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OPTIC Commentary

Want to Know If a New Drug Crisis Is Growing? Check the Wastewater
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.

All OPTIC Commentary

Illegal Opioids Are Hurting Too Many of Us. We Need a New Approach
Fatal overdoses are on the rise in the United States, with the proliferation of potent, synthetic opioids like illicit fentanyl. But deaths are just the tip of America's iceberg-sized opioid crisis. To save and improve lives, policymakers will need to take a holistic approach. People who use opioids and their families should be at the heart of this new response.
Mar 16, 2023
State of the Union 2023: Insights from RAND
In his second State of the Union address, President Joe Biden covered a wide range of issues facing the United States at home and abroad, including police violence, gun policy, Russia's war in Ukraine, and U.S. competition with China.
Feb 8, 2023
Synthetic Opioids Are an Everything Problem
Illegally manufactured synthetic opioids have accelerated the opioid crisis. These drugs have created new challenges across a wide range of policy areas. That's why this crisis warrants new strategies and a comprehensive response.
Jun 9, 2022
Fentanyl Makes an Already Dangerous Drug Market Deadlier Than Ever
Failure to recognize and respond to how rapidly illegal drug markets have changed with the arrival of illegally manufactured synthetic opioids will continue to put many Americans at risk of exposure to fentanyl, endangering the lives of hundreds of thousands more for years to come.
May 2, 2022
A Greater Focus On Harm Reduction Will Save Lives
For decades, elected officials brushed off harm reduction as a viable option for reducing the harms of drug use over concerns of enabling drug consumption. But now, these strategies are front and center, spoken aloud, from the largest podium in the land, and during prime time. What caused this historic about-face?
Apr 29, 2022
A New and More Dangerous Drug Market Requires a New Approach
Synthetic opioids are likely to increasingly reach illegal drug markets. Failure to recognize and respond to how rapidly drug markets have changed with the arrival of illegally manufactured synthetic opioids will continue to put many at risk of exposure to fentanyl, endangering the lives of hundreds of thousands more Americans for years to come.
Mar 16, 2022
Australia Contained COVID-19 Early On. Can It Do the Same with Synthetic Opioids?
Australia is at risk of a fentanyl problem, but it is better prepared than North America. If the country can make the same kind of concerted effort it did to keep COVID-19 at bay, that could save thousands of lives.
Apr 30, 2021
Policies That Punish Pregnant Women for Substance Use Don't Help Mother or Baby
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.
Jan 28, 2020
Fentanyl: The Most Dangerous Illegal Drug in America
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.
Jan 13, 2020
Where Science Says to Spend Any U.S. Opioid Settlement Money
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.
Dec 19, 2019
What Will the Opioid Crisis Look Like in Five Years?
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.
Nov 18, 2019
Synthetic Opioid Crisis Still Growing, Often Among Unwitting Users
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.
Oct 14, 2019
Tackle Fentanyl like a Poisoning Outbreak, Not a Drug Epidemic
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.
Sep 3, 2019
China's Ban on Fentanyl Drugs Won't Likely Stem America's Opioid Crisis
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.
May 22, 2019
A Holistic Approach to Solving the Opioid Crisis
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.
Apr 15, 2019
(Grey's) Anatomy of an Opioid Crisis
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.
Apr 8, 2019
Opioid-Dependent Newborns in My West Virginia Hometown Point to a Path Out of Drug Crisis
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.
Mar 6, 2019
Opioids and a Crisis of Unintended Consequences
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.
Feb 20, 2019
In Opioid Policy, One Size Does Not Fit All
To solve America's opioid crisis, policymakers will need to view the epidemic as an “ecosystem,” where policies that target only one part of the problem can have unintended consequences.
Oct 12, 2018

Researcher Spotlight

Rosanna Smart

Codirector, RAND Drug Policy Research Center

Rosanna Smart is an economist at the RAND Corporation, codirector of the RAND Drug Policy Research Center, and affiliate faculty of the Pardee RAND Graduate School. Her research is in applied microeconomics, with a focus on issues related to health behaviors, illicit markets, drug policy, and…
Bradley D. Stein

Director, Opioid Policy, Tools, and Information Center (OPTIC)

Bradley Stein (he/him) is director of the NIH-funded RAND-USC Schaeffer Opioid Policy Center and a senior physician policy researcher at the RAND Corporation. A health services and policy researcher and practicing child and adolescent psychiatrist, Dr. Stein's research focuses on better…

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