U.S. Opioid Overdose Epidemic

Nation in Crisis: The Opioid Epidemic


The Facts

In 2017, 11.4 million Americans misused prescription opioids.

Every day, more than 130 Americans die from an opioid overdose.

More than 42,000 people in the U.S. died from opioid overdoses in 2016.

Every day, more than 1,000 people are treated in U.S. hospital emergency departments for misuse of opioids, including heroin, fentanyl, Oxycontin, and other prescription pain relievers.

The CDC estimates that the total economic burden of the opioid epidemic in the U.S. is $78.5 billion a year.

At this time, the epidemic is arguably the nation’s foremost public health challenge.

How did it happen? 

There are many upstream determinants of today’s opioid epidemic.

DEATHS OF DESPAIR:  In the Great Recession of 2007-2009, the U.S. unemployment rate rose to 10%. The relationship between diminishing economic opportunity in some segments of the population – particularly middle-aged white men with a high school education or less – is associated with higher death rates, termed “deaths of despair.” A 1999-2014 nationwide study in the U.S. found that as county unemployment rates increased by 1%, opioid death rates increased by 3.6% and emergency department visits for overdose grew by 7%. It appears that economically dislocated workers are more likely to cope with anguish and despair by using opioids.

ILLEGAL OVERSEAS PRODUCTION: Illicit opioids are widely available and inexpensive in the U.S.  Failed U.S. policies to curtail poppy production in Afghanistan have reduced the street price of heroin, and clandestine laboratories in China export illicit fentanyl to the Americas with few obstacles. The U.S. Drug Enforcement Agency expects the flow of these drugs into the U.S. will continue to increase.  

 BIG PHARMA’S ROLE: Major pharmaceutical companies have heavily promoted prescription opioid pain relievers, such as Oxycontin, with the explicit goal of changing physicians’ prescription practices.   In 2007, Big Pharma executives pled guilty of deceiving the government, physicians and patients about the addiction risk of prescription pain killers such as Oxycontin. Currently, 41 State Attorneys General have filed lawsuits against opioid producers.  

Big Pharma is politically powerful, with deep pockets. Over the last decade, the industry spent almost $2.5 billion in lobbying and campaign contributions to members of the U.S. Congress. Much of this money was used to lobby against laws regulating the production and distribution of opioid medications.

One pharmaceutical firm, Purdue Pharma, withheld critical information from law enforcement. According to an extensive 2016 Los Angeles Times investigation, Purdue Pharma did not inform the DEA or other law enforcement officials about 10 years of data it had collected, pointing to probable illegal OxyContin trafficking in the U.S. Basically, the company took no action to stop OxyContin diversion to the street drug trade.

POLITICS AND THE FEDERAL GOVERNMENT’S ROLE:  Regulatory oversight of opioid production by pharmaceutical manufacturers was quietly eased during the Obama administration in 2016, with a new federal law that weakened the authority of the Drug Enforcement Agency.  A  Washington Post/CBS 60 Minutes investigation found that Congress and the White House passed the law by a unanimous consent procedure that required no debate and no Congressional vote.

IS THE EPIDEMIC COMING TO TEXAS? Texas has had lower rates of opioid overdoses and deaths than many other states. Advisories warn, though, that it may only be a matter of time before the epidemic reaches our own local communities and threatens the lives of people here at home.

U.S. Opioid Overdose Epidemic

Photo Wall Exhibit – EAD 701

References Supporting Exhibit Content

School of Public Health

February 2019


Alston, P. (2017). Statement on visit to the USA, by Professor Philip Alston, United Nations Special Rapporteur on extreme poverty and human rights. Office of the United Nations High Commissioner for Human Rights. Retrieved February 13, 2018, from http://ohchr.org/EN/ NewsEvents/ Pages/DisplayNews.aspx?NewsID=22533&LangID=E.

Barnett, M. L., Olenski, A. R., & Jena, A. B. (2017). Opioid-prescribing patterns of emergency physicians and risk of long-term use. New England Journal of Medicine, 376, 663–673.

Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: Coming of age. Annual Review of Public Health, 32, 381–398.

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129 (Suppl. 2), 19–31.

Burke, D. S. (2016). Forecasting the opioid epidemic. Science, 354, 529.

Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15083. Retrieved December 14, 2017, from www.pnas.org/content/112/49/15078.full.

Case, A., & Deaton, A. (2017). The media gets the opioid crisis wrong. Here is the truth. Washington Post. Retrieved December 25, 2017, from www.washingtonpost.com/opinions/the-truth-about-deaths-of-despair/2017/09/12/15aa6212-8459-11e7-902a-2a9f2d808496_story. html?utm_term=.538a63cc3b22.

Case, A., & Deaton, A. (2017). Mortality and morbidity in the 21st century. Brookings Paper on Economic Activity. Retrieved December 14, 2017, from www.brookings.edu/bpea-articles/ mortality-and-morbidity-in-the-21st-century.

Center for Responsive Politics. (2017). Pharmaceutical manufacturing. Retrieved December 7, 2017, from www.opensecrets.org/lobby/induscode.php?id=H4300&year=2017.

Centers for Disease Control and Prevention. (2017). Guideline for prescribing opioids for chronic pain. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved December 23, 2017, from www.cdc.gov/drugoverdose/pdf/ guidelines_factsheet-a.pdf.

Centers for Disease Control and Prevention. (2017). Opioid overdose. Atlanta: U.S. Department of Health and Human Services. Retrieved June 26, 2017, from www.cdc.gov/drugoverdose/ data/index.html.

Davidson, J. (2016, June 23). Is DEA a bad guy in opioid addiction fight? Washington Post. Retrieved December 11, 2017, from www.washingtonpost.com/news/powerpost/wp/2016/06/23/ is-dea-a-bad-guy-in-opioid-addiction-fight/?utm_term=.0061c4f2bce7.

Desilver, D. (2017, July 25). Most Americans unaware that as U.S. manufacturing jobs have disappeared, output has grown. Retrieved December 26, 2017, from www.pewresearch.org/ fact-tank/2017/07/25/most-americans-unaware-that-as-u-s-manufacturing-jobs-have-disappeared-output-has-grown.

Hadland, S. E., Krieger, M. S., & Marshall, B. D. L. (2017). Industry payments to physicians for opioid products, 2013–2015. American Journal of Public Health, 107, 1493–1495.

Haskins, J. (2019, February/March). Suicide, opioids tied to ongoing fall in US life expectancy: third year of drop. The Nation’s Health, 49, 1-10.

Hedegaard, H., Warner, M., & Miniño A.M. (2017). Drug overdose deaths in the United

States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. Retreived July 25, 2018, from www.cdc.gov/nchs/ data/databriefs/db294.pdf.

Higham, S., & Bernstein, L. (2017, October 15). The drug industry’s triumph over the DEA. Washington Post. Retrieved December 23, 2017, from www.washingtonpost.com/graphics/ 2017/investigations/dea-drug-industrycongress/?utm_term=.5331e25ae198.

Hill, T. D., & Jorgenson, A. (2018). Bring out your dead!: A study of income inequality and life expectancy in the United States, 2000–2010. Health and Place, 49, 1-6.[

Hollingsworth, A., Ruhm, C. J., & Simon, K. (2017). Macroeconomic conditions and opioid abuse. Journal of Health Economics, 56, 222–233.

Keefe, P. R. (2017, October 30). The family that built an empire of pain: The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts. The New Yorker. Retrieved December 20, 2017, from www.newyorker.com/magazine/2017/10/30/ the-family-that-built-an-empire-of-pain.

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadies, J. L., Clark, T. W., et al. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559–574.

Massey, J., Kilkenny, M., Batdorf, S., Sanders, S. K., Ellison, D., Halpin, J., et al. (2017). Opioid overdose outbreak—West Virginia, August, 2016. Morbidity and Mortality Weekly Report, 66, 975–980.

McGreal, C. (2017, October 19). How big pharma’s money—and it politicians—feed the US opioid crisis. The Guardian. Retrieved December 7, 2017, from www.theguardian.com/us-news/2017/oct/19/big-pharma-money-lobbying-us-opioid-crisis.

Meier, B. (2007, May 10). In guilty plea, OxyContin maker to pay $600 million. New York Times. Retrieved December 20, 2017, from www.nytimes.com/2007/05/10/business/11drug-web.html.

Perrone, M., & Weider, B. (2016, December 15). Pro-painkiller echo chamber shaped policy amid drug epidemic. Center for Public Integrity. Retrieved December 7, 2017, from www. publicintegrity.org/2016/09/19/20201/pro-painkiller-echo-chamber-shaped-policy-amid-drug-epidemic.

Portenoy, R. K. (1996). Opioid therapy for chronic nonmalignant pain: Clinician’s perspective. Journal of Law, Medicine, and Ethics, 24, 296–-309.

Portenoy, R. K., & Foley, K. M. (1986). Chronic use of opioid analgesics in non-malignant pain: Report of 38 cases. Pain, 25, 171–186.

Rannazzisi, J. T. (2014, December 29). Comments from the Drug Enforcement Administration. A letter to Marcia Crosse, Director of Health Care, U.S. General Accountability Office. U.S. Department of Justice, Drug Enforcement Administration. Retrieved December 11, 2017, from www.gao.gov/assets/670/668252.pdf.

Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Morbidity and Mortality Weekly Report, 65, 1445–1452.

Ryan, H., Girion, L., & Glover, S. (2016, July 10). More than 1 million Oxycontin pills ended up in the hands of criminals and addicts. What the drugmaker knew. Los Angeles Times. Retrieved December 6, 2017, from www.latimes.com/projects/la-me-oxycontin-part2.

Scutchfield, F. D., & Keck, C. W. (2017). Deaths of despair: Why? What to do? American Journal of Public Health, 107, 1564–1565.

United Nations Office on Drugs and Crime. (2017). Afghanistan opium survey 2017. Cultivation and production. Vienna: United Nations Office on Drugs and Crime and Islamic Republic of Afghanistan Ministry of Counter Narcotics. Retrieved December 7, 2017, from https://reliefweb.int/sites/reliefweb.int/files/resources/Afghan_opium_survey_2017_cult_prod_ web.pdf.

U.S. Bureau of Labor Statistics. (2012, February). The recession of 20072009. Retrieved December 12, 2017, from www.bls.gov/spotlight/2012/recession/ pdf/recession_bls _spotlight. pdf.

U.S. Drug Enforcement Administration. (2016). Counterfeit prescription pills containing Fentanyls: A global threat. DEA Intelligence Brief (unclassified), DEA-DCT-DIB-021-16. Retrieved December 10, 2017, from www.dea.gov/docs/Counterfeit% 20Prescription% 20Pills.pdf.

U.S. Drug Enforcement Administration. (2016). DEA reduces amount of opioid controlled substances to be manufactured in 2017. Retrieved December 11, 2017, from www.dea.gov/ divisions/ hq/2016/hq100416.shtml.

U.S. Drug Enforcement Administration. (2017). Diversion control division. Retrieved December 20, 2017, from www.deadiversion.usdoj.gov/21cfr/cfr/1301/1301_74.htm.

U.S. Drug Enforcement Administration. (2017). 2017 National drug threat assessment (unclassified), DEA-DCT-DIR-040-17. Retrieved December 10, 2017, from www.dea.gov/ docs/DIR-040-17_2017-NDTA.pdf.

U.S. General Accounting Office. (2015). Better management of the quota process for controlled substances needed; coordination between DEA and FDA should be improved (GAO-15-202). Washington, DC: Author.

U.S. General Accounting Office. (2003). Prescription drugs. OxyContin abuse and diversion and efforts to address the problem (GAO-04-110). Washington, DC: Author.

Van Zee, A. (2009). The promotion and marketing of OxyContin: Commercial triumph, public health tragedy. American Journal of Public Health, 99, 221–227.

This page was last modified on February 6, 2019