A new analysis from researchers at Stanford University and the scientific journal, The Lancet, has revealed a large number of Americans and Canadians are still becoming addicted to prescription opioids each year.
Without "urgent interventions", the members of the Stanford-Lancet Commission estimate this deepening disaster could claim the lives of up to 1.2 million people by 2029.
That's more than double the number of opioid overdose deaths recorded in North America over the last two decades.
"It took more than a generation of mistakes to create the North American opioid crisis," the researchers write.
"It might take a generation of wiser policies to resolve it."
The COVID-19 pandemic appears to have added fuel to an already raging fire. The first year of the pandemic saw record rates of opioid overdoses.
While numbers were already increasing in the US by mid-2019, 2020 saw them skyrocket, driven largely by a 38.4 percent rise in deaths from synthetic opioids like fentanyl. This was after a small drop in overdose deaths between 2017 and 2018.
In Canada, the jump was even more extreme, with deaths increasing by 67 percent in a single year to more than 6200.
Experts say the pandemic limited access to substance use disorder services and overwhelmed healthcare systems, while also creating extra stressors like unemployment, grief, and disability – all of which have likely exacerbated the opioid crisis.
"Even in the era of COVID-19, the opioid crisis stands out as one of the most devastating public health disasters of the 21st century in the USA and Canada," the article reads.
Not only does the Stanford-Lancet Commission lay out the full extent of the present-day crisis, the researchers also recommend numerous solutions.
Opioids themselves are not 'good' or 'bad', nor are those who take them, the authors note, but the ways in which these medicines are prescribed can be very dangerous.
"Some patients in pain might have benefited from increased opioid prescribing," the Commission concedes, "but the overall effect was catastrophic."
In 1996, Purdue Pharma began aggressively marketing a long-acting opioid medication called OxyContin as a 'less addictive' form of pain management – to be used not only in cases of cancer, surgery or palliative care, but also for dental procedures and bone fractures.
While the form of opioid in OxyContin isn't the most potent painkiller, it would prove to be among the most addictive.
As prescription rates exploded across North America, regulators did little to nothing to curb the spread of the dangerous drug.
At its peak in 2012, medical practitioners in Canada and the United States wrote enough opioid prescriptions to cover each adult in North America. With every new prescription, the risk of addiction and overdose increased.
In 2014, the crisis began to heat up even more, as illicit drug producers began targeting people addicted to prescription opioids with new synthetic versions, like fentanyl.
Most people today who are dying of heroin and fentanyl overdoses were first given prescription opioids. The more of these prescriptions medical providers write, the more money they receive from opioid manufacturers.
At first, those most affected by the opioid crisis were rural White and Indigenous populations, but today opioid overdoses are also growing among Black, Hispanic, and Latino people.
"Our analysis clearly lays out how lack of effective regulation and an unchecked profit motive created the opioid epidemic," says one of the team, public health expert Howard Koh from Harvard University.
"To ensure safeguards are in place to curb the opioid addiction epidemic and prevent future ones involving other addictive drugs, we must end the pharmaceutical and health care industry's undue influence on the government and its unregulated push for opioid use. This includes insulating the medical community from pharmaceutical company influence and closing the constantly revolving door between regulators and industry."
Apart from curbing the influence of opioid manufacturers in government and medicine, some of the recommendations made in the new paper include building up facilities and services for substance use disorders, promoting safer prescribing practices, expanding research on chronic pain and alternative treatments, and ending penalties for some drug-related crimes, like simple possession or use of illicit opioids, and substance use during pregnancy.
"Law enforcement officials cannot crush the opioid crisis through brute force," the authors warn, "and attempts to do so destroy many lives."
The authors acknowledge that even if all their recommendations are met, it will not be enough to completely eliminate the opioid crisis.
"Tragically," they say, "many future deaths are inevitable at this point."
But that's no reason not to act. If steps are taken now, officials can still save numerous lives and significantly reduce suffering. It's ethically imperative, and not just for the US or Canada.
Without regulations in the nations where opioids are manufactured the most, the rest of the world could become embroiled in a similar crisis.
Already, opioid prescriptions are increasing in the Netherlands, Iceland, England, Brazil, and Australia. In Brazil alone, opioid prescriptions increased by 465 percent between 2009 and 2015.
The Commission calls for high-income nations where opioid manufacturers are based to extend restrictions and legal sanctions to global operations. To give resource-limited countries an alternative to partnering with for-profit multinational corporations, the Commission recommends that the World Health Organization and donor nations provide free, generic morphine for analgesia to hospitals and hospices in low-income countries.
"The risk of global spread is greater where COVID-19 has ravaged health systems, where pain needs in resource-limited settings go unmet, and where corporations look for new markets, but are left to self regulate," argues an accompanying editorial.
"To manage pain, greed must be managed as well."
The report was published in The Lancet.