The U.S. Opioid Crisis: How Did We Get Here?

Photo by Volodymyr Hryshchenko on Unsplash

Written by: Michael Weaver, MD, DFASAM

In the 1990s, there was a concerted effort in the United States to address pain as “the fifth vital sign,” while at the same time newer long-acting opioid analgesics such as extended-release oxycodone and transdermal fentanyl became available and accepted for use in the treatment of more than just cancer pain. Physicians became more comfortable prescribing more opioid analgesics to patients and pharmacies began to stock more of them. Pharmaceutical companies marketed these new opioid medications to physicians with a large sales force and lavish dinners.

Some areas of the U.S. were disproportionately affected by the prescription opioid addiction epidemic. The population in these parts of the country has traditionally engaged in occupations involving industrial manual labor such as coal mining, railroad workers, and other mechanical factory jobs. These predominantly blue-collar workers may suffer job-related traumatic injuries or develop chronic pain.

The large proportion of persons with chronic pain who received chronic opioids led to more opioids being available for diversion from patients and pharmacies. Because easily available illicit drugs were scarce in these rural communities, young users turned to what was readily available: prescription opioid analgesics. High rates of prescription opioid abuse in these rural areas received national attention, resulting in the nickname “Hillbilly heroin” for abused extended-release oxycodone.

More recently, those who were already addicted turned from prescription opioids to heroin, which is riskier, but became easier to obtain than prescription opioids. The demand for more heroin has led to mixing it with more powerful opioids such as fentanyl, and even more potent analogues, which have been responsible for the continuing rise in opioid overdose deaths in the U.S.

Want to learn more about the origins of the opioid epidemic and how this is being addressed locally as well as nationally? Michael Weaver, MD, DFASAM, will go over all this in his lecture ““The U.S. Opioid Crisis: How Did We Get Here?” at the 11th Annual Psychiatry Update on the topic of Substance Use Disorders: Opioids & Beyond.

For a full list of speakers, topics, and to register, visit