. [8]
  • Since 2013, the overdose death rate related to synthetic opioid use, such as fentanyl, has tripled.
  • The opioid epidemic is a public health crisis, affecting millions of Americans across the country.
  • People of all demographics have been affected, and the government is attempting to respond to the national health crisis.

Facts About the Opioid Abuse Epidemic 

The opioid epidemic refers to opioid misuse and overdose caused by prescription and illicit opioid consumption. Here are some key facts:[4]

  • As of 2017, over 11 million people had misused prescription pain relievers in the past year
  • That same year, approximately 1.7 million people had an opioid use disorder related to prescription painkillers
  • About 652,000 people had a heroin use disorder

Three distinct waves of the epidemic coincide with an increase in fatal overdoses. Initially, an increase in prescription opioids led to the first wave of opioid overdose deaths. Beginning in approximately 2010, a fourfold increase in heroin overdoses was observed. Since 2013, the overdose death rate related to synthetic opioid use, such as fentanyl, has tripled.[4]

How Did the Opioid Epidemic Start? 

In the 1990s, OxyContin, a powerful and highly addictive opioid used for pain relief, was developed by Purdue Pharma and approved for medical use by the U.S. Food and Drug Administration (FDA). Purdue Pharma falsely marketed the opioid as less addictive than other painkillers. Physicians then began prescribing opioids for pain relief, unaware of the high risk of addiction.[9]

The national opioid epidemic spans over two decades. According to the Centers for Disease Control and Prevention (CDC), the initial wave of the epidemic began following this rise in prescription opioids. 

Although obtained legally, prescription opioids are highly addictive. Even when used as prescribed by a physician, addiction, overdose, and death can occur. 

As individuals became addicted to prescription opioids, they turned to more potent and affordable opioids, which led to the second wave of deaths linked to an increase in heroin use. Prescription opioids alone are responsible for over 263,000 deaths between 1999 and 2020, per the CDC.[9]

Prescription opioids alone are responsible for over 263,000 deaths between 1999 and 2020.

Major Impacts of the Opioid Epidemic 

The impacts of the nationwide opioid epidemic are many, including a huge wave of overdose deaths, mental health issues, homelessness, and significant economic impact. According to an independent analysis conducted by the Congressional Budget Office, opioid-related overdose deaths were among the leading causes of death in 2020. [7]

Despite an increase in federal funding to address the opioid epidemic, opioid overdose deaths continue to rise. A steep increase in opioid overdose deaths was seen during the COVID-19 pandemic when job loss and isolation drove many people to increase opioid misuse. 

Additional impacts of the epidemic include the following:[7]

  • An increase in diseases related to intravenous drug use, such as HIV and hepatitis C
  • An increase in newborns experiencing withdrawal due to their mothers using opioids while pregnant
  • A decline in life expectancy across the United States since 2014
  • An increase in federal spending on health care, social programs, and the welfare system
  • Lost earnings and decreased productivity from those with opioid use disorder 

Despite interventions in place at local, state, and federal levels, the opioid epidemic remains a growing problem. As substances become increasingly potent, opioid-related deaths also continue to rise. 

Who Has the Opioid Epidemic Affected? 

The opioid epidemic has impacted individuals and families across all demographics throughout the country. 

It has affected people of all ages and ethnicities, though some groups have been hit harder than others. Populations most affected by the epidemic include the following:[1]

  • Overdose death rates are higher for men than women.
  • People ages 25 to 34 have the highest overdose death rate, followed by individuals ages 34 to 44 and then people ages 45 to 54.
  • Nearly 80% of people who overdose are non-Hispanic white.
  • About 10% of people who overdose are Black and non-Hispanic, with 8% of overdoses seen in Hispanic people.
  • Mental health challenges, such as anxiety and depression, increase the risk of opioid use threefold.
  • As of 2017, over 51% of opioid prescriptions were given to individuals with mental health conditions.
  • About 50% of individuals prescribed opioids for physical pain relief develop an addiction. 

In addition to the above statistics, economists have identified that white Americans without college degrees who live in rural areas are at an increased risk for opioid overdose deaths. As manufacturing and construction jobs have decreased in rural areas over the past years, financial strain, distress, and desperation could explain the increase in opioid misuse among this population. 

Which States Are Most Affected by the Opioid Epidemic?

While virtually every state across the country is impacted by the opioid epidemic, some regions have been more affected than others. As of 2016, the mean national opioid overdose death rate was 14.98 per 100,000 people, with some states witnessing a death rate over twice as high, and others far lower. [5]

Overdose death rates vary across the country as follows:[5]

  • The highest death rate has been seen in West Virginia with 40.03 deaths per 100,000 people.
  • The next consecutive highest death rates by state include New Hampshire at 32.74, Ohio at 31.1, Maryland at 30.27, and Massachusetts at 29.21.
  • Conversely, the lowest opioid-related overdose death rates have been observed in Texas (4.93), Kansas (5.02), California (5.12), Hawaii (5.39), and Arkansas (5.66).

The above opioid-related death rates consider overdoses related to synthetic opioids, semisynthetic opioids, and heroin. From 2015 to 2016, opioid-related deaths increased the most in [5]

  • Maryland (67%)
  • Pennsylvania (64%)
  • Florida (49%)
  • Indiana (48%)

The states with the highest opioid overdose death rate are West Virginia, New Hampshire, Ohio, Maryland, and Massachusetts.

The Government’s Response to the Opioid Epidemic

Efforts are being made on both state and federal levels to combat the opioid epidemic. Interventions have been designed to target the prevention and treatment of opioid use disorder and overdose. The CDC has partnered with state and local entities on the following:[3]

  • Collecting data, monitoring trends, and advancing research on opioid-related overdoses and prevention 
  • Providing resources, including funding, to improve data collection and public health response and prevention efforts 
  • Partnering with paramedics, firefighters, law enforcement, and other public safety officials to effectively address the illegal opioid problem
  • Increasing public awareness through education on opioid misuse, overdose, and making safe choices, such as the Rx Awareness campaign
  • Improve patient safety by educating healthcare providers on safe opioid use
  • Increase patient access to effective and safer pain-relieving treatments

In 2016, the CDC released the Clinical Practice Guideline for Prescribing Opioids for Pain. This effort was intended to guide physicians on how to best prescribe opioid painkillers to reduce the potential for abuse and addiction. [2]

The NIDA’s Opioid Risk Tool is used to screen patients’ risk of opioid abuse. If a patient is classified as high-risk, it means opioids should be prescribed with extreme caution. Other pain management measures should be first exhausted. [17]

How to Address the Opioid Epidemic 

As the opioid abuse epidemic has intensified, efforts to prevent and combat opioid abuse have strengthened as well. SAMHSA created the Opioid Overdose Toolkit to educate individuals on opioid use disorder, opioid addiction treatment, and overdose prevention strategies. [6]

To prevent overdose deaths, SAMHSA recommends the following:

  • Learn how to prevent and manage overdoses 
  • Provide greater access to treatment for opioid use disorder
  • Increase access to naloxone (Narcan), an FDA-approved drug that can immediately reverse opioid overdose
  • Encourage individuals to call 911 if they suspect an opioid overdose
  • Use state prescription drug monitoring programs (PDMPs) to track misuse of prescription opioids 

The opioid epidemic is a public health crisis, affecting millions of Americans across the country. Individuals, communities, and local, state, and federal organizations must all play a role in ending this massive epidemic. 

Updated November 21, 2023
Resources
  1. A Population Health Approach to America’s Opioid Epidemic. (March/April 2019). Orthopaedic Nursing.
  2. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. (November 2022). Centers for Disease Control and Prevention.
  3. CDC’s Role in the Opioid Overdose Epidemic. (March 2021). Centers for Disease Control and Prevention.
  4. Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. (September 2018). U.S. Department of Health and Human Services, Office of the Surgeon General.
  5. Modeling Dynamics of Fatal Opioid Overdose by State and Across Time. (December 2020). Preventive Medicine Reports.
  6. Opioid Overdose Prevention Toolkit. (2018). Substance Abuse and Mental Health Services Administration.
  7. The Opioid Crisis and Recent Federal Policy Responses. (September 2022). Congressional Budget Office.
  8. Understanding the Opioid Overdose Epidemic. (June 2022). Centers for Disease Control and Prevention.
  9. What Led to the Opioid Crisis – And How to Fix It. (February 2022). Harvard School of Public Health.
  10. Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns. (September 2019). International Journal of Maternal and Child Health and AIDS.
  11. The Prescription Opioid Epidemic: A Review of Qualitative Studies on the Progression From Initial Use to Abuse. (September 2017). Dialogues in Clinical Neuroscience.
  12. The Public and the Opioid-Abuse Epidemic. (February 2018). The New England Journal of Medicine.
  13. The Opioid Crisis: A Contextual, Social-Ecological Framework. (August 2020). Health Policy Research and Systems.
  14. The Opioid Epidemic During the COVID-19 Pandemic. (September 2020). JAMA.
  15. A Time of Crisis for the Opioid Epidemic in the USA. (July 2021). The Lancet.
  16. Effectiveness of Policies for Addressing the US Opioid Epidemic: A Model-Based Analysis from the Stanford-Lancet Commission on the North American Opioid Crisis. (November 2021). The Lancet.
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