ABSTRACT
Chapter 4 begins by looking at the origins of the third opioid crisis. It traces the origin to push for new methods of pain management on the part of the medical profession, utilizing opioids. Pharmaceutical companies, such as Purdue and Johnson & Johnson, manufactured the new medications and strongly advocated, promoted, and pushed for their use. The companies often used misleading data to promote the idea that opioids were not addictive and thereby could be prescribed safely. As opioid-related deaths (ORD) mounted, governments began to place restrictions on them, leading to a second wave of the opioid crises, based on heroin, followed by a third wave based on fentanyl, a synthetic opioid. Both heroin and fentanyl (and analogues) were illegally imported into the United States, with much of fentanyl originating initially in China and then Mexico. The chapter examines problem indicators that lay out the extent of the various aspects of the problem. One example is the number of ORD in the 1999–2018 period, nearly 450,000 people. The chapter notes the demographic differences in the three opioid crisis periods. The first crisis focused on Chinese (and Mexicans); the second focused on urban minorities; and the third on the rural, white population. Chapter 4, as does Chapter 3, examines the role of the media in bringing attention to the problem and shaping perceptions. Addicts in the second crisis were seen as criminals and morally deficient. Addicts in the third crisis were seen as more likely to be afflicted by a disease and therefore more sympathetic. The George W. Bush administration, like administrations before, focused on supply and demand restrictions. The Barack Obama administration looked at the drug problem from a public health standpoint, also pushing for criminal justice reforms. The Trump administration declared a national public health emergency, which, despite the emergency declaration, did not mean a significant change in policy or funding. The chapter examines implementation failures during the Trump administration. The chapter concludes that while there were some policy successes, there were also missed opportunities and failures in the Bush, Obama, and Trump administrations.
