The Current Opioid Epidemic

The Evolution of the Current Epidemic
 
The current opioid epidemic began in the mid-1990s when physicians, concerned about the ongoing problem of pain management, were told that a new opioid, OxyContin, was non-addictive and would effectively manage long term pain.  These claims were false.  But Purdue Pharma, the producer of OxyContin, aggressively and effectively marketed the drug to a large audience of physicians and dentists. Purdue Pharma also effectively lobbied Congress and federal agencies, receiving government support to facilitate OxyContin sales.    Over time awareness of widespread addiction to OxyContin and other prescription opioids led to fewer prescriptions and increasing state regulation limiting access to the drugs.   With OxyContin and other prescription opioids less available, large numbers of users turned to heroin, a less expensive street opioid, and between 2011 and 2017 addiction to heroin increased in Illinois and nationally.  In 2017 dealers began mixing fentanyl, a very powerful synthetic opioid, with heroin and other drugs they sold.  Since 2017 the majority of opioid related deaths have been from use of heroin and fentanyl, often in combination. (3)
 
 
Who are the Opioid Addicts?
 
The majority of those who used prescription opioids to relieve physical pain did not go on to long-term addiction.  There is strong evidence indicating that individuals use drugs in addictive quantities as self-medication for depression. (4) (5)  Many who became long term addicts began prescription opioid-use to alleviate physical pain and continued using because opioids provided relief from the demoralization that they were experiencing.  Together with suicide and alcoholism, opioid-related deaths have been called “deaths of despair” among populations experiencing failure in an economy where decent paying jobs for those with less than a college education are increasingly unavailable. (6) Nationally and in Illinois the highest opioid-related death rates are among non-college educated white men in non-urban areas of economic decline.    In Illinois the highest rates of opioid death are in non-urban, largely white Winnebago, Greene, LaSalle, Jersey and Madison counties.  Opioid related death has contributed significantly to the recent decline in life expectancy of those aged 45 to 54 in the U. S.  
 
Since 2017 there has also been a substantial increase in opioid related deaths in inner city Black and Hispanic communities of Chicago.  This increase is attributed to drug dealers mixing heroin with the powerful synthetic opioid fentanyl. Long term heroin addicts in inner city minority communities are overdosing and dying from fentanyl now mixed with the heroin and other drugs they had taken for years. (7)
 
Past and Current Opioid Epidemics
 
There are important similarities between earlier epidemics that affected inner city minority communities in the 1960’s and 70’s and the current opioid epidemic.  Both occurred in the context of ongoing discouragement and social breakdown brought by declining economic opportunity. (8)(9)   With decent paying jobs difficult to find rates of participation in community organizations and activities declined and separation, divorce and out of wedlock births increased.   Demoralization-- the sense of personal failure and response to family breakdown and increasing disconnection from the larger community --resulted in significant increases in suicide, alcoholism and opioid abuse.  There is one major difference between the current epidemic affecting primarily lower income whites and past epidemics affecting inner city minorities.  Public policy emphasis in the current epidemic is on drug treatment. During earlier epidemics that affected urban minorities emphasis was on incarceration.
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