What caused the opioid crisis in the United States?
For context, this is a question I answered on Quora
Blatant marketing fraud that was allowed by the FDA and supported by the medical establishment for nearly 2 decades. This was the only drug epidemic in history that was enabled by public health authorities complicity in a fraudulent marketing campaign that made prescription opioids more potent and prolific than they needed to be creating grey markets for prescription opioid abuse in their wake.
As I mentioned in Who is Dr. Curtis Wright? the FDA suggested placing the fraudulent claim that ‘delayed absorption reduced the liability of abuse’ on the package insert of controlled release oxycodone based solely on their knowledge of the existing controlled release MS Contin (i.e. Morphine Sulfate) that was also produced and marketed by Purdue Pharma. This fraudulent claim formed the backbone of Purdue Pharma’s fraudulent marketing campaign. The FDA had a chance to reign in opioid marketing in 2002, before the worse of the epidemic happened, when they convened an advisory committee of 10 outside experts to make recommendations on oxycodone marketing for common chronic pain conditions. 8 out of 10 outside experts had financial ties to the opioid industry and unsurprisingly advised against narrowing the indication for marketing oxycodone for chronic pain. Since 2006 the FDA has allowed opioid makers to use a highly bias standard of evidence in clinical trials for new formulations called Enriched Enrollment Randomized Withdrawal trials in which participants who do not tolerate opioids well can be eliminated in an open label phase prior to randomization of remaining participants. This became standard practice after opioid industry executives arranged a closed door meeting with FDA officials.
The opioid industry also corrupted professional medical associations such as the AMA and inserted industry bias pseudoscience in both the scientific literature and continuing medical education courses for physicians. As I mentioned in Purdue Pharma Bought the AMA’s Pain Management Education for Physicians this corruption was epitomized in the concept of psuedo-addiction that was proliferated throughout scientific journals on pain management without a shred of evidence outside a dubious 1989 case study. Even though Richard Sackler only sat on the AMA foundation board for 6 years he left a lasting impression through his company’s sponsorship, through industry front groups, of their continuing medical education courses on pain management that inserted industry shills into positions of key opinion leaders to sell chronic opioid therapy as a panacea for pain to AMA accredited physicians and obfuscate the risks of addiction by gaslighting physicians into viewing most opioid seeking behavior as pseudo addiction caused by under treated pain and teaching that under treated pain is tantamount to medical malpractice.
Unlike cannabis, oxycodone and hydrocodone are actual gateway drugs to more lethal opioids such as heroin and fentanyl. The National Institute on Drug Abuse found that between 2002 and 2012, the initiation of heroin use was 19x higher among addicts who reported abusing prescription analgesics. Another survey found that 86% of junkies surveyed between 2008-09 abused prescription opioids obtained from family, friends or legally prescribed to them before moving on to heroin. Historically, heroin was the first step to opioid addiction; 80% of addicts who started abusing opioids in the 1960s started with heroin. This dramatically changed in the 21st century as 75% of addicts who began abusing opioids in the early 2000s started with a prescription opioid. Synthetic opioids are 65-70% of drug overdose deaths and by far the largest contributor to the exponential increase in drug overdose deaths since the turn of the century.
