Opioid addiction is the biggest drug epidemic in U.S. history. How’d we get here?

Every day brings another story about the depth of the country’s opioid crisis. A rise of pain killer prescriptions from doctors and a pharmaceutical industry eager to boost sales in the 1990s sparked a wave of addiction that shot up by almost 500 percent in the last 15 years. As a prologue to our series covering the opioid crisis, “America Addicted,” William Brangham reports on how we got here.

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    Every day brings another story about the depth of this country's opioid crisis: overdoses up, emergency services overwhelmed, another family burying a loved one.

    On Monday, we're starting an extensive series here on the "NewsHour," broadcast and online. It's called America Addicted, and it will look at how opioids are affecting communities throughout the country, from its toll on one city in West Virginia, to the rise of powerful new synthetic drugs like fentanyl in New England, and how new programs out West are trying to combat addiction.

    First, we wanted to take a quick look at exactly how this crisis began.

    William Brangham has that.


    It's hard to grasp the full scope and scale of the opioid crisis we're in the midst of.

    The numbers are staggering. Almost half-a-million Americans have died in the last 15 years from an overdose, and the majority of those involve opioids. On average, 91 Americans are still dying every single day.

    In that same period, the rate of addiction to opioids has shot up by almost 500 percent. And the availability of addiction treatment hasn't kept up at all.

    So, how did we get here?

    Most experts say this crisis began in the 1990s, when some doctors and medical associations argued that, for generations, their profession had ignored the problem of chronic pain, which had caused unnecessary suffering for millions of patients.

    They started pushing the idea that pain be seen as the fifth vital sign, something to be checked as often as blood pressure, and treated accordingly.

    At roughly the same time, the pharmaceutical industry, which was eager to boost sales of its new class of painkillers, like OxyContin, told doctors that these new drugs could be used without fear of their patients becoming addicted.

    The industry even put out testimonial videos, like this one from Purdue Pharma in 2000.

  • MAN:

    We doctors were wrong in thinking that opioids can't be used long-term. They can be, and they should be.


    The industry and even some doctors also cited this one-paragraph letter posted in "The New England Journal of Medicine" back in 1980.

    Its authors had looked at the use of opioid painkillers at one burn unit in Massachusetts and wrote — quote — "The development of addiction is rare in medical patients with no history of addiction."

    While the authors and "The New England Journal" have both said that this letter was misinterpreted, it was cited hundreds of times as an endorsement for the widespread use of opioids for pain.

    And, in fact, starting in the late '90s and early 2000s, the rate of opioid prescriptions began to snowball. By 2015, according to the CDC, enough pills were being prescribed for every American to be medicated around the clock for three straight weeks.

    But studies have now clearly shown that opioid medications can lead to dependency within just a matter of days, and so this flood of prescriptions led to a surge of addiction. And it also drove a steady rise in overdose fatalities.

    With these numbers growing, the medical community, local governments and law enforcement began to take action. New prescribing guidelines were issued. Databases were created to track prescriptions.

  • MAN:

    This was a pill mill operation. Those are the allegations tonight.


    And law enforcement cracked down on the so-called pill mills, the doctors and pharmacies that had been recklessly flooding certain communities with opioids.

    In 2010, prescriptions of opioids peaked, and have fallen ever since. Problem solved, right? Not so fast.

    In 2015, there were still three times as many opioid prescriptions being written as there were in 1999, and many people have turned to cheaper opioid substitutes, like heroin.

    Seizing on this booming market, drug dealers sought to boost potency, and their own profits, by lacing their heroin and other drugs with powerful synthetic opioids like fentanyl. Those additives have only accelerated the rise in overdose deaths, which last year killed more than 64,000 Americans.

    By almost any measure, this is the biggest drug epidemic in American history, dwarfing the number of lives lost to crack cocaine or methamphetamines. It's a crisis that took decades to create, and experts say will take a great deal of time, patience and work to undo.

    For the PBS NewsHour, I'm William Brangham.


    Our series America Addicted will continue all next week here on the NewsHour.

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