The Birth of a Drug-Addled Nation

Drug-Addled Nation

How did America get to the point of losing 64,000 Americans to drug overdoses in one year? We’ve traveled a long road to get to this point and in truth, most people haven’t even noticed the journey.

National overdose deaths from the CDC.

The majority of these Americans have been lost to overdoses of opioids, and the majority of people addicted to opioids either started with or are currently misusing the prescription forms of this class of drug—oxycodone, hydrocodone, hydromorphone, fentanyl, morphine and many other painkillers. This chart shows you the number of people we have lost each year to prescription pain relievers.

But it’s not just opioids that Americans are using, addicted to or dying from. Benzodiazepines—anti-anxiety drugs like Xanax, Valium, Halcion, Librium, Ativan and others—are also intensively involved in overdoses, very often in combination with opioid painkiller abuse. You can see the number of deaths from benzodiazepines represented on the chart below.

The CDC reports on the number of deaths from benzodiazepines.

America could not have arrived at this point without a dramatic shift in their acceptance of drugs by both sexes and all ages. In the 1940s and 1950s, going to the doctor and getting a prescription for whatever ailed you was not the norm. In the next few decades, that attitude would undergo a drastic change. We’ll look at what brought about that change.

Spending Increases for Drug Advertising and Healthcare

In the second half of the 20th Century, healthcare costs, spending to advertise the use of prescription drugs and prescribing of many major drugs by doctors were all in growth trends. For example:

  • The Kaiser Family Foundation notes, “Spending in the US for prescription drugs was $234.1 billion in 2008, nearly 6 times the $40.3 billion spent in 1990.”
  • By 2016, this number had reached $450 billion.
  • Over time, families had to cover less of their own healthcare costs and insurance companies and governments paid more. Household spending went from 56 percent of healthcare costs in 1960 to 28 percent in 2013. This shift would lower the financial barrier to obtaining medications prescribed by doctors.
  • From the medical reporting website, “Prescription drugs accounted for nearly 17 percent of total health care spending in 2015, up from about 7 percent in the 1990s.”

So what happened to convince Americans that they needed medical drugs in such volume? Here’s a few notable changes:

  • According to a report from the Centers for Medicare and Medicaid Services, starting in the late 1990s, “the emergence of several new blockbuster drugs and a dramatic increase in direct-to-consumer advertising contributed to greater use of prescription drugs.” One of those “blockbuster drugs” was the potent painkiller OxyContin. We’ll talk more about this drug in a moment.
  • The Kaiser Family Foundation reported that the money spent advertising medical drugs directly to consumers more than doubled between 1999 and 2009, increasing from $1.8 billion to $4.3 billion.

Apparently, all that advertising worked. Patients got the idea that prescription drugs could solve their problems. Now, add another layer of advertising and sales pressure to the mix—this time, directly to prescribers—doctors, dentists and other medical professionals. While this pressure was applied on the behalf of many kinds of drugs, the pressure to prescribe more painkillers was the one that had the most deadly effects.

A Focus on Opioid Painkillers

In the mid-1990s, there was a multi-pronged campaign to convince doctors to prescribe more pain medication. It took more than a decade for the damage to start becoming obvious and another decade for news services to really begin connecting the dots.

In 2017, The Economist reported that sales of prescription opioids almost quadrupled between 1999 and 2014, and attributed that growth not to an increase in pain but to an increase in rates of addiction. In tracing the causes for this increase, the magazine commented on misleading statements made by Purdue Pharma, the patent-holder for OxyContin, to regulators, doctors and patients.

Starting in 1995, Purdue had launched an aggressive marketing campaign directed at prescribers. According to a Los Angeles Times story, Purdue sales representatives pitched doctors on prescribing OxyContin—an opioid painkiller with the potential to easily addict a patient—for common conditions such as backaches and knee pain. This was a distinct change from the usual reasons doctors would prescribe opioids—severe, end-of-life or cancer pain. In those cases, the need for strong pain relief outweighed the risk of addiction.

Doctors were treated to impromptu lunches, dinner seminars and weekends at resorts. This new formulation was not likely to be addictive, said the reps. Doctors responded favorably to this campaign and OxyContin sales skyrocketed. By 2003, sales of this one drug were close to $2 billion.

As prescriptions for opioids increased, so did overdose deaths and treatment admissions.

As sales of OxyContin and other opioid painkillers went up, overdose deaths and addiction treatment admissions followed, as you can see in this chart from the Centers for Disease Control and Prevention (CDC).

Flanking this effort by pharmaceutical companies, pain foundations that appeared to be non-profit, public benefit organizations began to promote the more aggressive treatment of pain. “Pain is the fifth vital sign,” (along with temperature, heart rate, respiration rate and blood pressure) said the American Pain Society in 1996, urging doctors to prescribe more opioids to make patients more comfortable.

Doctors and nurses began to ask their patients the now-ubiquitous question, “On a scale from 1 to 10, how severe is your pain?” Prescriptions for addictive, opioid pain medication continued to climb in response to the patient answers.

As you can see in the chart above, the effect of all this marketing and pressure was a tragic increase in the number of addicted people and the number of overdose deaths.

While there were a lot of conversations among legislators, law enforcement, media and community organization about bringing prescribing under control, a new development would almost render that effort relatively ineffective.

The Switch to Heroin and Illicit Opioids

In 2010, OxyContin, the most popular drug among those who were misusing and addicted to opioids, was reformulated to make it harder to abuse. At the same time, the word was finally out on the addictiveness of this pill and doctors began reining in their prolific prescriptions for the drug. This double-whammy meant there were fewer pills available for those who were addicted.

The solution for an addicted person was often switching to heroin which was far cheaper than pills and required no visits to the doctor. A shift in heroin delivery methods made it even easier for these addicted individuals to make this switch—just a few years before, they would have had to drive to inner cities to buy heroin from a disreputable dealer standing on a scary street corner.

New drug dealers respond to phone calls or texts to deliver heroin.

As documented in his book Dreamland: The True Tale of America’s Opiate Epidemic, Sam Quinones describes how a new breed of drug dealer from Mexico made deliveries of heroin to the suburbs, just requiring a text or call to their cell phone to bring them running. What could be easier? Now there was a solution for those who could not get OxyContin from their doctor or those who had run out of money—in most cases because addiction was unraveling their lives.

Overdoses began to rise even further because of the unpredictable potency of heroin. Representative of the tens of thousands of lives lost in this way was the distinguished actor Philip Seymour Hoffman, lost to a heroin overdose in 2014.

The Game Changes Again

One thing you can expect with drug trafficking, drug abuse and addiction is change. Trends are always changing and anyone who wants to grasp the nature of this problem must keep up with the changes. A few years after the migration from painkillers to heroin, fentanyl and other illicitly manufactured opioids arrived on the scene.

Fentanyl and carfentanil are both legitimate prescription drugs. Carfentanil is only used on large animals to take them down for medical treatment. Fentanyl is an extremely powerful painkiller that is often prescribed as a patch or slow-dissolving lollipop to prevent overdose.

In 2016, fentanyl manufactured in shady overseas labs began making its way into the U.S. heroin supplies, followed by the vastly more powerful carfentanil and other variations. In some areas, overdose deaths were attributable more often to fentanyl than heroin.

The Nature of Today’s Beast

According to the Substance Abuse and Mental Health Services Administration, more than two million people are currently addicted to painkillers. If you add in the people addicted to tranquilizers, stimulants and sedatives, the number becomes 2.7 million. Nearly 19 million are misusing them, which means using more than prescribed, in a different way than prescribed or using medications that were not prescribed for them.

CDC reports on which opioids killed the most people.

In 2016, the CDC published an updated chart on the number of opioid overdose deaths and the drugs that caused them.

In 2015, there were more than 22,000 deaths involving prescription opioids. In 2015, total drug overdose deaths reached 52,404 and by 2016, that number had increased to 64,070. Is there no way to stop this runaway train?

Fighting Back

This is the story of how America became such a huge consumer of prescription drugs and how those drugs seemed to turn against us. But the end of the story has not yet been written. Every day, more legislators, law enforcement, healthcare and community organizations are on board with fighting back against this devastating situation. Hundreds of parents who have lost a child have become outspoken activists.

You can fight back, too. Here’s some ideas for you.

  • If you are a parent, you can make sure that you talk to your children about the dangers of all drugs and the underage consumption of alcohol. And then get very well informed about the particular threat of prescription drug abuse and deliver that message with your own heart-felt concern. You can learn more about the drugs your children might abuse here.
  • You can team up with community organizations fighting drug abuse in your area. Do an internet search for “anti-drug coalition” in your community and see what you find.
  • You can check out your children’s school drug prevention program. Make sure there is one, first, then check into it to find out its effectiveness in reducing drug abuse among youth. If there is no such evidence, keep looking to find a program that does get a positive result and recommend it to your children’s school.
  • If someone you care about is struggling with dependence on any prescription drug, talk to your doctor to find out how you might be able to help them. Find out if there are non-drug options to help this individual with their pain or other situation their drugs are prescribed for.
  • And if someone you care about is addicted—meaning their lives are damaged by their use of this substance but they continue using it, perhaps despite promises to quit—get help. Rally your family and friends and intervene. You really don’t have to wait for the person to hit rock bottom to get them help. Too many people have died before reaching that rock bottom.

For a better understanding of how drug rehabilitation can give this person a new life, call Narconon. We have helped tens of thousands of people back to sobriety over the last fifty years. We can help you, too. Call today for help.


Karen Hadley

For more than a decade, Karen has been researching and writing about drug trafficking, drug abuse, addiction and recovery. She has also studied and written about policy issues related to drug treatment.