The opioid epidemic sweeping our nation did not happen overnight. Its origins reach back three decades to efforts to manage and relieve pain through pharmaceutical solu- tions. A large factor attributed as a root of today’s crisis is the rise of prescription drug addiction and abuse. Most notably, Purdue Pharma’s OxyContin was overprescribed to patients by doctors targeted by the com- pany’s extensive marketing campaign. Since 1996, when the drug was brought to market, Purdue Pharma downplayed the addictive nature of this ‘wonder drug’ with marketing statements such as, “less than 1% of patients become addictive” (Frontline, 2016). In 2007, the company admitted to charges of fraudu- lent marketing following a four-year federal investigation, paying $600 million in fines and settlements (Frontline, 2016). A ccording to the Centers for Disease Control (2018), fifty- three thousand Americans died from opioid overdoses in 2016, exceeding car crash and gun violence deaths. In 2017, opioids killed roughly 142 Americans each day (Office of National Drug Control Policy [ONDCP], 2017). Research suggests a variety of factors have contributed to the rise of opioid abuse, including: the philosophy of pain management and associated attempts to alleviate suffering through pharmaceutical drugs, the over- prescription of pain medications like OxyContin, shame felt by predominantly suburban whites whose addiction falls outside

traditional middle class social norms, and passing of addiction from parents to children, called neonatal abstinence syndrome (ONDCP, 2017; Frontline, 2016; House of Representatives, 2015). In 2012, the problem of prescription drug abuse had reached epidemic proportions, as evidenced by growing federal government attention and strategies devoted to address pre- scription drug abuse. On March 7, 2012, the House of Represen- tative subcommittee on crime, terrorism, and homeland security held hearings to review the prescription drug epidemic in America. These hearings reveal the extent to which this crisis had grown, with testimony and written statements asserting that: / 254 million prescriptions for opioids were filled in the U.S. in 2010, which is “enough painkillers to medicate every single American adult around the clock for a month” (House of Representatives, 2012). / The original purpose for OxyContin was to only be prescribed to help patients in the last stages of cancer or other severe illnesses, but OxyContin and other generic oxycodone drugs are being prescribed for less severe reasons, which has expanded the availability of the drugs and potential for their abuse (House of Representatives, 2012). Simultaneously, while prescription drug abuse was reaching epidemic proportions, the last two decades have also witnessed an expansion of the epidemic from prescription drugs to street opiates like heroin. The evolution of prescription drug and heroin epidemics has occurred for a multitude of reasons, including both push and pull factors. Among the pull factors is the demand for opioids from people who have become addicted to prescription drugs to manage pain. Efforts to address prescription drug abuse have focused on educating prescribers on the risks of prescribing opioids and expansion of programs for monitoring prescription drugs (ONDCP, 2015). While these efforts have been successful in slowing prescription opioid overdoses, the success in reducing prescription opioid overdoses has largely been offset by easy ac- cess to cheaper, more potent, and less controlled opioid sources, such as heroin and synthetic opiates like fentanyl. Among the many push factors, the influx of heroin from Mexican drug cartels in the last two decades has produced an illicit market flooded with cheap and available heroin. As Sam

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