Preventable drug overdose deaths are one of leading causes of death in the United States, with the number of deaths increasing by 58 percent between 2019 and 2021.
Opioids — both illicit and prescription — have led to 77 percent of all preventable drug overdose deaths, totaling 75,785 in 2020, according to data from the National Safety Council.
Becker's recently connected with Arthur Robin Williams, MD, to discuss the history of the opioid epidemic and how public perception has changed. Dr. Williams is an assistant professor of clinical psychiatry on substance use disorders at Columbia University in New York City and chief medical officer of Ophelia, a virtual OUD treatment provider.
Note: Responses have been edited for clarity and brevity.
Question: There has been a recent increase in media portrayals of the opioid crisis. What should the general public know about this epidemic that isn't included in these portrayals?
Dr. Arthur Robin Williams: The media, I would say, has had a very selective and simplistic portrayal of the opioid crisis… The point is that the country has had a very difficult time. You overlay COVID and the overdose rates are really high. Purdue can try to sell as many pills as they want, but they're only gonna sell them if there's demand, and the country has had an incredible amount of demand in the last 10 or 20 years. I think the simplistic part of the narrative that the media overlooks is that the prescribers and pharmacies were eager to write and dispense these pills, but ultimately, it's because people wanted to get them.
Q: What are some of the underlying factors and demographics that could make a person more prone to opioid addiction?
AW: There's a couple parts of this. First of all, one of the observations of epidemiological research in the U.S. is that white patients were much more likely to be prescribed opioids. I'm in New York City [and] I've worked with a bunch of city and state agencies over the last 10 years and if anything, there was a disinterest in some ways, and in some quarters for working on the opioid crisis, because it was perceived as a wealthier, wider issue, and not something that was really affecting the whole country. It's really sad, because of course, now the rate of overdose is skyrocketing among Black and brown populations, and a lot of that is actually fentanyl and the cocaine supply, in the drug supply more broadly. But the point is that a lot of the prescribed opioids in the aughts, so through 2010 or so, was among white populations, and that really shifted around 2010, which is when heroin became the No. 1 cause of death among overdose-involved fatalities, rather than pills. It was a shift from prescription opioids to the black market, so there were in some ways very well described trends in prescribing patterns that was wrapped up in all this, but it is big enough that it's gotten worse on its own.
Q: What is the difference in public perception for someone who may be addicted to opioids via prescription pills versus those who are addicted to drugs through dealers or the black market?
AW: I'm an addiction psychiatrist, I see my own patients in New York City. I teach all the med students and residents in my faculty at Columbia. One point I always emphasize is that this is not our first opioid crisis or opioid addiction, it's the third. The first one was the opium epidemic in the late 1880s to early 1900s, which is part of what spawned the Harrison Narcotic Act in 1914. The second one was the heroin epidemic in the 60s and 70s, which led to methadone programs. Now we're in this third opioid crisis since the late 90s, with OxyContin [and] prescription opioids that has kind of turned into this whole other thing. If you look at the U.S., just like most countries, a lot of people use drugs. … Drug policy has been a way to target and stigmatize minority groups. With prescription opioids, like with OxyContin, we sort of slept through this in a way. I was in college and med school, in the aughts, and very much aware that we were in the middle of an opioid epidemic. This was the George W. Bush administration, no one was talking about it and the people in the field were very much aware of what was happening. It was prescriptions to relatively middle class, upper class people, and there wasn't the alarm. And then, not a surprise, everything shifted toward the black market because it's cheaper and stronger over the last twenty years. Unfortunately, we're in this era where the drug supply is so lethal – we've never encountered this ever, in the history of the U.S. So there's plenty of stigmatization, but prescribed or non-prescribed, I think we're in a new world in terms of drugs and just how dangerous everything is.
Q: What action is being taken in the United States to address the recent increase in danger in the drug supply?
AW: The Drug Enforcement Administration came out with a campaign [a few] years ago called "One Pill Can Kill." The problem with the DEA … is that it has been prone to sensationalism that doesn't hold up. But with this current campaign, they're right. You look at middle school students, it's really wild, the rate of middle school students dying from overdoses, it's something like five or 10 times [more] in the last couple of years. It was a relatively less common thing than like a 25 year old who died from heroin, but it's just gone through the roof. Most of our friends have kids at this point, and they're terrified and they should be, because it really is that dangerous. None of us grew up with this dangerous of a drug supply, and I think we have to help parents and families understand how to talk to their children and the teenagers and the tweens and talk to them about drugs in a much more specific and nuanced way because the reality is, it's just incredibly dangerous. Hopefully this is a temporary thing, but whether it's temporary or not, this is the era that we're in.