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handle is hein.crs/govejoc0001 and id is 1 raw text is: Congressional Research Service Mar Informning the Iegislative debate since 1914 0 December 1, 2022 The Opioid Crisis in the United States: A Brief History Opioids act on receptors in the brain that are important in regulating pain and emotion. For centuries, opioids have been used as medicines to manage or treat pain. Natural opioids (sometimes referred to as opiates), such as morphine, are derived from the opium poppy plant, while synthetic opioids like methadone and fentanyl are made entirely in a laboratory. Semi-synthetic opioids, which include heroin and many prescription pain medications such as oxycodone and hydrocodone, are synthesized from naturally occurring opium products, such as morphine and codeine. Opioids-particularly those with higher potencies-can pose significant dangers, such as dependence and overdose resulting in death. The Opioid Crisis in the United States In the 1990s, the intensified marketing of newly reformulated prescription opioid medications (e.g., OxyContin) and an influential pain advocacy campaign that encouraged greater pain management led to a precipitous rise in opioid use in the United States. Research from the Centers for Disease Control and Prevention (CDC) shows that prescription opioid sales in the United States quadrupled from 1999 to 2010. At the same time, opioid misuse and opioid-involved overdose deaths increased (Figure 1). Between 1999 and 2010, the rate of opioid- involved overdose deaths in the United States doubled from 2.9 to 6.8 deaths per 100,000 people. This initial rise in opioid-related deaths is often referred to as the first wave of the recent opioid crisis. Figure I. Drug-Related Overdose Deaths in the United States, by Opioid Involvement, 1999-2020 Non-Opioid U Cpioid r 100k a a- S75k ~550k Z25k 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 Source: CRS analysis using data from CDC WONDER. Heroin Around the time that the opioid crisis's first wave was unfolding, retail prices for heroin-an illegal opioid in the United States-began to decline. Around 2010, the predominant source of heroin in the United States shifted from South America to Mexico. Increases in Mexican production ensured a reliable supply of low-cost heroin. As prices declined and availability increased, heroin-related overdose deaths began to rise. From 2010 to 2016, the rate of heroin-involved deaths increased from 1 to 4.9 per 100,000. In 2015, heroin surpassed prescription medications as the leading opioid involved in overdose deaths. The rise in heroin-involved deaths has been referred to as the second wave of the opioid crisis in the United States. Figure 2. Opioid-Involved Overdose Deaths in the United States, by Opioid Type, I 999-2020 c60k 45k a c 0 30k G 4o 15k 0 2000 2005 2010 2015 2020 Source: CRS analysis using data from CDC WONDER. Notes: Overdose deaths may involve more than one opioid and should not be summed. Natural and semi-synthetic opioids includes prescription opioid medications other than methadone. Synthetic opioids consists primarily of fentanyl and fentanyl analogues. Heroin and methadone are classified separately in CDC mortality data. Fentanyl In 2016, synthetic opioids-led by fentanyl-surpassed heroin and prescription drugs as the leading type of opioids involved in U.S. overdose deaths. Fentanyl is a synthetic opioid and is up to 50 times stronger than heroin. Pharmaceutical fentanyl is used to treat severe pain. Illicit, non-pharmaceutical fentanyl and similar chemical formulations, known as analogues, are used illegally as recreational drugs. While some pharmaceutical fentanyl is diverted for recreational use, most fentanyl-related overdoses involve illicit, non-pharmaceutical fentanyl. This form is manufactured primarily in Mexico with chemical inputs, or precursors, from China and smuggled across the southwest border. Illicit fentanyl is used by itself, mixed with other drugs (e.g., heroin or cocaine), or pressed into counterfeit prescription pills, sometimes without the consumer's knowledge. From 2015 to 2020, the rate of opioid-involved overdose deaths-driven by fentanyl- once again doubled, from 10.4 to 21.4 per 100,000. The rise in fentanyl-involved overdose deaths is often referred to as the third wave of the U.S. opioid crisis (Figure 2). US. Efforts to Address the Crisi Between 1999 and 2020, 565,000 Americans died of opioid-involved overdoses. In turn, federal, state, and local governments responded with various legal and policy

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