Killing More than Pain: Etiology and Remedy for an Opioid Crisis

The search for effective pain relief has been ever present across human history. The discovery of opium’s ability to relieve pain stimulated the refinement of opium and generation of synthetic analogues to create more effective, potent, and faster-acting analgesics. The social and economic value of opioids has remained high not only due to their demonstrated efficiency in mitigating pain but also their noteworthy ability to reliably produce rewarding psychological effects. Consequently, at various times during the past several hundred years, opioids have sparked wars, fueled black markets and cartel crime, and triggered numerous opioid addiction and overdose death epidemics around the world. The increased therapeutic desire to address pain together with pharmaceutical discoveries in medication design, rapid manufacture, and highly effective opioid marketing and distribution has led more recently to increased availability and accessibility to potent prescription opioids, which has sparked the deadliest overdose crisis in human history. This chapter describes the etiology and epidemiology of the opioid crisis using public health and Health Belief Model frameworks and reviews approaches that have been applied to address supply (e.g., overprescribing) and demand (e.g., medication treatments) sides of the equation. Causes of the growth and spread of the overdose epidemic are analyzed as a way to inform a successful end to the current crisis as well as to prevent future epidemics.