opioids, opioid epidemic
What to know
Opioids are a broad class of drugs that include natural opioids like morphine; semi-synthetic opioids such as heroin, oxycodone, and hydrocodone; and synthetic opioids such as fentanyl and carfentanil. There are many brand-name opioid medications such as OxyContin, Percocet, and Vicodin. Today, a doctor might prescribe opioids to patients recovering from an accident or injury, during or after surgery (such as a colonoscopy, childbirth, or appendectomies), for palliative care, or for cancer-related treatment. Opioids are still routinely and safely used for these purposes. Because of their role treating pain, the World Health Organization has designated many opioids as essential medicines.
In 2022, the Centers for Disease Control and Prevention updated clinical guidelines on prescribing opioids for pain to take into account their potential for misuse and dependency, emphasizing that opioids should not be the go-to treatment for pain. The CDC also recommends addressing clinician bias and longstanding health disparities in pain treatment between white and nonwhite patients.
If not used as prescribed, all opioids carry a risk of physical and psychological dependence, tolerance, opioid addiction (opioid use disorder), overdose, and overdose death. Risk factors that can increase the risk of developing an opioid addiction include previous or family history of drug or alcohol misuse, use of opioids at an early age, sexual abuse, and mental health disorders, but the long-term use of opioids by any patient increases risk.
opioid epidemic
The opioid epidemic began in the 1990s when pharmaceutical companies started aggressively marketing highly addictive opioids. A prominent example is OxyContin (oxycodone), which the US Food and Drug Administration approved in 1995 as an extended-release tablet that was said to be safer and less addictive than other opioids. The maker of OxyContin, Purdue Pharma, provided no clinical studies on the risks of addiction potential, and marketed the drug misleadingly, disguising that it was more potent than any other opioid on the market. Analyses have also found that the Food and Drug Administration played a part in exacerbating the epidemic by improperly enforcing provisions of the Food, Drug, and Cosmetic Act that require manufacturers to prove the safety and efficacy of their products before being able to market them.
As Patrick Radden Keefe writes in “Empire of Pain,” Purdue “funded research and paid doctors to make the case that concerns about opioid addiction were overblown, and that OxyContin could safely treat an ever-wider range of maladies.” At around the same time, the American Pain Society introduced the “pain as the fifth vital sign” campaign and began pushing the idea that pain was an untreated epidemic. By the early 2000s, so-called pain clinics, or “pill mills” — facilities that existed for the express purpose of distributing opioids, often illegally and for nonmedical use — sprang up across the country, and other pharmaceutical companies began to push their own opioids. According to the Centers for Disease Control and Prevention, the number of deaths from opioid overdoses more than tripled from 1999 to 2006.
In 2011, the CDC officially declared a prescription painkiller epidemic. In 2017, in response to increasing overdose deaths involving opioids, the Department of Health and Human Services declared a public health emergency. In 2022, it was estimated that around 6.1 million Americans ages 12 and older had an opioid use disorder. In 2023, an average of 217 Americans died each day from an opioid overdose.
The Sackler family is largely recognized as the face of the opioid crisis, as many members at one point held positions of leadership within the now-dissolved Purdue Pharma and made billions from OxyContin sales. They blamed patients for opioid use disorder and refused to admit the drug was addictive, offering gifts and kickbacks and ignoring safety concerns. Multiple courts have found companies including Purdue and Johnson & Johnson liable for “intentionally play[ing] down the dangers and over[selling] the benefits of opioids.” As of 2023, settlements in opioid cases were over $50 billion. In June 2025, a $7.4 billion court settlement with Purdue Pharma was approved by attorneys general in 55 states and territories that would make payouts over the next 15 years. This is an evolving story and requires same-day fact-checking on the current status to ensure accuracy.
treatment
Opioid addiction is defined as a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. According to the American Society for Addiction Medicine, “Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.” Opioid addiction can be diagnosed by a trained professional, generally when someone has two or more symptoms (pharmacological factors, risky use, social impairment, impaired control), and can range from mild to severe. Opioid addiction is treatable with FDA-approved medications such as methadone, buprenorphine, or naltrexone, and treatment may include other elements such as behavioral therapy.
Despite the proven effectiveness of these treatments, access varies according to factors such as geographic area, socioeconomic status, and race or ethnicity. Some experts point out that states and cities could do more to incentivize health care providers to prescribe buprenorphine, which is less tightly regulated than methadone. There can be stigma associated with this type of treatment; careful language choice (for instance, using person-first language and explaining the scientific evidence in favor of the treatment) can help avoid reinforcing this stigma. Treatment with these drugs is often referred to as “medication-assisted treatment,” though critics of the term suggest it can also reinforce stigma by seeming to put this in a separate category from other treatments involving medication (such as cholesterol-lowering drugs). Alternative phrasing would be to simply call it treatment for opioid use disorder.
The FDA has approved the opioid overdose reversal drug naloxone for over-the-counter sales, but other interventions including fentanyl test strips and safe injection sites are not fully legal or widely accepted in the US. Training more clinicians and hospitals in substance use disorder and its treatment could help combat the stigma around addiction and its treatment. Advocates hope that the more than $50 billion from opioid case settlements will be used effectively for efforts such as treatment, education, and social services, but allocation and oversight vary widely by state and locality.
In coverage of opioid use, misuse, and addiction, it may be beneficial to readers to offer links or callouts to resources, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline: 1-800-662-HELP (4357).
media coverage
Much media coverage of the opioid epidemic has focused on its effects on rural, white communities, which were flooded with prescription opioids early on. But in 2020, fatal drug overdoses of Black Americans surpassed those of white Americans for the first time since 1999. Racism within health care settings continues to pose major barriers — white Americans have better access to opioid use disorder treatment. Native tribes have suffered disproportionately high rates of OUD and fatal overdoses; American Indian and Alaska Native people experienced some of the highest rates of fatal overdoses in 2019-2020 compared to other racial groups, with only rates for Black Americans being higher.
Media coverage of the opioid epidemic and opioid use disorder can often stigmatize those who use opioids to deal with chronic pain and suggest a dichotomy of “good” people following medical advice and “bad” people using drugs illegally, which can often have racist connotations. Careful coverage will stay away from stigmatizing drug use or pain management techniques, avoid stereotypes of who is at risk of an opioid use disorder or how it might manifest, account for the role of industry and deceptive marketing practices in creating conditions for addiction, and treat addiction like any other disease rather than blaming the individual. When covering the opioid epidemic’s impact on historically underserved communities, it’s important to note that over-focusing on negative outcomes like addiction and death, without offering greater context and ideas for solutions, can contribute to harmful stereotypes and preclude hope.
Additional resources
- Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 (Centers for Disease Control and Prevention)
- Opioid Treatment Program Directory (Substance Abuse and Mental Health Services Administration)
- Rx Pain Medications Know the Options, Get the Facts: Managing Your Pain – Which Approach is Right for You? (Substance Abuse and Mental Health Services Administration)
- Addiction Medicine Checklist (Centers for Disease Control and Prevention)
- National Opioids Crisis: Help and Resources (US Department of Health and Human Services)
- Understanding the Opioid Overdose Epidemic (Centers for Disease Control and Prevention)
- Drug Overdose Death Rates (National Institutes of Health)
- NIH launches harm reduction research network to prevent overdose fatalities
- Opioid Overdose Tracker (National Emergency Medical Services Information System)
- Recovery and Recovery Support (Substance Abuse and Mental Health Services Administration)
- Overdose Epidemic Report (American Medical Association)
Summary
Opioids are a broad class of drugs that include natural opioids like morphine; semi-synthetic opioids such as heroin, oxycodone, and hydrocodone; and synthetic opioids such as fentanyl and carfentanil. The opioid epidemic began in the 1990s when pharmaceutical companies started aggressively marketing highly addictive opioids. It is now the biggest drug epidemic in US history. Much media coverage of the opioid epidemic has focused on its effects on rural, white communities, but in 2020, fatal drug overdoses of Black Americans surpassed those of white Americans for the first time since 1999. Racism within health care settings continues to pose major barriers — white Americans have better access to opioid use disorder treatment. Careful coverage of opioids and the epidemic will stay away from stigmatizing drug use or pain management techniques, avoid stereotypes of who is at risk of an opioid use disorder or how it might manifest, account for the role of industry and deceptive marketing practices in creating conditions for addiction, and treat addiction like any other disease rather than blaming the individual. It’s important to note that over-focusing on negative outcomes like addiction and death, without offering greater context and ideas for solutions, can contribute to harmful stereotypes and preclude hope.