Abstract
The opioid epidemic has become severe in America, which started with the permission of prescribed opioid use in the 1990s. This paper has presented the historical background of this social problem so that its solution can be offered. It has been noted that opioid use disorders are overwhelmingly high in American society, and their prescribed use has paved the way for other opioids like heroin and fentanyl. Deaths due to all kinds of opioids have been rising more than in earlier years. It has been termed as the first, second, and third waves of deaths. Therefore, the first response to this should have come from legislation. An effective piece of legislation is the 21st Century Cures Act. Expansion of Medicaid and the Affordable Care Act insurance coverage for opioid disorders is also a ray of hope. In addition, countermeasures are in place, such as the use of oxycodone drugs. In addition, better treatment, and response measures for those involved in these disorders can reverse this epidemic from spreading further.
Keywords: Opioid epidemic, Opioid use Disorders, Heroin, Fentanyl, Oxycodone
Introduction
The US has been facing one of the most devastating public health catastrophes that started in the mid-1990s. It did not start from nowhere, but pharmaceutical companies, on the back of approval from the Food and Drug Administration, promoted opioid use. This approval paved the way for the prescription of opioids within legal limits. The soil was fertile for the second wave of opioids when heroin came to serve already addicted people. The third wave is in the form of illegal synthetic opioids like fentanyl (Staff Writer, 2022). This background shows how America is trapped in the opioid epidemic. This paper aims to analyze this problem through the lens of its historical background so that viable solutions to the problem can be found.
The problem
This is an opioid epidemic that has covered American society. An epidemic is a disease or a virus that spreads without limits. The definition of opioid is especially important here, so that the epidemic is also understandable. Opioids are chemicals, whether they are synthetic or semi-synthetic, and can block pain signals by binding to receptors in the brain and body. Opioids can also produce euphoria, which leads users to overuse them. Common types of opioids are fentanyl, morphine, and oxycodone. The problem is its harmful effects on human health and its ability to cause addiction. It can also cause deaths, as in 2019, about 600,000 deaths were caused by drug use. Among them, 80 per cent was related to opioid use, and 25 per cent was the result of opioid overdose (World Health Organization, 2025). Further analysis is going to be presented, considering the historical background, so that its legality and spread can be understood.
Analysis of the problem and historical background
The introduction and some background information have clarified that opioid use has become a problem in America. Initial research has revealed two more facts surrounding opioid use. First, opioid use helps in pain relief. Second, pharmaceutical companies and the FDA allowed their use, which means opioids got legitimized due to them. After these two realities, the fact is that it has harmful effects on those who use it. The World Health Organization has unveiled the number of deaths caused by opioid use. Another credible source from Harvard has also termed it a problem, so terms like opioid epidemic can fit with it.
The history of opioids in the United States can best be explained by an official source from the Congress website. It states that the opioid use prevailed in the United States in the 1990s on the back of better pain management and as part of pain advocacy campaigns. Along with it, pharmaceutical companies also paved the way through their intensified marketing campaigns as they had presented newly reformulated prescription opioid medications. Another official source, the Centers for Disease Control and Prevention, has been referred to in this report, which states that prescription opioid sales quadrupled in the US from 1999 to 2010. It raised an alarming issue side by side when opioid-related deaths doubled from 2.9 to 6.8 deaths per 100,000 people in the same period (Duff et al., 2022). It was the first time that the opioid overdose or addiction surfaced, and society started to feel this as a crisis.
Not all forms of opioids were allowed, as Heroin remained illegal, but during this period from the 1990s through 2010, its retail prices started to go down. Prices already went down, the availability of heroin increased, and the main source of heroin into the US became Mexico around 2010. This was the second wave of opioid addiction and overdose when this illegal opioid caused deaths. Heroin related deaths were one in 2010 and increased to 4.9 per 100,000 in 2016 (Duff et al., 2022). 2015 was the year when heroin became the most dominant opioid among American citizens than prescription medications. In this context, one should also note that legal opioid use also increased the number of deaths, and heroin also increased this number. Side effects of opioid legality include improved affordability of heroin.
In the history of the opioid epidemic in America, the third wave was yet to come, which was in the form of a synthetic opioid. In 2016, it was the leading cause of overdose deaths, more than heroin and prescription drugs. Fentanyl is a synthetic opioid and is 50 times stronger than heroin. Here are two sides of this opioid. Its legal and pharmaceutical form helps to treat severe pain. Its illicit use became common for recreational use when it was mixed with other inputs to enhance its effects. The synthetic opioid, fentanyl, was responsible for the third wave when its related overdose deaths doubled from 2015 to 2020. It was driven by fentanyl when overall opioid overdose-related deaths increased from 10.4 in 2015 to 21.4 per 100,000 in 2020 (Duff et al., 2022). The historical pattern justifies using it as an opioid epidemic that is hitting in the form of waves, and the number of deaths is increasing with each new wave until 2020.
Possible solutions to the problem
The opioid problem is present in the US, and there are voices to curb it. One of the possible responses is to completely ban opioid use. However, it is not a rational approach because pain-related patients benefit from opioid use, and its health benefits exist clearly. Therefore, reduction of opioid risks should be a priority for policymakers and legislative bodies (Kertesz & Gordon, 2019). Thus, the possible solutions to this problem are to regulate its use so that it is not excessive and is not at harmful levels. This falls under interventions to control opioid abuse while its use remains intact for pain-related areas.
Development of countermeasures is the best strategy to counter this harmful process that continues affecting opioid users. Pain-affected opioid users choose it to relieve pain, but they face harms related to opioid use and overdose. Thus, the solution comes in the form of countermeasures where naloxone is an effective response. It is an abuse-deterrent opioid formulation and medication-assisted treatment. It is an effective cure for those who have developed opioid disorders and are habituated to using opioids. Research has noted that weekly naloxone prescriptions reached 8000 in 2017, and they are set to rise (Ayoo et al., 2020). These countermeasures come with a drug, and they can also be prescribed or be available for use. The research has been in the process of these deterrents and countermeasures, which come in the form of drugs. These allow patient access to drugs and help to relieve opioid abuse.
A drug before a drug can be a wise policy, as opioid abuse should be tackled by another drug. However, another hint goes on the legislative side. It is the permission given to prescribed opioids in the 1990s when pharmaceuticals paved the way for it. The first wave of deaths arrived at that time; therefore, a rational approach is to h9old legislative branch accountable for this. The United States has come up with this response through federal legislation. The latest one is the Comprehensive Addiction and Recovery Act of 2016. There are other legislative responses, including the SUPPORT Act, the Fentanyl Sanctions Act, the 21st Century Cures Act, and the Blocking Deadly Fentanyl Imports Act. The most important one is the 21st Century Cures Act, which is a serious and major federal effort to tackle the opioid epidemic. However, there are frequent limitations and missed opportunities which exacerbate the opioid crisis (Beletsky, 2018). This legislation has not moved towards completely banning opioid use. Instead, these legislations ban the misuse of opioids and ensure more prevention of substance use disorders. Some aspects of this legislation are clear to monitor overseas and international drug movements. Counternarcotics cooperation is important to curb its spread. These solutions affect policymaking and the legislation area of this problem, so that the legal environment responds to what is needed for citizens and opioid users.
Legislative response to the opioid epidemic needs to be more comprehensive and detailed, where funding efficiency and proper preparation should be the top priority. The best and most effective response is to promote drugs that help opioid users counter opioid’s negative effects. Abuse deterrent formulations and efforts from the FDA towards improvement of such response are highly relevant. The focus should be on pain management, in which psychosocial risk factors are helpful in the treatment (Jones et al., 2018). Thus, many scholarly sources have focused on practical countermeasures to deal with the epidemic, but there are other solutions as well, including supporting people using opioids and the way they manage their pain-related needs.
Some advancements in vital areas are there, like substance use disorders, which are the focus, and there is little mention of substance use. Therefore, the problem is being addressed objectively. Expansion of Medicaid is there, and the Affordable Care Act is going to cover insurance plans for substance use disorder services (Staff Writer, 2022). These hopes note that opioid use disorders are getting a response through policies, and there is no complete ban on these drugs. Other measures that have been proposed to solve the opioid epidemic include reducing stigma, improving prescription of these drugs, increasing medication when someone is facing this disorder, and playing a direct role in reducing fatal overdoses (Lyden & Binswanger, 2019). These kinds of comprehensive responses can work.
Conclusion
It is to conclude that the opioid epidemic has trapped America, and its related deaths are increasing. Response to the epidemic is in the form of policy, in which countermeasures are diverse. The major focus is to offer better and expanded treatment options to those who have developed this disorder. Countermeasures are in line, and drugs to reverse this use are being implemented. Still, these responses might not be that effective as the problem has no limits. It is recommended to focus on its prevention through an improved and comprehensive response. The focus should be to avoid misuse of opioids and promoting their healthy use only.
References
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Beletsky, L. (2018). 21st century cures for the opioid crisis: promise, impact, and missed opportunities. American journal of law & medicine, 44(2-3), 359-385. https://d1wqtxts1xzle7.cloudfront.net/59030343/Beletsky_21Cent_Cures_Opioids_AJLM_201820190425-110541-5m3qkr-libre.pdf?1556220915=&response-content-disposition=inline%3B+filename%3D21st_Century_Cures_for_the_Opioid_Crisis.pdf&Expires=1773638713&Signature=
Duff, J. H., Lampe, J. R., Rosen, L. W., & Shen, W. W. (2022). The Opioid Crisis in the United States: A Brief History. https://www.congress.gov/crs-product/IF12260
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Kertesz, S. G., & Gordon, A. J. (2019). A crisis of opioids and the limits of prescription control: United States. Addiction, 114(1), 169-180.
Lyden, J., & Binswanger, I. A. (2019). The United States opioid epidemic. In Seminars in Perinatology (pp. 123-131). Wb Saunders.
Staff Writer. (2022). What led to the opioid crisis—and how to fix it? https://hsph.harvard.edu/news/what-led-to-the-opioid-crisis-and-how-to-fix-it/
World Health Organization. (2025). Opioid overdose. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
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