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Understanding the Origins of the Opioid Abuse Epidemic to Advance Solutions


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A new report by Avalere Health, "Trends in Opioid Use: History, Background, and Origins of the Epidemic," comes at a critical point in the broader discussion about opioid abuse and misuse, and provides important context around the clinical, regulatory and policy milestones that contributed to the public health epidemic and impacted the national response to the crisis.

Treating Pain More Aggressively

An increased emphasis on treating pain more aggressively, combined with a de-emphasis of the potential for addiction, led to a rapid increase in the number of opioids prescribed.

Spurred by the “Pain, the Fifth Vital Sign” campaign in the mid-1990s, national scientific bodies and the medical community reached a broad consensus about the importance of assessing and managing pain as closely as pulse, respiration, temperature and blood pressure.

As a result, the total volume of prescription opioids dispensed was growing at a rate of 6 percent each year. Federal policies further increased the credibility of the push to treat pain more aggressively, with the Department of Veterans Affairs officially designating pain as the “fifth vital sign” in 1999.

Incentivizing Aggressive Pain Management

Quality measures and reimbursement practices reflected this change in clinical practice and further incentivized aggressive pain management. For example, the Hospital Consumer Assessment of Healthcare Provider Systems (HCAHPS) survey — a tool the Centers for Medicare & Medicaid Services used to determine hospital reimbursement and payment — included two questions about pain management.

Increasing the Supply of Prescription Opioids

The federal government regulates the supply of opioids through the Drug Enforcement Administration’s (DEA) Aggregate Production Quotas (APQs). From 1993 to 2015 the DEA increased production quotas for opioids 39-fold. It was not until 2016 that APQ data suggest the federal government took a more active role in limiting the production for opioids with a 31.6 percent reduction in annual quotas.

Responding to an Evolving Addiction Crisis

The epidemic touches nearly every community across the country and is part of a larger addiction trend. As the report notes, recent research indicates that over the past four decades, the United States has seen a remarkably steady, exponential increase in drug overdose deaths — from cocaine to methamphetamine to opioids.

Moreover, the epidemic has evolved as heroin and illicit opioids account for a greater share of overdose deaths.

Addressing the Crisis with Comprehensive Solutions

A comprehensive understanding of the multiple drivers of the opioid epidemic, as outlined in the report, is a critical step in moving forward with solutions to address the public health crisis.

Healthcare distributors are working with government and private sector stakeholders to turn the tide of the epidemic. HDA and our members are committed to stopping prescription opioid abuse and misuse before it occurs through investments in information technology monitoring tools, initiatives to provide education and awareness to consumers and practical policy solutions to address opioid abuse and misuse.

View the full report here, and check out our resources for more information on practical solutions to combat opioid addiction and abuse across the country.


The Healthcare Distribution Alliance (HDA) represents primary pharmaceutical distributors — the vital link between the nation’s pharmaceutical manufacturers and pharmacies, hospitals, long-term care facilities, clinics and others nationwide. Since 1876, HDA has helped members navigate regulations and innovations to get the right medicines to the right patients at the right time, safely and efficiently. The HDA Research Foundation, HDA’s nonprofit charitable foundation, serves the healthcare industry by providing research and education focused on priority healthcare supply chain issues.


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