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Worst Epidemic in U.S. History? Opioid Crisis Now Leading Cause of Death for Americans Under 50

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Drug overdoses are now the leading cause of death for Americans under the age of 50. To put the death toll into perspective, opioid deaths have now surpassed the peak in death by car crash in 1972, AIDS deaths in 1995 and gun deaths in 1993. After 20 years of heavy combat in South Vietnam, U.S. military casualties represented only one-third of the death toll from 10 years of opioid overdoses. Meanwhile, counties and states around the country have filed lawsuits to hold pharmaceutical companies accountable for the public health crisis. "The United States is in the midst of the worst drug addiction epidemic in its history," says Dr. Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. He is also co-founder and director of Physicians for Responsible Opioid Prescribing.

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report, as we turn now to look at the opioid epidemic and a new crackdown by the Trump administration. During a joint news conference with Drug Enforcement Agency officials Tuesday, Deputy Attorney General Rod Rosenstein said drug overdose is now the leading cause of death for Americans under the age of 50.

DEPUTY ATTORNEY GENERAL ROD ROSENSTEIN: This is not a subjective interpretation. People are dying of drug abuses—pardon me, people are dying of drug overdoses in record numbers. We’re not talking about a slight increase. There’s a horrifying surge in drug overdoses in the United States of America. Some people say we should be more permissive, more tolerant, more understanding about drug abuse. I say we should be more honest, and we should be forthcoming with the American people about the clear and present danger that we now face.

AMY GOODMAN: According to Justice Department numbers, 52,000 people died from drug overdoses in 2015. More than half those deaths involved the use of heroin, the synthetic pain medication fentanyl and other opioid drugs. Early numbers for 2016 show the numbers of deaths attributed to drug overdose rose to 60,000. But what has experts most alarmed is the skyrocketing number of deaths since 2011. The health services company Optum published a graph that depicts nationwide deaths from opioids and heroin rose from 1999 to 2014, with a sudden acceleration in the last several years. To put the death toll in perspective, opioid deaths have surpassed the peak in death by car crash in 1972, AIDS deaths in 1995 and gun deaths in 1993. After 20 years of heavy combat in South Vietnam, U.S. military casualties represented only one-third of the death toll from 10 years of opioid overdoses.

Meanwhile, counties and municipalities around the country have filed lawsuits to hold drug companies accountable for the public health crisis. The Ohio attorney general, Mike DeWine, filed a lawsuit against Purdue Pharma, the maker of OxyContin, as well as Teva Pharmaceuticals and Johnson & Johnson, accusing the companies of spending millions on marketing campaigns that, quote, "trivialize the risks of opioids while overstating the benefits of using them for chronic pain." Similar lawsuits have been filed in Washington, New York, Illinois, Mississippi and California.

For more on the epidemic, we’re joined by Dr. Andrew Kolodny, co-director of the opioid policy research at the Heller School for Social Policy and Management at Brandeis University. He’s also co-founder and director of Physicians for Responsible Opioid Prescribing.

Welcome to Democracy Now!, Dr. Kolodny. Can you respond to both the epidemic in opioid use and deaths and also how the Trump administration is proposing to deal with it?

DR. ANDREW KOLODNY: Sure, happy to, and thanks for having me.

The United States is in the midst of the worst drug addiction epidemic in its history. And when I say that, I’m referring to the number of people who are addicted and the number of people dying from overdose deaths. The epidemic isn’t new. It began 20 years ago and has gotten worse every year steadily. But, as you mentioned, since 2011, it’s gotten much worse very quickly.

We have two groups of Americans who have become opioid-addicted over the past 20 years: an older group and a younger group. The older group are people in their forties up through their eighties. Their addiction has developed really almost entirely from medical use of opioids. And the older group has been overdosing on prescription opioids. The younger group, people mostly in their twenties and thirties, are developing their opioid addiction also from prescription opioids, that were used either medically or recreationally or sometimes a combination of both. The younger folks, when they become addicted, they have a hard time maintaining their supply of opioids visiting doctors. And it isn’t that doctors or dentists don’t like to give young people opioids. Unfortunately, we’re pretty comfortable, too comfortable, doing that. But doctors don’t like to give healthy-looking 25-year-olds a large quantity on a monthly basis. So, this younger group, when they become addicted, to maintain their supply, they wind up on the black market. The prescription opioids are very expensive on the black market, so they’ve been switching to heroin. And this switching began, you know, 20 years ago. If the young person was in a region of the country where heroin was available, they switched because it was cheaper. What we’ve seen happen since 2011 is there’s been this very sharp increase in overdose deaths—excuse me—involving these young heroin users, because the heroin supply became much more dangerous. Increasingly, it has fentanyl in it, and fentanyl is many times more potent than heroin. So we’ve seen this sharp rise in deaths in this younger heroin-using group. But up until very recently, we’ve actually seen more deaths in the older group that’s been using prescription opioids.

The response to the opioid crisis from the federal government has been awful. From the very beginning, the federal government was really only focusing on the issue of nonmedical use. If you look at what was coming from the federal government, it was a focus on, you know, kids getting into grandma’s medicine chest. Nobody was really looking at why every grandma now has opioids in her medicine chest. And so, that’s started to change. We’re now seeing more attention on the root of the problem, which is doctors writing too many opioid prescriptions.

Before I answer your question about President Trump, what I will say is that President Obama, I think, really did an awful job. President Obama neglected the opioid crisis until his last year in office. And then, in his last year, he did start to do many of the right things. For example, he sought funding from Congress, a billion dollars in funding, to address the problem. But prior to his last year in office, he wasn’t speaking about it, and he wasn’t seeking funding for this problem. In many ways, I think President Obama’s response to the opioid epidemic was similar to the way President Reagan responded to the AIDS crisis, because Reagan also ignored the AIDS epidemic, wouldn’t speak publicly about it, wouldn’t say the word "AIDS" in public, until his last year in office. And many people believe if Reagan had responded more forcefully to the AIDS epidemic, it might not have gotten as bad as it did.

So, it would have been very easy for President Trump to improve upon President Obama’s performance, but, unfortunately, he’s off to a very bad start. What we’ve seen from the Trump administration has been a lot of talk about the opioid crisis, a commission that he’s formed. And he certainly campaigned on the issue. But we haven’t seen any real action. And the actions that we have seen are potentially harmful. For example, there’s a—the healthcare changes that the administration is proposing could lead to less people being able to have their addiction treatment paid for, which would certainly worsen the opioid crisis. And even though President Trump talked about draining the swamp when he was campaigning for office, what we’ve seen now with his pick for the FDA commissioner, I would say that that’s the opposite of draining the swamp. He’s put at the helm of FDA, the agency that’s supposed to regulate pharmaceutical companies, someone with a history of having worked very closely with the pharmaceutical industry.

AMY GOODMAN: And so, what about the role of Big Pharma, of the drug companies?

DR. ANDREW KOLODNY: Well, the reason we have this epidemic, as I mentioned, is because doctors have been writing too many prescriptions. And that change in the way we treated pain began in the late ’90s. And as the prescribing took off, it led to parallel increases in addiction and overdose death—excuse me.

And so, the reason that the medical community started to prescribe opioids so much more aggressively is that, in many ways, we were responding to a brilliant marketing campaign that was launched initially by Purdue Pharma, the manufacturer of OxyContin, but ultimately other opioid makers would participate in this campaign. And it was a campaign that misinformed the medical community. Doctors, beginning in the ’90s, start to hear that we had been underprescribing opioids, that we were allowing patients to suffer needlessly because of an overblown risk of addiction. We start hearing that when opioids are prescribed for legitimate pain, the risk of a patient getting addicted is extremely low. The statistic that was used was much less than 1 percent of patients will get addicted. And we start to hear that the compassionate way to treat just about any complaint of pain was with an opioid.

And we didn’t just hear this directly from the pharmaceutical company. We heard it from pain specialists eminent in the field of pain medicine. We started to hear it from our professional societies, from our hospitals, from our state medical boards. From every different direction, doctors begin hearing that if you’re an enlightened physician in the know, you’ll understand that opioids are a gift from Mother Nature and should be prescribed much more liberally for patients in pain. And as we responded to this brilliant campaign and as the prescribing took off, it led to a public health catastrophe.

AMY GOODMAN: And then, can you talk about the states and how, from Ohio to New York to Mississippi, states are taking on the drug industry? They’re suing.

DR. ANDREW KOLODNY: Yeah, so we’re now seeing municipalities and states across the country filing lawsuits against opioid makers. And at the heart of these lawsuits, it’s really a claim of false advertising. What these municipalities are saying is that because the opioid makers promoted their medicines for conditions where they’re not safe or effective, but promoted them as safe and effective for these conditions, like low back pain, chronic headache, fibromyalgia—because of that campaign, it led to this very expensive problem, and so now they’re filing these lawsuits.

And these lawsuits are important for two reasons. Of course, the states and municipalities have a very expensive problem they now need to deal with. It’s expensive because treating addiction is expensive. Treating hepatitis C, which has become an epidemic among injection drug users, is expensive. You’ve got children winding up in the foster care system, infants stuck in the hospital very long after they’ve been born, because they have to be treated for opioid dependency. You’ve got this very complicated, expensive problem, and the municipalities need funding to address the problem. And it is sensible for them to seek that funding from the corporations that helped create this mess.

But the litigation is also important because this is a way of trying to keep the opioid makers from continuing to promote their products for common conditions. You know, extended-release opioids, drugs like OxyContin, these are very good medicines for easing suffering at the end of life, but there’s not much of a market in end-of-life cancer pain. The patients won’t be on your drug for very long, because they’re at the end of life. And end-of-life cancer pain is not a common condition. So, all of the opioid makers have been promoting opioids for common chronic pain, and that’s why we’re in this mess.

AMY GOODMAN: What do you say, Dr. Kolodny, to those who question the new focus on treatment for opioid addiction, when African Americans and other people of color have suffered from addiction, particularly heroin addiction, for decades and have been criminalized for it?

DR. ANDREW KOLODNY: Yeah, well, I think they’re correct in questioning that, because during our last two addiction epidemics—the heroin epidemic of the 1970s, the crack cocaine epidemic of the 1980s—those epidemics disproportionately hit low-income, non-white inner-city communities, and what we got from policymakers during those epidemics was a war on drugs, which really meant a war on drug users, and it led to mass incarceration.

Now that we have an epidemic that’s disproportionately white, very much so, we’re seeing a very different response from policymakers, even conservative Republican politicians. When you hear them talk about the opioid crisis, they frequently start off by saying, you know, "We can’t arrest our way out of this. We need to see that people get treatment for their addiction." You didn’t hear that during the heroin epidemic and the crack—of the ’70s and the crack cocaine epidemic. So, you know, to the extent that maybe there is a silver lining to this crisis, I think it is leading to maybe less stigma of addiction and certainly a more enlightened approach to responding to the problem.

AMY GOODMAN: Dr. Kolodny, I want to thank you for being with us. Of course, we’ll continue to follow this. Dr. Andrew Kolodny is co-director of the opioid policy research at the Heller School for Social Policy and Management at Brandeis University.

That does it for our show. I’ll be speaking Thursday night at Walter Reade Theater at Lincoln Center at 6:00 p.m., on Saturday at 9:30 in the morning at McCormick Place and on Sunday at 1:00 at Green Fest at the Jacob Javits Center in New York. You can check our website.

The original content of this program is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License. Please attribute legal copies of this work to democracynow.org. Some of the work(s) that this program incorporates, however, may be separately licensed. For further information or additional permissions, contact us.

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