Few people foresaw how quickly fentanyl would displace heroin, doubling or tripling opioid overdose deaths in some pockets of the United States from 2013 to 2017. But we could have been warned—if only we'd checked our wastewater.
About half of all U.S. states now have policies that criminalize substance use during pregnancy, consider it grounds for civil commitment, or consider it child abuse or neglect. But research suggests that punitive policies aren't beneficial for infants or their mothers.
America's fentanyl crisis is unlike previous drug epidemics and is likely to get worse. Deaths involving fentanyl and other synthetic opioids have surged from around 3,000 in 2013 to more than 30,000 in 2018. Solving the problem requires innovative approaches and unprecedented resources.
A global settlement with pharmaceutical companies has started to appear more and more likely. Even with billions of dollars, the settlement resources won't be unlimited. To avoid mistakes made in the tobacco master settlement agreement, any opioid funds must be carefully allocated.
Despite variations in European opioid markets, there is an overarching commonality too: Once a synthetic opioid like fentanyl becomes dominant, it stays that way. The United States should prepare for fentanyl and other synthetic opioids as a lasting phenomenon. Learning from other countries' experiences is an important part of that effort.
Although opioid prescriptions in the U.S. have fallen, opioid overdose deaths remain at historic levels. The continued spread of fentanyl and other illicitly manufactured synthetic opioids suggests the problem could still get worse.
America's fentanyl problem is far deadlier than past crises with other illegal drugs. New ideas, be they public policies, technologies or law enforcement strategies, are desperately needed. Continuing to treat fentanyl just like previous drug epidemics will likely be insufficient and may condemn thousands more to early deaths.
Given China's recent decision to ban the unauthorized manufacture of fentanyl, authorities there appear to recognize a growing problem. But China cannot solve the U.S. opioid problem. The United States could do more to reduce demand for opioids as well as drug users' exposure to these powerful drugs.
While federal, state and, local governments deploy strategies to tackle the opioid crisis, the problem continues to proliferate. RAND researchers suggest that these strategies fail to solve the larger problem because they've largely been developed in silos. The opioid crisis is an ecosystem, and mitigating the problem will require a holistic approach.
More than 130 Americans die every day after overdosing on opioids. So when one of the most popular shows on TV made opioid misuse a major plotline, RAND experts paid attention to how it presented this public health crisis. The show mirrored reality pretty closely, for the narrow slice of the opioid crisis it addressed.
In small, rural towns like Bluefield, West Virginia, economies are hurting, the opioid epidemic is growing, and together they are taking a toll on a surprising population: pregnant women and their babies.
The pain medicine OxyContin was reformulated in 2010 to make it more difficult to crush or dissolve. But this had unintended consequences, including a rise in hepatitis C infections as drug abusers switched from taking OxyContin to injecting heroin.