The leading cause of death for Americans younger than 50 is drug overdose, and in 2016, 40 percent of those overdose deaths were linked to prescription opioids, according to the Centers for Disease Control.
The number of prescriptions for opiate-based drugs quadrupled from 1999 to 2010, and deaths from prescription opioid overdoses have seen a parallel increase. Hundreds of cities, states, municipal agencies and counties-including Miller County, Ark., and Bowie County, Texas-have joined or filed lawsuits accusing Big Pharma of creating the problem.
The suits allege that pharmaceutical manufacturers and distributors employed nurses and doctors to engage in "white coat marketing" to downplay the dangers prescription opioids pose. Doctors who once were leery of handing out repeated prescriptions for patients involved in lengthy recoveries or suffering from chronic pain were duped into believing opioids were a viable, safe medical solution, the suits allege.
Instead, the opioid crisis was born.
In 2006, 54.2 opioid prescriptions were written per 100 Miller County residents. Six years later, that number had more than doubled to 134.3, according to the CDC.
Prescribing rates began to increase in the late 1990s and peaked in 2010, information from the CDC shows. In 2015, the number of opioids prescribed was enough for every American to be medicated around the clock for three weeks.
"This just didn't happen in the past year or two. I've seen a shift from street drugs to pharmaceuticals as long as 10 years ago when I was still a prosecutor," said Carlton Jones, an Arkansas Circuit Judge who serves Miller and Lafayette counties and presides over a drug court.
"In any of the evaluations that we do to initially assess a drug court participant, 50 percent are abusing prescriptions," Jones said.
Jones said prescription drug abuse is particularly tricky for probation and parole officers to manage in the populations they supervise when the drug user has a legitimate prescription for opiates or benzodiazepenes, another widely misused class of drugs.
"We have to get the doctors on board," Jones said.
Drugs that treat pain-be it physical or emotional-are often abused, Jones said.
"The professionals tell us meth is the hardest to kick," Jones said. "But opioids are probably right behind it."
Addiction often drives criminal behavior. Officials with the Bowie County Community Supervision and Corrections Department, commonly referred to as probation, estimate that roughly 42 percent of the women participating in residential treatment through the Bowie County Women's Center report having abused prescription opioids.
Bowie County Chief Probation Officer Terri Giles and Jones said it is difficult to assign a hard number to the cost of opioid abuse in the criminal justice system. Many whose criminal behavior is motivated by addiction are polysubstance abusers. An offender convicted of theft may be stealing because they've lost their job related to a prescription drug problem and not have an arrest that is clearly drug-related.
Bowie County Judge James Carlow said the county has seen an increase locally in indigent, mental health and jail populations of individuals for whom opioid abuse is a serious problem. Bowie County Auditor William Tye said the county budgets more than $1 million annually for indigent health care. That figure includes all expenses related to the medical care of inmates and the county's indigent, not just for opioid addiction, but officials say there is no denying the financial impact the epidemic of prescription abuse has had.
Businesses lose money when employees miss work or produce less because of an opioid abuse problem. Health insurance costs increase when the addicted require treatment. Addicts who lose their jobs because of opioid abuse can no longer support their families, putting a strain on government assistance programs. Addicts don't always make good parents, and the involvement of child protective agencies and law enforcement can be required.
The lawsuits filed against Big Pharma seek to recoup some of that and to force the companies to change the way they do business. Many of the suits, including one filed by Bowie County, have been moved to a federal court in Ohio for management as a multidistrict litigation.
The rippling effects of opioid abuse have led the U.S. Council of Economic Advisers to estimate the expense to the 2015 U.S. economy at more than $500 billion. In comparison, the price tag for the 16 weather disasters of 2017, including Hurricane Harvey, is estimated at $306 billion.
If you or someone close to you needs help for a substance abuse disorder, talk to your doctor or call the Substance Abuse and Mental Health Services Administration at 800-662-HELP. If you are looking for treatment, visit the SAMHSA's Behavioral Health Treatment Services Locator online.