The Opioid Crisis
A New Class of Drugs ravages America.
The earliest recorded use of opioids can be traced to when 8000-year-old Sumerian tablets were prescribed to relieve pain.1
In the United States, it became commonplace when it was used to treat troops during the Civil War in the 1860s. In 1914, the Harrison Narcotics Act was passed in order to limit widespread commercial sales.2
Doctors also were very careful in prescribing opioids for pain up till the 1970s. However, this changed in the 1980s and 1990s. Opioids were gradually introduced for the treatment of chronic pain.
Photo By: Virginia Tech
Photo By: Virginia Tech
According to the International Narcotics Board, the United States has 4.4% of the World's population while consuming almost 30.2% of the total opioid consumption in circulation.3
Opioid Usage and Death
The amounts of death that have occurred as a result of opioid overuse is rising in the United States in a staggering manner.
In the visualization below, we can see the number of deaths by substance type from 1990 to 2019. Out of all substance use disorders, it can be seen that opioid overdose has increased exponentially in the past 30 years.
Opioid Use by Age
We are not only seeing an increase in the usage and deaths from opioids, but we are also seeing a big uptick in usage among the youthful population. According to Our World in data, most people who die from smoking are over 70 years old.4 In addition to that, most people who die from alcohol liver damage are also a little bit advanced in age.
However, from our chart below, we see that there is an exponential increase in the number of deaths from opioids for the 15 to 49 demographics. This is a concerning trend.
How did Opioids become so widespread?
- Pharmaceutical Companies Recruited Academics
There was a concerted push to get doctors and pain specialists in the academic community to convince the patients that pain was undertreated and opiates were not dangerous. - Primary Care Doctors
There was a marketing push by pharma companies to direct market the drugs to primary care clinics through the use of incentives and coupons. - Increased Influence by Companies
In 1992, The Prescription Drug User Fee Act was passed to take the FDA from fully tax-funded to an organization funded by tax and pharma dollars.
This means that over the years, the ratio of government to tax funding has been reducing. You can see below
It is very hard for a regulatory body to appropriately regulate a body when it depends on it for over half of its funding.
The large funding that accrues to the FDA as a result of user fees makes the FDA more malleable to pharma influence. In addition, it also makes the FDA more willing to be lenient with companies. There has been a huge uptick in the number of first-time applications for medications approved by the FDA. According to The Conversation, it took the FDA 29 months to approve a drug in 1987. By 2014, the time period was down to 13months. It took 10 months as of 2018.5
The graph to the side shows the decrease in the number of months it takes for a new drug to reach the market.6
What can we do?
1). The user fee agreement is reauthorized every five years by Congress. The next authorization date is in September of 2022. There can be a more direct push to Congress to have them re-examine the law.
2). Public enlightenment for the general populace that opioids are not effective for long-term pain.
3). There is currently a huge disconnect between the medical industry and patients. The health industry's actions are currently based on profit. There should be a stop to volume-based revenue on opioids for clinics.
References
1. Sankar Bandyopadhyay "An 8,000-year History of Use and Abuse of Opium and Opioids: How That Matters For A Successful Control Of The Epidemic?" Neurology, March 1, 2021.
https://n.neurology.org/content/92/15_Supplement/P4.9-055
2. Virginia Tech "America’s Original Opioid Crisis: Civil War Veterans and Opiate Addiction" College of Liberal Arts and Science, October 26, 2020
https://liberalarts.vt.edu/news/events/2020/10/america-s-original-opioid-crisis--civil-war-veterans-and-opiate-.html
3. International Narcotics Board. https://www.incb.org/incb/en/about.html
4. Hannah Ritchie and Max Roser "Drug Use" Our World in Data, December 2019.
https://ourworldindata.org/drug-use
5. C. Michael White "Why is the FDA funded in part by the companies it regulates?" The Conversation, May 13, 2021.
https://theconversation.com/why-is-the-fda-funded-in-part-by-the-companies-it-regulates-160444
6. Stephen J Ezell "How the Prescription Drug User Fee Act Supports Life-Sciences Innovation and Speeds Cures" ITIF, February 2017.
https://www2.itif.org/2017-pdufa-life-sciences-innovation.pdf
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