More than 1.2 million additional people across North America are expected to die of opioid overdoses by 2029 if dramatic interventions are not taken to prevent it, according to a new study published in the Lancet.
Overdose deaths from all drugs, including opioids, have increased dramatically in the US and Canada during the Covid-19 pandemic.
The Lancet report, prepared by the Stanford-Lancet commission on the North American Opioid Crisis, is a wide-ranging analysis which seeks to highlight evidence-based recommendations to the opioid crisis.
The report predicts that the number of overdoses will “grow exponentially” in the next seven years, killing an additional 1.2 million people. Such a figure would represent a doubling of the number of deaths seen over the last two decades.
As long as the status quo stands, “We will continue to have these kinds of addiction outbreaks in our healthcare system,” said Keith Humphreys, chair of the commission and a professor of psychiatry at Stanford University, which financed the commission’s research.
The commission emphasized that while specific vulnerabilities in American regulations accelerated the current problem, there was also evidence the opioid crisis had “got a good chance of spreading globally,” Humphreys added.
“As we show in [the report], Australia has a 15-fold increase in opioid prescribing. England has doubled. Finland has gone up by a factor of seven. Brazil by 465%,” he said.
Provisional data released by the Centers for Disease Control and Prevention (CDC) showed that during the 12-month period ending in April 2021, more than 100,000 people died in the US of drug overdoses, including more than 75,000 people whose deaths involved opioids.
Opioids, a broad class of drugs including prescription painkillers and illicit drugs such as fentanyl and heroin, are involved in about three-quarters of overdose deaths in the US. The number of overdose deaths involving fentanyl has risen sharply since 2015.
In North America, more than 600,000 people have died of opioid overdoses since 1999. The opioid epidemic is broadly recognized to have started when drug companies, such as Purdue Pharma, aggressively and fraudulently marketed opioids despite evidence they were being abused and diverted.
Humphreys argued that weak regulation, poor addiction treatment services and disinvestment in preventive measures make the US particularly vulnerable to future waves of addiction epidemics involving other drugs.
“It may not be opioids, but it may be tranquilizers or stimulants,” said Humphreys. Regardless of the class, he warned, all would cause unnecessary injury and death.
In North America, the opioid crisis is largely seen to have occurred in three waves. Widespread prescribing of opioid painkillers in the 1990s led millions, particularly white and Indigenous people living in rural areas, to become addicted.
Insufficient addiction treatment resources expanded markets for illicit heroin, and also moved the opioid epidemic into urban centers, expanding their use among Black Americans. Those markets were then flooded with fentanyl, a synthetic opioid 50 to 100 times more potent than morphine, leading to recent peaks in opioid overdose deaths.
To try to “unwind” the opioid epidemic in the US over the coming years, the commission argued efforts should start by curbing pharmaceutical industry influence on doctors, politicians, regulatory agencies, medical students and the public through industry-supported patient advocacy groups.
The commission then calls for opioid stewardship that takes into account both benefits and risks of painkillers; addiction treatment that is part of core public health services; criminal justice reform; investment in healthier communities and childhood education; innovations in biomedical research to find non-addictive painkillers; and lastly a commitment from wealthy nations to enact policies to avoid exporting the opioid crisis to developing countries.
Even if lawmakers only tackled the influence of pharmaceutical companies, such a change would represent a dramatic realignment of power in the US. The pharmaceutical and health industry spent more than $352m lobbying members of Congress in 2021. In 2020, the pharmaceutical industry alone donated to two-thirds of sitting members of Congress, or 356 lawmakers, according to the health publication Stat.
Humphreys acknowledged such change was daunting, but argued it should not be ignored. “We’re not going to pretend [that] because this is politically impossible at this moment that it’s not an issue – of course it’s an issue, the role of money,” said Humphreys.
Previous research by the commission suggested that 25% of the increase in predicted overdose deaths could be averted with widespread distribution of the opioid overdose antidote naloxone.
In the US, SAMHSA’s National Helpline is at 800-662-4357. In the UK, Action on Addiction is available on 0300 330 0659. In Australia, the Opioid Treatment Line is at 1800 642 428 or call the National Alcohol and Other Drug Hotline on 1800 250 015