Opioid Deaths in North America Predicted to Soar

Without bold and urgent action, including public health policy reform and stricter corporate regulations, an additional 1.2 million people in North America will die of an opioid overdose by 2029, according to an analysis by the Stanford-Lancet Commission.

"Over the past quarter-century, the opioid epidemic has taken nearly 600,000 lives and triggered a cascade of public health catastrophes such as disability, family breakdown, unemployment, and child neglect in North America," Commission chair Keith Humphreys, PhD, said in a news release.

"If no action is taken, by the end of this decade, we are predicting the number of deaths to be twice as high as it has been over the last 20 years," said Humphreys, professor of psychiatry and behavioral sciences at Stanford University in California.

The report – Responding to the Opioid Crisis in North America and Beyond: Recommendations of the Stanford-Lancet Commission – was published online February 2 in The Lancet.

Blame It on COVID-19?

The COVID-19 pandemic has both overshadowed and exacerbated the opioid crisis in North America, the Commission points out in their report.

Their analysis suggests that 2020 was the worst year on record for overdose deaths in the US and Canada in terms of both the total number of deaths and percentage annual increase.

In the US, opioid overdose deaths increased by 37%, from 51,133 in 2019 to 70,168 in 2020, bringing the total number of deaths since 1999 to 583,000.

In Canada, opioid overdose deaths jumped by 72%, from 3668 in 2019 to 6306 in 2020, with a further 3515 deaths reported in the first 6 months of 2021.

Although the 2020 spikes might be partly due to the effects of the COVID-19 pandemic, a rising trajectory of deaths was evident in both the US and Canada before the pandemic hit, the Commission says.

Profit Motives, Lack of Regulation

The Commission blames the opioid epidemic on a lack of adequate regulation and oversight coupled with profit motives of the pharmaceutical and healthcare industry.

"To ensure safeguards are in place to curb the opioid addiction epidemic and prevent future ones involving other addictive drugs, we must end the pharmaceutical and health care industry's undue influence on the government and its unregulated push for opioid use," Commission member Howard Koh, MD, MPH, said in the news release.

"This includes insulating the medical community from pharmaceutical company influence and closing the constantly revolving door between regulators and industry," said Koh, with the Harvard T. H. Chan School of Public Health in Boston.

In addition to regulation and policy reform, the Commission says prevention efforts that focus on treating addiction as a chronic condition are key.

The US, in particular, lacks accessible, high-quality, nonstigmatizing, and integrated health and social care services for people experiencing opioid use disorder, the Commission notes.

Addiction-related services must become a permanent feature of health and social care systems in the US and Canada, in line with established chronic disease management models that are financed and organized as a core public health commitment, the Commission says.

"Addiction is an enduring part of population health and should not be treated as a moral failing that needs punishment but as a chronic health condition that requires ongoing treatment and long-term support," Commission member Yasmin Hurd, PhD, director of the Addiction Institute at Icahn School of Medicine at Mount Sinai in New York, said in the release.

Investing in young people to reduce the risk of addiction will also be important going forward.

"Preventing drug addiction should be part of a comprehensive public health strategy that starts in childhood and lays the foundation for long-term declines in addiction," said Commission member Chelsea Shover, PhD, with University of California, Los Angeles.

"Audacious but Achievable Goal"

The Commission calls for a nuanced approach to pain management that prioritizes innovation both in society's response to drug addiction through policy reform and by supporting the development of new, nonaddictive pain management options.

"Opioids should not be viewed as good or bad, but instead as a class of medications essential to the management of pain. However, opioids also come with serious risks, some of which can be difficult to recognize," Commission member David Juurlink, MD, PhD, said in the release.

"Clinicians should begin learning about responsible pain management prescribing in medical school and continue to learn about it as part of their commitment to continued medical education throughout their careers," said Juurlink, with Sunnybrook Health Sciences Centre in Toronto, Canada.

Humphreys said ending the opioid epidemic in North America and preventing its global spread is "an audacious but achievable goal" that will require a "dramatic shift in policy and culture where innovation, collaboration, and regulation are encouraged.

"We can save and improve lives by summoning the resources and political will necessary to eliminate the sources of addiction and boldly implement policies that will maximize efforts to treat it," Humphreys added.

The study was funded by Stanford University School of Medicine. A complete list of author disclosures for Commission members is available with the original article.

Lancet. Published online February 2, 2022. Abstract

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