Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA.
Departments of Pharmacology, Yale School of Medicine, New Haven, CT USA.
Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT USA.
Departments of Pediatrics, Yale School of Medicine, New Haven, CT USA.
The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication. This led to massive diversion of prescription opioids into illicit markets. A peculiar tragedy is that many health professionals prescribed opioids in a misguided response to legitimate concerns that pain was under-recognized and undertreated. The crisis grew not only from over-prescribing, but also from other sources, including a lack of research into non-opioid pain management, ethical lapses in corporate marketing, historical stigmas directed against people who use drugs, and failures to deploy evidence-based therapies for opioid addiction and to comprehend the limitations of supply side regulatory approaches. Regulations that restricted opioid prescribing perversely accelerated narco-trafficking of heroin and fentanyl with consequent increases in opioid overdose mortality As injection replaced oral consumption, outbreaks of hepatitis B and C virus and HIV infections have resulted. This viewpoint explores the origins of the crisis and directions needed for effective mitigation.