How the crackdown on Opioids created the Heroin Addiction Crises

Opioids and unintended consequences

As Congress looks for more ways to address the opioid epidemic, one subset of policy changes is focused on making prescription painkillers harder to abuse — limiting the number of pills in a prescription, for example. But that approach hasn't necessarily worked in the past and may have had some unintended consequences, according to a new working paper published by the National Bureau of Economic Research. Between the lines: There have been three distinct phases in this crisis: Deaths from abuse of prescription painkillers rose steadily from 2004–2010 — the first phase. The second phase began in August 2010, when the pace of opioid-related deaths started to flatten out and heroin deaths surged. The working paper attributes that to the August 2010 reformulation of OxyContin — a leading prescription painkiller. Those changes made the drug harder to abuse, but "each prevented opioid death was replaced with a heroin death," the paper says. Adapted from Evans et. al., 2018,  "How the Reformation of OxyContin Ignited the Heroin Epidemic", The National Bureau of Economic Research; Note: "Opioids" includes all opioid related deaths aside from those that are exclusively attributed to heroin; Chart: Axios Visuals Federal data indicates that we're now in a third phase, in which deaths from illegal synthetic opioids like fentanyl are skyrocketing, and have even outpaced heroin. That trend began in about 2013. Why it matters: As my colleague Caitlin Owens explains in more detail, this is a poignant illustration of why this crisis has been so hard to solve. It also helps explain why public health experts are so adamant that Congress should be pumping more money into treatment. Cracking down on the supply of drugs is important, but when people can easily switch from one drug to another, treating the underlying addiction may have a bigger impact.

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