The Centers for Disease Control and Prevention (CDC) of the Department of Health and Human Services, reported that more than 130 individuals in the United States do not survive opioid-related overdoses each day (CDC, 2018). Although the daily death rate is severe, the widespread effect of the abuse is more common than expected. In a more quantifiable analysis, misuse of prescribed opioids and illegal use of heroin “affects more than 2 million Americans and an estimated 15 million people worldwide each year. The prevalence of opioid misuse and addiction is rapidly increasing” (Medline, n.d.). The U.S. drug-overdose epidemic is worsening. Almost 90,000 U.S. overdose deaths occurred between September 2019 and September 2020, which is the highest figure since the late 1990s, according to data from the CDC (Smith, 2021). 

The Medical History

Dating to the mid-1800s, medics used morphine during the Civil War to aid as an anesthetic during battle, which led to dependency after the war ended (CNN, 2021). The National Institute on Drug Abuse pinpointed the modern-day opioid issue commencing in the late 1990s—namely, when the pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and then health care providers began to prescribe them at greater rates. These events subsequently led to a widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive (National Institute on Drug Abuse, 2019).

The second major increase came in 2010, with rapid development of heroin overdoses. Beginning in 2013, synthetic drugs rapidly increased overdoseinduced deaths, mainly from IMF (illicitly manufactured fentanyl). From 1999 through 2017, overdose deaths comprised of both prescription opioids and illicit opioids reached a total of nearly 400,000. In 2017 alone, more than 68 percent of all reported drug overdoses were related to an opioid. In comparison, the opioid-related deaths reported in 2017 were more than six times higher than those reported in 1999, at the start of the crisis (CDC, 2021).

National Side Effects

The CDC quantified the national crisis in dollar figures as costing an estimated $78.5 billion each year due to the misuse of prescription opioids; this amount considers health care costs, loss of productivity, addiction and prevention treatments, as well as criminal justice expenditures (CNN, 2021). Shedding light on recent public policy tactics, the United States government enacted the 21st Century Cures Act in 2016, with the goal of funding treatment and prevention programs. In 2017, the Department of Justice launched an Opioid Fraud and Abuse Detection Unit.

Ex-president Donald Trump made nationwide efforts in October 2018 to introduce opioid legislation. The goal of the SUPPORT for Patients and Communities Act was to fund both research for alternative drugs for nonaddictive pain management and treatments for Medicaid patients with substance abuse disorders. “State legislatures are also introducing measures to regulate pain clinics and limit the quantity of opioids that doctors can dispense” (CNN, 2021).

There are several tiers of major stakeholders affected by this crisis: first and foremost, patients. Since opioids are costly and not readily available, opioidaddicts often turn to a cheaper drug choice—heroin—which leads to another devastating and life-threatening habit. Additionally, families of addicts are affected secondarily. Pharmaceutical companies have a large profit motive in this industry, causing many firms to mislead consumers and prescribing physicians. Taxpayers and regulatory bodies are being relied on to fund and eradicate the crisis. When filling prescriptions, pharmacies such as CVS are able to control and limit the number of days a patient is supplied opioids....

Questions for Discussion

1. What did you learn from this case that you didn’t know about opioids in America?

2. Explain if and how using a stakeholder AND an issues management approach can help understand this case better than just reading it?

3. What specific ethical principles and reasoning are relevant to apply in this case?

4. Who is to blame, and why, in this case?

5. Is the opioid crisis in America over? Why or why not? What solution paths would you recommend to help contain, if not eradicate, the crisis?