The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse or abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates or opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.
Opioids are a diverse class of moderate to strong painkillers, including oxycodone (commonly sold under the trade names OxyContin and Percocet), hydrocodone (Vicodin, Norco), and fentanyl (Abstral, Actiq, Duragesic, Fentora), which is a very strong painkiller that is synthesized to resemble other opiates such as opium-derived morphine and heroin. The potency and availability of these substances, despite the potential risk of addiction and overdose, have made them popular both as medical treatments and as recreational drugs. Due to the sedative effects of opioids on the respiratory center of the medulla oblongata, opioids in high doses present the potential for respiratory depression and may cause respiratory failure and death.
Opioids are highly effective for treating acute pain, but there is strong debate over whether they are suitable for treating chronic or high impact intractable pain, as the risks may outweigh the benefits.
North America United States
From 1999 to 2021 it is estimated 645,000 Americans have died from opioid use. The number of overdose deaths involving opioids in 2021 was ten times what it was in 1999. What the U.S. Surgeon General dubbed "The Opioid Crisis" was theorized to have been caused by the over-prescription of opioids in the 1990s, which led to the CDC Guideline for Prescribing Opioids for Chronic Pain, 2016 and the resulting impact on medical access to prescription opioids "outside of active cancer treatment, palliative and end of life." Opioids initiated for post-surgical pain management have long been debated as one of the causative factors in the opioid crisis, with misuse/abuse estimated at 4.3% of people continuing opioid use after trauma or surgery.
When people continue to use opioids beyond what a doctor prescribes, or when opioids are over-prescribed, whether to minimize pain or induce euphoric feelings, it can mark the beginning stages of an opiate addiction, with a tolerance developing and eventually leading to dependence, when a person relies on the drug to prevent withdrawal symptoms. Writers have pointed to a widespread desire among the public to find a pill for any problem, even if a better solution might be a lifestyle change, such as exercise, improved diet and stress reduction. Opioids are relatively inexpensive, and alternative interventions, such as physical therapy, may not be affordable.
In 2017, around 100 million people or a third of the U.S. population was estimated to be affected by chronic pain at any given time. This led to a push by drug companies and the federal government to expand the use of painkilling opioids. In the 1990's, initiatives like the Joint Commission began to push for more attentive physician response to patient pain, referring to pain as the fifth vital sign. This exacerbated the already increasing number of opioids being prescribed by doctors to patients.
Between 1991 and 2011, painkiller prescriptions in the U.S. tripled from 76 million to 219 million per year. In 2016, more than 289 million prescriptions were written for opioid drugs. This was exacerbated by the aggressive and misleading marketing of drug makers, e.g. Purdue Pharma. Purdue trained its sales representatives to convey to doctors that the risk of addiction from OxyContin was "less than one percent."
Mirroring the growth of opioid pain relievers prescribed was an increase in the admissions for substance abuse treatments and opioid-related deaths. This illustrates how legitimate clinical prescriptions of pain relievers were diverted through an illegitimate market, leading to misuse, addiction, and death. With the increase in volume, the potency of opioids also increased. By 2002, one in six drug users were being prescribed drugs more powerful than morphine. By 2012, the ratio had doubled to one in three. The most commonly prescribed opioids have been oxycodone and hydrocodone.
The epidemic has been described as a "uniquely American problem". The structure of the US healthcare system, in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies. According to Professor Judith Feinberg in 2017, "Most insurance, especially for poor people, won't pay for anything but a pill." Prescription rates for opioids in the US are 40 percent higher than the rate in other developed countries, such as Germany or Canada.
While the rates of opioid prescriptions increased between 2001 and 2010, the prescription of non-opioid pain relievers (aspirin, ibuprofen, etc.) decreased from 38% to 29% of ambulatory visits in the same time period, and there has been no change in the amount of pain reported in the U.S. This has led to differing medical opinions, with some noting that there is little evidence that opioids are effective for chronic pain not caused by cancer. In the years preceding 2024, access to prescription opioids tightened somewhat as safety-related prescribing guidelines were enhanced.Nguyen, D., Javaheri, J., & Han, V. (2025). National Trends in Opioid Prescription Spending Among Medicaid and Medicare Part D Recipients. The Annals of Family Medicine, 23 (Supplement 1), 7940. https://doi.org/10.1370/afm.23.s1.7940
The opioid epidemic affects women and men differently. For instance, women are more likely than men to report recent and non-recent prescription opioid use. Women are also more likely to have chronic pain than men are. In cases of domestic abuse and rape, women are prescribed pain medicine more than men. During pregnancy, women may use prescription opioids to help with pregnancy pain, especially with post-pregnancy pain. The number of women who died from opioid pain relievers increased 5 times from 1999 to 2010. To help stop the spread of opioid abuse in women, it is advised that women are educated on the drugs that they are taking and the possible risk of addiction. Alternatives should always be used when possible in order to prevent addiction.
Most research gone into understanding the epidemic is mostly focused on females, specifically anticipated mothers. Women are at the greatest risk for opioid addiction compared to men. Usually, opioid misuse in women stems from unused prescription drug hoarding, the dependence of the drugs and higher pain levels compared to men. Women are less likely to report opioid misuse in contrast to the male population. Analyzers of the epidemic stress that their main concern is the female victims, and studies tend to neglect the male population, when over 70% of prescription drug intake and overdose, happen to males.
Adolescents can become easily addicted to opioids. Even before their teenage years, children go through the rapid growth of their reward center, the Mesolimbic pathway. The development of the Mesolimbic pathway allows children to be easily satisfied by small rewards to encourage learning, motivation, and acceptable behavior. This growth peaks in their adolescent years, and they start to feel a need for larger, more meaningful rewards, such as psychoactive substances which produce reward signals through direct receptor binding. Teens have an underdeveloped prefrontal cortex which governs impulse control and decision making. The combination of underdeveloped prefrontal cortex and a rundown reward system can lead to adolescents with addictive seeking behaviors and higher susceptibility to the neurological changes developed in substance use disorder (SUD). The Centers for Disease Control and Prevention estimates that In 2018, over 53 million people aged 12 years and older in the United States, reported the misuse of prescription drugs.
A 2020 review of the opioid epidemic in pediatrics stated that there were 4,094 opioid overdose deaths in people ages 14–24 in 2017. Teens commonly use opioids as recreational drugs, instead of what they are supposed to be used for, pain management. Centers for Disease Control and Prevention says that for every opioid death of a teen there are 119 emergency visits and 22 treatment admissions related to opioid abuse. Half a million teenagers in 2014 were reported as non medically prescribed opioid users and a third of those as having a substance use disorder (SUD).
Family is widely discussed as an influence for factors affecting adolescent opioid misuse behavior and in the treatment of adolescent opioid misuse. Family involvement has been shown to be effective in decreasing substance use in adolescents by addressing family risk factors that may be contributing to an adolescent's substance use. Easy accessibility is a risk factor. The late 1990s, increases in opioid recommendations from pharmaceutical companies created an abundance of prescription painkillers in adult households. If family members are taking opioids for pains or have taken them in the past and did not dispose of them correctly or do not protect them properly, it can make it easy for adolescents to get their hands on them.
Proper disposal of these drugs is crucial to reducing adolescent misuse. A national insurance cohort reviewed almost 90,000 opioid prescribed patients, 13–21 years old, and found that 5% continued to fill their prescription 90 days or more after surgery. Medicine take-back programs are the most recommended and regulated disposal method by the United States Drug Enforcement Agency, although, it is not guaranteed that the prescribed patient will comply with this recommendation. There are eight different at-home drug disposal products on the market but none of them is federal agency approved or in the process of being evaluated. The main concern of proper opioid disposal is trash and sewage disposal that create pharmaceutical pollution and still grants access for adolescents with substance use disorders.
Youth are at a heightened risk of developing opioid addictions, and treating youth opioid use disorder is more difficult than it is for older individuals. A systematic review of the epidemiological literature has found that adolescents and young adults consistently have shorter retention times in medication treatments for opioid use disorder than do older adults. This is why it is important for schools to implement effective strategies and programs to teach young children about the dangers and consequences of opioid misuse. Although the retention time of adolescents is much lower than adults, educating them from a younger age on opioid misuse should help keep children away from these drugs.
In 2018, there was a lack of appropriate treatments and treatment centers across the nation. In 2018, big cities like New York City were lacking in treatment services and health offices as well as small rural areas. Another reason the opioid epidemic is hard to combat is due to available housing being limited to recovering addicts. Having limited housing makes it easy for recovering substance users to return to the environments and relationships that promoted drug misuse.
Jobs for recovering addicts can be difficult to find. Individuals with substance use disorders that have criminal records have a more difficult time finding jobs once they leave recovery. Having to combat job insecurity can lead to stress, which can cause someone to relapse. "Wraparound services", or programs that provide services for patients who have just come out of rehabilitation centers or programs, are rare to non-existent, and are a contributing reason as to why the opioid epidemic has gone on for so long.
Public policy response