Opioid crisis in the US

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Opioid overdose deaths in the United States, 2000–2017. Deaths per 100,000 people.

Under the opioid crisis or opioid epidemic ( English opioid crisis or opioid epidemic ) the sharp increase in the number of drug addicts and deaths related to the abuse of opioid painkillers in the United States is understood. The crisis intensified during the COVID-19 pandemic . According to the CDC , almost 841,000 people died from drug overdoses between 1999 and March 2021. Most of them had become addicted to painkillers that had previously been prescribed .

background

Number of opioid deaths per year in the United States from 1999 to 2019

The phenomenon began with the prescription pain reliever Oxycontin , which the Sackler family and their company Purdue Pharma launched in 1996 and aggressively advertised as a pain reliever and allegedly with a very low potential for addiction. The main component of this painkiller, oxycodone , has been available in Germany since 1929 only with a prescription for narcotics. Purdue and other drug companies, on the other hand, used lobbying and aggressive marketing to get opioids, previously used primarily for the seriously ill and dying, to be prescribed for everyday pain in the United States. A significant proportion of those treated in this way developed an addiction and then often switched to illegal, cheaper opioids. The sharp increase in the number of drug -related deaths in the USA was one of the reasons why average life expectancy has fallen since 2015 for the first time since the First World War .

Opioids have a massive impact on brain chemistry and can quickly lead to addiction. Overdoses result in numerous deaths because the opioids can affect and paralyze the respiratory center . Such medications include oxycodone (trade name Oxycontin or Percocet), tramadol , hydrocodone (trade name Vicodin). While prescriptions for those drugs fell by 50% from 2012 (the year when the number of opioid prescriptions issued peaked) through 2021, people turned to the illegally available, low-cost opioid heroin (diacetylmorphine ) and to fentanyl . With the sharp rise in drug-related deaths in 2020, more people died from doctor-prescribed opioids than at the peak of prescriptions in 2012 , according to the Food and Drug Administration (FDA).

From 2006 to 2012, just over 76 billion opioid painkillers were shipped to the US market by pharmaceutical companies. These were traded in 360 million transactions in the same period. The most active producers were SpecGx (38 percent market share), followed by Actavis Pharma , Par Pharmaceutical and Purdue Pharma (3.2 percent market share). Six firms shared three-fourths of the US retail business during the same period: McKesson , Walgreens , Cardinal Health , AmerisourceBergen , CVS Health , and Walmart . The opioid crisis in the US was of such proportions that President Donald Trump declared a medical emergency on October 26, 2017.

A national survey of drug use and health in the USA found that in 2018 around 314,000 addicts without health insurance were unable to start treatment. Another 100,000 were insured, but their treatment was either not paid for at all or not in full. And more than 200,000 said they didn't know where to go for help. Of the almost two million opioid addicts in 2018, only 23 percent were in treatment. According to Bradley Stein, a psychiatrist and addiction expert who also directs Rand Corporation's Opioid Policy Tools and Information Center, funded by the National Institutes of Health , people with drug and alcohol problems are subject to stigma . Those affected would seek help less often and the family and supposed friends would ignore the addiction problem. US health insurance companies have historically not paid for addiction treatment. Aid organizations that offer outpatient advice and treatment have emerged as a result, but this is still rare. There are rehabilitation clinics, but only the wealthy or well-insured can afford them. A month-long rehab is estimated to cost between $6,000 and $20,000. This design of the US healthcare system goes back to US President Richard Nixon 's War on Drugs - and reflects the republican mentality that is not uncommon in the USA, which does not focus on the common good , but instead on personal responsibility .

In the run-up to the 2020 US presidential election , two-thirds of members of Congress received money from drug companies.

Development of the number of deaths

Data collection from 2006 to 2017, Source: Government Accountability Office
  • Top third of counties in opiate prescription per capita
  • Top third of counties in per capita disability insurance claims
  • Top third of counties in both opioid prescriptions per capita and disability insurance claims per capita
  • According to the Drug Enforcement Administration (DEA), overdose deaths reached epidemic proportions in 2015 . Already between 1999 and 2008 the number of deaths from overdoses, the sale and the abuse of painkillers rose sharply. From around 4,000 in 1999, the number of deaths rose to 16,000 in 2010.

    While legal prescription opiate overdoses leveled off in the 2010s decade, illicit opiate overdoses nearly tripled over the period 2010-2015.

    In 2016, more than 64,000 people (including 42,249 from opioids) died from overdoses in the United States , more than from car accidents and guns in the same period. According to the CDC , the number of victims in 2017 rose again by 10% compared to the previous year to 72,287. 2020 saw an all-time high of 93,331 deaths, a 30% increase from 2019. Overall, more than 450,000 people died from opioids in the United States between the start of the epidemic and 2020.

    Drug overdose is the leading cause of death in Americans under the age of 50, with opioids now causing two-thirds of deaths. This has contributed to the fact that average life expectancy in the USA has fallen in recent years. Unlike in the past, drug addiction is no longer primarily limited to social hotspots in big cities, but primarily affects the middle class in the American provinces. One of the main reasons is believed to be the reckless prescribing of opioids for pain relief in Pill Mills .

    Many of the deaths can be traced back to the very powerful fentanyl , which, like heroin, is usually smuggled into the USA via Mexico . Unlike heroin, it is also increasingly being synthesized locally. Fentanyl is being used more and more to cut down on the less potent heroin. Due to the much higher effectiveness of the mixture, unintentional overdoses often occur. In March 2017, the governor of Maryland declared his state a state of emergency to combat the crisis ; in July 2017, the crisis was described as the biggest challenge for the Food and Drug Administration (FDA).

    From 2020 or the onset of the COVID-19 pandemic (in the United States) through March 2021, at least approximately 96,800 people died from drugs in the United States, according to preliminary figures. Of the more than 93,000 people who died from an overdose in 2020, half took fentanyl. More than 16,000 of 2020's drug deaths were from doctor-prescribed opioids. One reason for the high death toll is that heroin, cocaine and cannabis are often mixed with the highly potent fentanyl.

    processing in court

    Purdue Pharma , which heavily promoted oxycodone and was fined $ 634.5 million in the wake of the opioid crisis , grew its revenues to $35 billion by 2017. The owners, the Sackler family , were nevertheless able to file for bankruptcy – bankruptcy in the USA leads to “legal immunity”.

    In 2007, Purdue Pharma and three executives were fined $ 634.5 million in a settlement for aggressively marketing Oxycontin . In 2019, Massachusetts became the first state to sue eight members of the Sackler family who own Purdue Pharma . A class action lawsuit filed by US municipalities in the Cleveland District Court alleges that Walmart, Purdue, Mallinckrodt , CVS, Cardinal and others willfully "flooded" municipalities with opioid painkillers for profit. The plaintiffs cite, among other things, the Racketeer Influenced and Corrupt Organizations Act (RICO). Purdue Pharma ($270 million) and Teva ($85 million) made settlement payments before the trial began, resulting in their criminal cases being dropped. However, further lawsuits against the pharmaceutical companies followed, most notably Purdue Pharma was sued for billions of dollars in damages and subsequently filed for bankruptcy , even though it had posted revenues of $35 billion by 2017 . However, the Sackler owners' filing for bankruptcy was only a means to an end, since bankruptcy in the USA leads to "legal immunity".

    In August 2019, an Oklahoma court ordered the pharmaceutical company Johnson & Johnson to pay $572 million in compensation in connection with the opioid crisis. In October 2019 , the pharmaceutical companies McKesson , AmerisourceBergen and Cardinal Health in the US state of Ohio averted further legal investigations by means of a settlement . In December 2020, the US Department of Justice sued Walmart; the authority complains that the group has illegally sold addictive painkillers. In February 2021, McKinsey agreed to settle claims filed by more than 40 states for at least $573 million. McKinsey had advised Purdue Pharma and its owning family during the opioid crisis.

    For the first time in the United States, pharmacies were found guilty of being too lax in dispensing opioid painkillers. In the trial in Cleveland , Ohio , three large pharmacy chains were found guilty of contributing to the crisis by laxly dispensing the addictive drugs. A federal court jury found on November 23, 2021 that U.S. retailers Walmart , CVS , and Walgreens failed to adequately control the sale of pain relievers in the state of Ohio.

    In January 2022, four pharmaceutical companies (Johnson & Johnson, McKesson, Cardinal Health and AmerisourceBergen) agreed to pay Native Americans a total of $590 million following a lawsuit filed by 400 Native American tribes. That compensation fund would be open to all 574 officially recognized Native American tribes in the United States, even if they had not filed any lawsuits. Of any population in the United States, Native Americans have the highest rate of overdoses.

    Distribution in Europe

    According to the European Drug Report, almost 119 million opioid tablets were seized in Europe in 2017.

    reception

    Documentary, feature film or series

    literature

    web links

    Commons : Drug-related death statistics  - Collection of images, videos and audio files

    itemizations

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