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The Opioid Crisis

Jan 21, 2022
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Over the past twenty years, over half a million Americans have died of opioid overdoses.

In this episode, we'll explore how this happened, who is responsible, and ask ourselves whether the USA will ever be able to kick its addiction to prescription opioids.

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[00:00:00] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English. 

[00:00:12] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.

[00:00:22] I'm Alastair Budge, and today we are going to be talking about The Opioid Crisis in America.

[00:00:29] In the United States, 75,000 people every year, that’s over 200 people every single day, die from opioid-related drug overdoses. 

[00:00:41] This is a number that has boomed since the mid 1990s.

[00:00:45] So, in this episode we are going to talk about some of the reasons why that is, why has the US become the world’s hotspot, or world capital even, of opioid addiction, why so many Americans are becoming addicted to opioids, who is responsible for this, and what it is doing to society.

[00:01:07] OK, then, the opioid crisis.

[00:01:12] Let’s start with a quick definition of what an opioid is. 

[00:01:17] An opioid is a drug that kills pain and causes pleasure.

[00:01:22] The name comes from the original, natural, opioid: opium - the drug that can be found in poppy seeds.

[00:01:31] Other opioids include morphine, heroin, fentanyl, codeine, and oxycodone.

[00:01:38] And in the past twenty years, over half a million Americans, that’s more than the population of Malta and almost ten times as many Americans as died in the Vietnam war, have died after overdosing on opioids.

[00:01:54] It is a uniquely American problem, it’s something that doesn’t happen anywhere else to anywhere near the same degree.

[00:02:02] In the United States there are 19 opioid-related deaths per 100,000 people.

[00:02:09] The average for Western Europe is 2.14, so the average person in the United States is almost 9 times more likely to die of an opioid overdose than someone living in Western Europe.

[00:02:24] In 1990, however, those two numbers were much closer. In the United States there were 2.01 opioid deaths per 100,000 people vs. 1.39 in Western Europe.

[00:02:38] So, the question you might be quite rightly asking yourself is…what happened?

[00:02:45] The United States has spent over a trillion dollars on the so-called “War on Drugs”, yet there have never before been more Americans using and dying from drugs and opioids in particular.

[00:03:00] What is going on?

[00:03:02] Well, if you are unfamiliar with the Opioid Crisis, how the United States got itself into this situation may surprise you.

[00:03:11] When we are taught in schools about why we shouldn’t take drugs, we are normally shown videos of teenagers being pressured to take drugs at a party or at the swings at a public park. 

[00:03:26] The traditional view of drug addiction, or at least the view when I was growing up, was that it might start with something small - a few puffs of a cigarette or secretly stealing a bottle of alcohol from your parents’ cupboard to drink with your friends, which might lead to smoking cannabis, snorting cocaine, and before long you are addicted to heroin and selling all of your possessions to feed your habit.

[00:03:53] In the American case, however, the boom in drug use was not caused by teenagers just getting naughtier.

[00:04:02] In fact, when the majority of problem opioid users were first introduced to opioids, it wasn’t on a park bench or at a party when they were teenagers.

[00:04:14] It was in a doctor’s clinic, by their doctor, who prescribed them as a way to treat pain.

[00:04:22] Now, although the boom in prescription opioids started in the late 1990s, doctors have known about the pain-killing properties of opioids for hundreds of years.

[00:04:34] In the American Civil War large numbers of soldiers returned home addicted to morphine, which they had first taken as a painkiller.

[00:04:44] Heroin was also legally manufactured, and it was sold at pharmacies until 1924.

[00:04:53] The reason that it was stopped, that it was made illegal, and that doctors stopped freely prescribing opioids to patients was precisely because they’re addictive.

[00:05:05] Opioids don’t just kill pain, they make you feel pleasure, and the more you take them, the harder it is to stop taking them. 

[00:05:15] They are highly addictive, and even though they might be very effective drugs to stop the pain, the body often becomes dependent on the drug.

[00:05:26] Doctors could prescribe opioids, but they were often reluctant to do so unless there were no alternatives - they knew that patients could get addicted, and wanted to avoid this at all costs.

[00:05:40] Then, in the mid 1990s there was a new kid on the block, a new drug that came along, which its creators claimed wasn’t addictive.

[00:05:52] In 1996 an American pharmaceutical company called Purdue Pharma released a drug called OxyContin, which its representatives claimed was significantly less addictive than other opioids, indeed underlining that less than 1% of people using the drug become addicted.

[00:06:15] Purdue Pharma already had a number of other successful painkillers, but they were used to treat severe pain for people suffering from diseases such as cancer.

[00:06:27] If they could convince doctors that this new drug was non-addictive, then doctors would be more likely to prescribe it for patients with less severe pain - people recovering from accidents, people who weren’t always in extreme pain but people who would benefit from pain relief. 

[00:06:49] And if these patients were able to be relieved of their pain, no matter how small, on this drug that was incredibly unlikely to lead to addiction, then that was the right thing for the doctors to do.

[00:07:05] What’s more, sales representatives, the employees who were responsible for encouraging doctors to prescribe these drugs to their patients, were highly incentivised to get doctors to start prescribing their drugs - the more drugs their doctors prescribed, the bigger bonus the salesperson would get.

[00:07:26] Indeed, in 2001 the average sales representative’s salary for Purdue Pharma was $55,000 yet the average bonus paid out was $71,500, so more than half of their total pay was coming from these bonuses they got after persuading doctors to sell more and more OxyContin.

[00:07:52] As you might expect, sales grew quickly, and by 2001 Oxycontin was the most prescribed brand name narcotic medication for treating moderate-to-severe pain. 

[00:08:06] Millions of Americans were using it, and the Purdue Pharma salespeople had become increasingly efficient at getting doctors to prescribe it to more and more people, and in larger and larger doses.

[00:08:21] The FDA, the Food and Drug Administration, first approved 10mg, 20mg and 40mg doses of the pill, but later on approved 80 and 160 mg doses.

[00:08:38] The larger the dose and the more pills doctors prescribed, the more money Purdue Pharma and its salespeople made, and there are multiple reports of employees being encouraged to pressure the doctors into prescribing more and more OxyContin.

[00:08:56] After all, fewer than 1% of patients become addicted, and it was very effective at killing the pain, so what was the issue?

[00:09:06] Well, the issue was that the “less than 1%” number could not be substantiated, they couldn’t prove it, and it simply wasn’t true.

[00:09:17] Before long, doctors started to see this for themselves, and to suspect that the real number was much higher. Patients couldn’t get off OxyContin, they couldn’t stop using it. When they did, many suffered withdrawal symptoms, pain, and mood swings.

[00:09:37] Their bodies needed the drug to continue functioning. They couldn’t live a normal life without it.

[00:09:45] What’s more, people had started to abuse OxyContin, they had started to use it in a way it wasn’t designed for, and in a way that Purdue Pharma had claimed was not possible, or at least was not easy to do. 

[00:10:01] In its original form, it came as a tablet, which the patient would swallow, and the pill would be broken down in the body over a period of 12 hours. 

[00:10:14] Essentially, the claim was that, although one pill contained a powerful drug, only small amounts of the drug would be released into the body over a prolonged period.

[00:10:26] Before long, people found ways to take the pill in other ways, either crushing up the pill and snorting it, that's sucking it up into their nose, or even injecting it directly into their veins

[00:10:43] Taking the drug in this way meant that the high, the feeling of pleasure, was a lot more intense - the drug went directly into the system, as opposed to being released over a longer period.

[00:11:00] Recent investigations have shown that Purdue Pharma senior executives were aware of this - they knew exactly what was going on - but didn’t do anything about it.

[00:11:13] This increasing abuse of OxyContin led to both a black market in the drug and the growth of so-called “pill mills”, doctors’ clinics that were happy to provide prescriptions to anyone even if they didn’t medically need them.

[00:11:32] But even if these pills were bought on the black market, from a pill mill or from another unlicensed individual, prescription opioids weren’t cheap. It might cost $15 or $20 for one OxyContin pill, if bought illegally. 

[00:11:51] And the same types of people that were illegally selling these prescription pills, the drug dealers essentially, they would often have something else for sale that was much more powerful and much cheaper: heroin, and later its even more powerful cousin, fentanyl.

[00:12:12] The cycle of addiction that doctors started to see would be someone first prescribed an opioid to treat pain, which would lead to abuse of the drug - either using it more frequently or in larger quantities than prescribed by the doctor - and often lead to the abuse of more serious, illegal and really dangerous opioids such as heroin and fentanyl.

[00:12:40] To give you some numbers on this, data from the National Institute on Drug Abuse suggests that in America anywhere between 20-30% of patients who are prescribed opioids misuse them, and around 10% of people who use opioids develop some sort of addiction.

[00:13:03] Of those people who misuse opioids, around 5% of them move on to heroin and fentanyl. So, for every 100 people who are prescribed opioids by their doctor, 1 is likely to develop a heroin or fentanyl addiction.

[00:13:21] Put the other way, of heroin users in the United States, 80% of them first abused prescription opioids - 4 out of 5 heroin users in the country got started with drugs prescribed by a doctor.

[00:13:38] And to state the obvious, to say what we all know, becoming a heroin addict isn’t generally a sensible life choice. 

[00:13:47] For most addicts, it is an all-consuming disease, and your entire life becomes based on feeding your expensive drug addiction. For many people it is a disease that leads to homelessness, increased criminal activity, and overdose and death.

[00:14:07] What’s more, the boom in use of fentanyl, which is a synthetic opioid even more powerful and dangerous than heroin, has made the life of an American opioid addict even more precarious, even more scary and dangerous.

[00:14:25] Fentanyl, like heroin and morphine, is nothing new. 

[00:14:29] It was first made in 1960 and used as a pain killer. But it is even stronger than heroin - about 50 times stronger to be precise - and cheaper.

[00:14:41] So, as more and more Americans looked for cheaper alternatives to the opioids their doctors were prescribing them, there was a boom in the production of fentanyl for sale on the street.

[00:14:55] Because it is so powerful and cheap to produce, it can be smuggled into the United States more easily than any other drug.

[00:15:04] One kilogramme of fentanyl can be bought from suppliers in East Asia for around $3,000, and relatively easily brought into the United States, either simply posted in the normal post or sent first to Mexico and then smuggled across the border. 

[00:15:23] This one kilo, because it is so incredibly powerful, can be cut up and mixed with other substances and can lead to up to $1.5 million in profits for the drug dealers.

[00:15:37] And of course, for the drug users, the people who are either using fentanyl knowingly, or are using other drugs that have small amounts of fentanyl in them, this can be incredibly dangerous.

[00:15:51] Just 2mg, 0.002 grammes, is considered to be a lethal dose for the average person, so it is very easy for someone to unwittingly, unintentionally, take more than they think and die.

[00:16:10] Indeed, of the 100,000 people who died of a drug overdose in the United States in the last year, two thirds were linked to fentanyl.

[00:16:20] So, you might be thinking, who is actually responsible for this, and is this situation going to change any time soon?

[00:16:30] In terms of the responsibility question, there have been numerous lawsuits against the drug manufacturers and sales organisations for pushing their drugs on doctors, encouraging them to prescribe them while being aware that they were more addictive than they claimed.

[00:16:49] The main target in this is Purdue Pharma, the company behind OxyContin, and indeed the Sackler family, the people who own Purdue Pharma.

[00:17:01] There is no doubt that Purdue Pharma and the Sackler family grew fabulously wealthy on the back of OxyContin, with estimates of sales of the drug totalling $30 billion over the past 25 years or so.

[00:17:16] Evidence has come to light that has shown that senior executives were aware of the fact that it was addictive, and the company was fined $4.5 billion in exchange for the Sackler family receiving immunity from future prosecution. 

[00:17:34] Essentially, the Sacklers agreed to pay out this vast amount of money so that they wouldn’t have to pay out any more, or didn’t risk being thrown in prison. 

[00:17:46] This case is still ongoing, so we will have to see where it ends.

[00:17:52] US authorities have been clamping down onpill mills”, the doctors clinics and pharmacies that were giving out prescriptions to anyone, regardless of whether they were actually in pain or not. And dozens of doctors and pharmacy owners have been prosecuted and ended up in jail.

[00:18:11] But the reality is that the very drugs that started the opioid crisis - drugs such as OxyContin - are still prescribed in vast amounts every single day.

[00:18:23] In 2020 there were 142,816,781 opioid prescriptions, one for every 2.4 people, including children. 

[00:18:37] To put it another way, if you were to take five average Americans, two would have a prescription for opioids.

[00:18:47] In the interests of balance - this number has gone down. At its peak in 2012 there were 255,207,954 opioid prescriptions, almost exactly one opioid prescription for every single adult in the United States.

[00:19:09] So, doctors are prescribing fewer opioids than they were 10 years ago, but the number is still massive.

[00:19:17] What’s next, you might be thinking?

[00:19:19] “Fixing” the opioid crisis is clearly far more complicated than simply stopping prescribing opioids. 

[00:19:27] Opioids are incredibly effective at reducing pain, and pain is recognised as a global health problem that affects 20% of the adult population. There are hundreds of millions of people who use opioids, use prescription painkillers, safely and happily, and for whom these drugs allow them to live a normal and pain-free life when the alternative would be constant pain. 

[00:19:55] So there are few that are suggesting that preventing the use of opioids is the answer.

[00:20:01] Indeed, there are plenty of other countries, Germany for example, that prescribe opioids in similarly high levels to the United States, but where there has not been a corresponding epidemic of opioid misuse and addiction.

[00:20:18] There is also the problem of the ten million or so Americans who currently misuse opioids, and the million or so who are currently addicted to heroin and fentanyl. Again, clearly simply telling them to “stop” is not a solution, especially - for the ones addicted to heroin and fentanyl at least - they are already getting their drugs from illegal drug dealers. The fact that what they are doing is illegal is not a sufficient deterrent.

[00:20:48] In terms of making it harder to abuse these opioids, the makers of OxyContin have made the drug harder to misuse

[00:20:58] In 2010 they released a new form of the pill which meant that if it was crushed it would turn into a substance that was harder to snort or inject.

[00:21:10] The idea was good - the theory was that if it were harder to abuse, people would abuse it less. They would have to swallow it, and the slow-release system would mean that there wasn’t a near-instant high.

[00:21:25] Unfortunately, data suggests that this simply accelerated people’s switch to heroin and fentanyl. Almost immediately after this new “abuse-proof” pill was released, heroin overdoses jumped up

[00:21:41] So the theory goes that abusing this legal, prescription pill became such a hassle that people just switched over to the easy, illegal, cheaper and more powerful alternatives.

[00:21:55] Of course, there are plenty of theories about how to reduce the number of people who end up addicted to opioids, and there are really three key stages to this journey, three key areas that people talk about.

[00:22:10] Firstly, it starts with the manufacturers of prescription opioids, and ensuring that the drugs that they are bringing to market can be taken as safely as possible, and that these drugs are offered to doctors with correct, evidence-based guidance on their use.

[00:22:29] Secondly, that the doctors are prescribing the drugs to the people who really need them, not to people who want to abuse them.

[00:22:38] And thirdly, for people who do unfortunately end up abusing opioids, especially those who move to more powerful and dangerous “street” drugs, such as heroin and fentanyl, that there are support networks for them to both take drugs safely, without the risk of dying, and to overcome their addiction, to kick their habit, and to return to society and live a normal life again.

[00:23:07] There is increasing pressure on the government, especially from groups of people who have lost a loved one to the opioid crisis, to work on each of these three stages, three areas, but the Opioid Crisis is not just still in full swing, there are more and more people dying every single year. 

[00:23:27] Indeed, there were 35% more opioid-related deaths in 2021 than in 2020, and although the number of opioids prescribed is reducing, the number of people dying continues to increase every year.

[00:23:45] In some areas of the United States, the levels of opioid-related deaths have even meant that the average life expectancy has decreased, so for the first time in history people are dying younger than their parents.

[00:24:03] So, while there is no easy or simple solution in sight, and the American opioid industry remains a multi-billion dollar market, the grim reality is that hundreds of thousands, if not millions, of people will continue to die unnecessarily.

[00:24:21] And the terrible irony of it all is that for the majority of people who will die, the journey towards addiction and death will start with being handed a harmless-looking piece of paper by their doctor.

[00:24:38] OK then, that is it for today's episode on The Opioid Crisis. I know we normally like to finish on a positive note, but unfortunately when it comes to this particular subject, there isn’t a lot of good news to share.

[00:24:53] As always, I would love to know what you thought of this episode. 

[00:24:57] What do you see as some potential solutions to this crisis? 

[00:25:01] What are the policies towards drug use and drug addiction in your country? 

[00:25:05] What do you think works, and doesn’t work?

[00:25:09] I would love to know.

[00:25:11] You can head right into our community forum, which is at community.leonardoenglish.com and get chatting away to other curious minds.

[00:25:20] You've been listening to English Learning for Curious Minds, by Leonardo English.

[00:25:25] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.


[END OF EPISODE]


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[00:00:00] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English. 

[00:00:12] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.

[00:00:22] I'm Alastair Budge, and today we are going to be talking about The Opioid Crisis in America.

[00:00:29] In the United States, 75,000 people every year, that’s over 200 people every single day, die from opioid-related drug overdoses. 

[00:00:41] This is a number that has boomed since the mid 1990s.

[00:00:45] So, in this episode we are going to talk about some of the reasons why that is, why has the US become the world’s hotspot, or world capital even, of opioid addiction, why so many Americans are becoming addicted to opioids, who is responsible for this, and what it is doing to society.

[00:01:07] OK, then, the opioid crisis.

[00:01:12] Let’s start with a quick definition of what an opioid is. 

[00:01:17] An opioid is a drug that kills pain and causes pleasure.

[00:01:22] The name comes from the original, natural, opioid: opium - the drug that can be found in poppy seeds.

[00:01:31] Other opioids include morphine, heroin, fentanyl, codeine, and oxycodone.

[00:01:38] And in the past twenty years, over half a million Americans, that’s more than the population of Malta and almost ten times as many Americans as died in the Vietnam war, have died after overdosing on opioids.

[00:01:54] It is a uniquely American problem, it’s something that doesn’t happen anywhere else to anywhere near the same degree.

[00:02:02] In the United States there are 19 opioid-related deaths per 100,000 people.

[00:02:09] The average for Western Europe is 2.14, so the average person in the United States is almost 9 times more likely to die of an opioid overdose than someone living in Western Europe.

[00:02:24] In 1990, however, those two numbers were much closer. In the United States there were 2.01 opioid deaths per 100,000 people vs. 1.39 in Western Europe.

[00:02:38] So, the question you might be quite rightly asking yourself is…what happened?

[00:02:45] The United States has spent over a trillion dollars on the so-called “War on Drugs”, yet there have never before been more Americans using and dying from drugs and opioids in particular.

[00:03:00] What is going on?

[00:03:02] Well, if you are unfamiliar with the Opioid Crisis, how the United States got itself into this situation may surprise you.

[00:03:11] When we are taught in schools about why we shouldn’t take drugs, we are normally shown videos of teenagers being pressured to take drugs at a party or at the swings at a public park. 

[00:03:26] The traditional view of drug addiction, or at least the view when I was growing up, was that it might start with something small - a few puffs of a cigarette or secretly stealing a bottle of alcohol from your parents’ cupboard to drink with your friends, which might lead to smoking cannabis, snorting cocaine, and before long you are addicted to heroin and selling all of your possessions to feed your habit.

[00:03:53] In the American case, however, the boom in drug use was not caused by teenagers just getting naughtier.

[00:04:02] In fact, when the majority of problem opioid users were first introduced to opioids, it wasn’t on a park bench or at a party when they were teenagers.

[00:04:14] It was in a doctor’s clinic, by their doctor, who prescribed them as a way to treat pain.

[00:04:22] Now, although the boom in prescription opioids started in the late 1990s, doctors have known about the pain-killing properties of opioids for hundreds of years.

[00:04:34] In the American Civil War large numbers of soldiers returned home addicted to morphine, which they had first taken as a painkiller.

[00:04:44] Heroin was also legally manufactured, and it was sold at pharmacies until 1924.

[00:04:53] The reason that it was stopped, that it was made illegal, and that doctors stopped freely prescribing opioids to patients was precisely because they’re addictive.

[00:05:05] Opioids don’t just kill pain, they make you feel pleasure, and the more you take them, the harder it is to stop taking them. 

[00:05:15] They are highly addictive, and even though they might be very effective drugs to stop the pain, the body often becomes dependent on the drug.

[00:05:26] Doctors could prescribe opioids, but they were often reluctant to do so unless there were no alternatives - they knew that patients could get addicted, and wanted to avoid this at all costs.

[00:05:40] Then, in the mid 1990s there was a new kid on the block, a new drug that came along, which its creators claimed wasn’t addictive.

[00:05:52] In 1996 an American pharmaceutical company called Purdue Pharma released a drug called OxyContin, which its representatives claimed was significantly less addictive than other opioids, indeed underlining that less than 1% of people using the drug become addicted.

[00:06:15] Purdue Pharma already had a number of other successful painkillers, but they were used to treat severe pain for people suffering from diseases such as cancer.

[00:06:27] If they could convince doctors that this new drug was non-addictive, then doctors would be more likely to prescribe it for patients with less severe pain - people recovering from accidents, people who weren’t always in extreme pain but people who would benefit from pain relief. 

[00:06:49] And if these patients were able to be relieved of their pain, no matter how small, on this drug that was incredibly unlikely to lead to addiction, then that was the right thing for the doctors to do.

[00:07:05] What’s more, sales representatives, the employees who were responsible for encouraging doctors to prescribe these drugs to their patients, were highly incentivised to get doctors to start prescribing their drugs - the more drugs their doctors prescribed, the bigger bonus the salesperson would get.

[00:07:26] Indeed, in 2001 the average sales representative’s salary for Purdue Pharma was $55,000 yet the average bonus paid out was $71,500, so more than half of their total pay was coming from these bonuses they got after persuading doctors to sell more and more OxyContin.

[00:07:52] As you might expect, sales grew quickly, and by 2001 Oxycontin was the most prescribed brand name narcotic medication for treating moderate-to-severe pain. 

[00:08:06] Millions of Americans were using it, and the Purdue Pharma salespeople had become increasingly efficient at getting doctors to prescribe it to more and more people, and in larger and larger doses.

[00:08:21] The FDA, the Food and Drug Administration, first approved 10mg, 20mg and 40mg doses of the pill, but later on approved 80 and 160 mg doses.

[00:08:38] The larger the dose and the more pills doctors prescribed, the more money Purdue Pharma and its salespeople made, and there are multiple reports of employees being encouraged to pressure the doctors into prescribing more and more OxyContin.

[00:08:56] After all, fewer than 1% of patients become addicted, and it was very effective at killing the pain, so what was the issue?

[00:09:06] Well, the issue was that the “less than 1%” number could not be substantiated, they couldn’t prove it, and it simply wasn’t true.

[00:09:17] Before long, doctors started to see this for themselves, and to suspect that the real number was much higher. Patients couldn’t get off OxyContin, they couldn’t stop using it. When they did, many suffered withdrawal symptoms, pain, and mood swings.

[00:09:37] Their bodies needed the drug to continue functioning. They couldn’t live a normal life without it.

[00:09:45] What’s more, people had started to abuse OxyContin, they had started to use it in a way it wasn’t designed for, and in a way that Purdue Pharma had claimed was not possible, or at least was not easy to do. 

[00:10:01] In its original form, it came as a tablet, which the patient would swallow, and the pill would be broken down in the body over a period of 12 hours. 

[00:10:14] Essentially, the claim was that, although one pill contained a powerful drug, only small amounts of the drug would be released into the body over a prolonged period.

[00:10:26] Before long, people found ways to take the pill in other ways, either crushing up the pill and snorting it, that's sucking it up into their nose, or even injecting it directly into their veins

[00:10:43] Taking the drug in this way meant that the high, the feeling of pleasure, was a lot more intense - the drug went directly into the system, as opposed to being released over a longer period.

[00:11:00] Recent investigations have shown that Purdue Pharma senior executives were aware of this - they knew exactly what was going on - but didn’t do anything about it.

[00:11:13] This increasing abuse of OxyContin led to both a black market in the drug and the growth of so-called “pill mills”, doctors’ clinics that were happy to provide prescriptions to anyone even if they didn’t medically need them.

[00:11:32] But even if these pills were bought on the black market, from a pill mill or from another unlicensed individual, prescription opioids weren’t cheap. It might cost $15 or $20 for one OxyContin pill, if bought illegally. 

[00:11:51] And the same types of people that were illegally selling these prescription pills, the drug dealers essentially, they would often have something else for sale that was much more powerful and much cheaper: heroin, and later its even more powerful cousin, fentanyl.

[00:12:12] The cycle of addiction that doctors started to see would be someone first prescribed an opioid to treat pain, which would lead to abuse of the drug - either using it more frequently or in larger quantities than prescribed by the doctor - and often lead to the abuse of more serious, illegal and really dangerous opioids such as heroin and fentanyl.

[00:12:40] To give you some numbers on this, data from the National Institute on Drug Abuse suggests that in America anywhere between 20-30% of patients who are prescribed opioids misuse them, and around 10% of people who use opioids develop some sort of addiction.

[00:13:03] Of those people who misuse opioids, around 5% of them move on to heroin and fentanyl. So, for every 100 people who are prescribed opioids by their doctor, 1 is likely to develop a heroin or fentanyl addiction.

[00:13:21] Put the other way, of heroin users in the United States, 80% of them first abused prescription opioids - 4 out of 5 heroin users in the country got started with drugs prescribed by a doctor.

[00:13:38] And to state the obvious, to say what we all know, becoming a heroin addict isn’t generally a sensible life choice. 

[00:13:47] For most addicts, it is an all-consuming disease, and your entire life becomes based on feeding your expensive drug addiction. For many people it is a disease that leads to homelessness, increased criminal activity, and overdose and death.

[00:14:07] What’s more, the boom in use of fentanyl, which is a synthetic opioid even more powerful and dangerous than heroin, has made the life of an American opioid addict even more precarious, even more scary and dangerous.

[00:14:25] Fentanyl, like heroin and morphine, is nothing new. 

[00:14:29] It was first made in 1960 and used as a pain killer. But it is even stronger than heroin - about 50 times stronger to be precise - and cheaper.

[00:14:41] So, as more and more Americans looked for cheaper alternatives to the opioids their doctors were prescribing them, there was a boom in the production of fentanyl for sale on the street.

[00:14:55] Because it is so powerful and cheap to produce, it can be smuggled into the United States more easily than any other drug.

[00:15:04] One kilogramme of fentanyl can be bought from suppliers in East Asia for around $3,000, and relatively easily brought into the United States, either simply posted in the normal post or sent first to Mexico and then smuggled across the border. 

[00:15:23] This one kilo, because it is so incredibly powerful, can be cut up and mixed with other substances and can lead to up to $1.5 million in profits for the drug dealers.

[00:15:37] And of course, for the drug users, the people who are either using fentanyl knowingly, or are using other drugs that have small amounts of fentanyl in them, this can be incredibly dangerous.

[00:15:51] Just 2mg, 0.002 grammes, is considered to be a lethal dose for the average person, so it is very easy for someone to unwittingly, unintentionally, take more than they think and die.

[00:16:10] Indeed, of the 100,000 people who died of a drug overdose in the United States in the last year, two thirds were linked to fentanyl.

[00:16:20] So, you might be thinking, who is actually responsible for this, and is this situation going to change any time soon?

[00:16:30] In terms of the responsibility question, there have been numerous lawsuits against the drug manufacturers and sales organisations for pushing their drugs on doctors, encouraging them to prescribe them while being aware that they were more addictive than they claimed.

[00:16:49] The main target in this is Purdue Pharma, the company behind OxyContin, and indeed the Sackler family, the people who own Purdue Pharma.

[00:17:01] There is no doubt that Purdue Pharma and the Sackler family grew fabulously wealthy on the back of OxyContin, with estimates of sales of the drug totalling $30 billion over the past 25 years or so.

[00:17:16] Evidence has come to light that has shown that senior executives were aware of the fact that it was addictive, and the company was fined $4.5 billion in exchange for the Sackler family receiving immunity from future prosecution. 

[00:17:34] Essentially, the Sacklers agreed to pay out this vast amount of money so that they wouldn’t have to pay out any more, or didn’t risk being thrown in prison. 

[00:17:46] This case is still ongoing, so we will have to see where it ends.

[00:17:52] US authorities have been clamping down onpill mills”, the doctors clinics and pharmacies that were giving out prescriptions to anyone, regardless of whether they were actually in pain or not. And dozens of doctors and pharmacy owners have been prosecuted and ended up in jail.

[00:18:11] But the reality is that the very drugs that started the opioid crisis - drugs such as OxyContin - are still prescribed in vast amounts every single day.

[00:18:23] In 2020 there were 142,816,781 opioid prescriptions, one for every 2.4 people, including children. 

[00:18:37] To put it another way, if you were to take five average Americans, two would have a prescription for opioids.

[00:18:47] In the interests of balance - this number has gone down. At its peak in 2012 there were 255,207,954 opioid prescriptions, almost exactly one opioid prescription for every single adult in the United States.

[00:19:09] So, doctors are prescribing fewer opioids than they were 10 years ago, but the number is still massive.

[00:19:17] What’s next, you might be thinking?

[00:19:19] “Fixing” the opioid crisis is clearly far more complicated than simply stopping prescribing opioids. 

[00:19:27] Opioids are incredibly effective at reducing pain, and pain is recognised as a global health problem that affects 20% of the adult population. There are hundreds of millions of people who use opioids, use prescription painkillers, safely and happily, and for whom these drugs allow them to live a normal and pain-free life when the alternative would be constant pain. 

[00:19:55] So there are few that are suggesting that preventing the use of opioids is the answer.

[00:20:01] Indeed, there are plenty of other countries, Germany for example, that prescribe opioids in similarly high levels to the United States, but where there has not been a corresponding epidemic of opioid misuse and addiction.

[00:20:18] There is also the problem of the ten million or so Americans who currently misuse opioids, and the million or so who are currently addicted to heroin and fentanyl. Again, clearly simply telling them to “stop” is not a solution, especially - for the ones addicted to heroin and fentanyl at least - they are already getting their drugs from illegal drug dealers. The fact that what they are doing is illegal is not a sufficient deterrent.

[00:20:48] In terms of making it harder to abuse these opioids, the makers of OxyContin have made the drug harder to misuse

[00:20:58] In 2010 they released a new form of the pill which meant that if it was crushed it would turn into a substance that was harder to snort or inject.

[00:21:10] The idea was good - the theory was that if it were harder to abuse, people would abuse it less. They would have to swallow it, and the slow-release system would mean that there wasn’t a near-instant high.

[00:21:25] Unfortunately, data suggests that this simply accelerated people’s switch to heroin and fentanyl. Almost immediately after this new “abuse-proof” pill was released, heroin overdoses jumped up

[00:21:41] So the theory goes that abusing this legal, prescription pill became such a hassle that people just switched over to the easy, illegal, cheaper and more powerful alternatives.

[00:21:55] Of course, there are plenty of theories about how to reduce the number of people who end up addicted to opioids, and there are really three key stages to this journey, three key areas that people talk about.

[00:22:10] Firstly, it starts with the manufacturers of prescription opioids, and ensuring that the drugs that they are bringing to market can be taken as safely as possible, and that these drugs are offered to doctors with correct, evidence-based guidance on their use.

[00:22:29] Secondly, that the doctors are prescribing the drugs to the people who really need them, not to people who want to abuse them.

[00:22:38] And thirdly, for people who do unfortunately end up abusing opioids, especially those who move to more powerful and dangerous “street” drugs, such as heroin and fentanyl, that there are support networks for them to both take drugs safely, without the risk of dying, and to overcome their addiction, to kick their habit, and to return to society and live a normal life again.

[00:23:07] There is increasing pressure on the government, especially from groups of people who have lost a loved one to the opioid crisis, to work on each of these three stages, three areas, but the Opioid Crisis is not just still in full swing, there are more and more people dying every single year. 

[00:23:27] Indeed, there were 35% more opioid-related deaths in 2021 than in 2020, and although the number of opioids prescribed is reducing, the number of people dying continues to increase every year.

[00:23:45] In some areas of the United States, the levels of opioid-related deaths have even meant that the average life expectancy has decreased, so for the first time in history people are dying younger than their parents.

[00:24:03] So, while there is no easy or simple solution in sight, and the American opioid industry remains a multi-billion dollar market, the grim reality is that hundreds of thousands, if not millions, of people will continue to die unnecessarily.

[00:24:21] And the terrible irony of it all is that for the majority of people who will die, the journey towards addiction and death will start with being handed a harmless-looking piece of paper by their doctor.

[00:24:38] OK then, that is it for today's episode on The Opioid Crisis. I know we normally like to finish on a positive note, but unfortunately when it comes to this particular subject, there isn’t a lot of good news to share.

[00:24:53] As always, I would love to know what you thought of this episode. 

[00:24:57] What do you see as some potential solutions to this crisis? 

[00:25:01] What are the policies towards drug use and drug addiction in your country? 

[00:25:05] What do you think works, and doesn’t work?

[00:25:09] I would love to know.

[00:25:11] You can head right into our community forum, which is at community.leonardoenglish.com and get chatting away to other curious minds.

[00:25:20] You've been listening to English Learning for Curious Minds, by Leonardo English.

[00:25:25] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.


[END OF EPISODE]


[00:00:00] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English. 

[00:00:12] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.

[00:00:22] I'm Alastair Budge, and today we are going to be talking about The Opioid Crisis in America.

[00:00:29] In the United States, 75,000 people every year, that’s over 200 people every single day, die from opioid-related drug overdoses. 

[00:00:41] This is a number that has boomed since the mid 1990s.

[00:00:45] So, in this episode we are going to talk about some of the reasons why that is, why has the US become the world’s hotspot, or world capital even, of opioid addiction, why so many Americans are becoming addicted to opioids, who is responsible for this, and what it is doing to society.

[00:01:07] OK, then, the opioid crisis.

[00:01:12] Let’s start with a quick definition of what an opioid is. 

[00:01:17] An opioid is a drug that kills pain and causes pleasure.

[00:01:22] The name comes from the original, natural, opioid: opium - the drug that can be found in poppy seeds.

[00:01:31] Other opioids include morphine, heroin, fentanyl, codeine, and oxycodone.

[00:01:38] And in the past twenty years, over half a million Americans, that’s more than the population of Malta and almost ten times as many Americans as died in the Vietnam war, have died after overdosing on opioids.

[00:01:54] It is a uniquely American problem, it’s something that doesn’t happen anywhere else to anywhere near the same degree.

[00:02:02] In the United States there are 19 opioid-related deaths per 100,000 people.

[00:02:09] The average for Western Europe is 2.14, so the average person in the United States is almost 9 times more likely to die of an opioid overdose than someone living in Western Europe.

[00:02:24] In 1990, however, those two numbers were much closer. In the United States there were 2.01 opioid deaths per 100,000 people vs. 1.39 in Western Europe.

[00:02:38] So, the question you might be quite rightly asking yourself is…what happened?

[00:02:45] The United States has spent over a trillion dollars on the so-called “War on Drugs”, yet there have never before been more Americans using and dying from drugs and opioids in particular.

[00:03:00] What is going on?

[00:03:02] Well, if you are unfamiliar with the Opioid Crisis, how the United States got itself into this situation may surprise you.

[00:03:11] When we are taught in schools about why we shouldn’t take drugs, we are normally shown videos of teenagers being pressured to take drugs at a party or at the swings at a public park. 

[00:03:26] The traditional view of drug addiction, or at least the view when I was growing up, was that it might start with something small - a few puffs of a cigarette or secretly stealing a bottle of alcohol from your parents’ cupboard to drink with your friends, which might lead to smoking cannabis, snorting cocaine, and before long you are addicted to heroin and selling all of your possessions to feed your habit.

[00:03:53] In the American case, however, the boom in drug use was not caused by teenagers just getting naughtier.

[00:04:02] In fact, when the majority of problem opioid users were first introduced to opioids, it wasn’t on a park bench or at a party when they were teenagers.

[00:04:14] It was in a doctor’s clinic, by their doctor, who prescribed them as a way to treat pain.

[00:04:22] Now, although the boom in prescription opioids started in the late 1990s, doctors have known about the pain-killing properties of opioids for hundreds of years.

[00:04:34] In the American Civil War large numbers of soldiers returned home addicted to morphine, which they had first taken as a painkiller.

[00:04:44] Heroin was also legally manufactured, and it was sold at pharmacies until 1924.

[00:04:53] The reason that it was stopped, that it was made illegal, and that doctors stopped freely prescribing opioids to patients was precisely because they’re addictive.

[00:05:05] Opioids don’t just kill pain, they make you feel pleasure, and the more you take them, the harder it is to stop taking them. 

[00:05:15] They are highly addictive, and even though they might be very effective drugs to stop the pain, the body often becomes dependent on the drug.

[00:05:26] Doctors could prescribe opioids, but they were often reluctant to do so unless there were no alternatives - they knew that patients could get addicted, and wanted to avoid this at all costs.

[00:05:40] Then, in the mid 1990s there was a new kid on the block, a new drug that came along, which its creators claimed wasn’t addictive.

[00:05:52] In 1996 an American pharmaceutical company called Purdue Pharma released a drug called OxyContin, which its representatives claimed was significantly less addictive than other opioids, indeed underlining that less than 1% of people using the drug become addicted.

[00:06:15] Purdue Pharma already had a number of other successful painkillers, but they were used to treat severe pain for people suffering from diseases such as cancer.

[00:06:27] If they could convince doctors that this new drug was non-addictive, then doctors would be more likely to prescribe it for patients with less severe pain - people recovering from accidents, people who weren’t always in extreme pain but people who would benefit from pain relief. 

[00:06:49] And if these patients were able to be relieved of their pain, no matter how small, on this drug that was incredibly unlikely to lead to addiction, then that was the right thing for the doctors to do.

[00:07:05] What’s more, sales representatives, the employees who were responsible for encouraging doctors to prescribe these drugs to their patients, were highly incentivised to get doctors to start prescribing their drugs - the more drugs their doctors prescribed, the bigger bonus the salesperson would get.

[00:07:26] Indeed, in 2001 the average sales representative’s salary for Purdue Pharma was $55,000 yet the average bonus paid out was $71,500, so more than half of their total pay was coming from these bonuses they got after persuading doctors to sell more and more OxyContin.

[00:07:52] As you might expect, sales grew quickly, and by 2001 Oxycontin was the most prescribed brand name narcotic medication for treating moderate-to-severe pain. 

[00:08:06] Millions of Americans were using it, and the Purdue Pharma salespeople had become increasingly efficient at getting doctors to prescribe it to more and more people, and in larger and larger doses.

[00:08:21] The FDA, the Food and Drug Administration, first approved 10mg, 20mg and 40mg doses of the pill, but later on approved 80 and 160 mg doses.

[00:08:38] The larger the dose and the more pills doctors prescribed, the more money Purdue Pharma and its salespeople made, and there are multiple reports of employees being encouraged to pressure the doctors into prescribing more and more OxyContin.

[00:08:56] After all, fewer than 1% of patients become addicted, and it was very effective at killing the pain, so what was the issue?

[00:09:06] Well, the issue was that the “less than 1%” number could not be substantiated, they couldn’t prove it, and it simply wasn’t true.

[00:09:17] Before long, doctors started to see this for themselves, and to suspect that the real number was much higher. Patients couldn’t get off OxyContin, they couldn’t stop using it. When they did, many suffered withdrawal symptoms, pain, and mood swings.

[00:09:37] Their bodies needed the drug to continue functioning. They couldn’t live a normal life without it.

[00:09:45] What’s more, people had started to abuse OxyContin, they had started to use it in a way it wasn’t designed for, and in a way that Purdue Pharma had claimed was not possible, or at least was not easy to do. 

[00:10:01] In its original form, it came as a tablet, which the patient would swallow, and the pill would be broken down in the body over a period of 12 hours. 

[00:10:14] Essentially, the claim was that, although one pill contained a powerful drug, only small amounts of the drug would be released into the body over a prolonged period.

[00:10:26] Before long, people found ways to take the pill in other ways, either crushing up the pill and snorting it, that's sucking it up into their nose, or even injecting it directly into their veins

[00:10:43] Taking the drug in this way meant that the high, the feeling of pleasure, was a lot more intense - the drug went directly into the system, as opposed to being released over a longer period.

[00:11:00] Recent investigations have shown that Purdue Pharma senior executives were aware of this - they knew exactly what was going on - but didn’t do anything about it.

[00:11:13] This increasing abuse of OxyContin led to both a black market in the drug and the growth of so-called “pill mills”, doctors’ clinics that were happy to provide prescriptions to anyone even if they didn’t medically need them.

[00:11:32] But even if these pills were bought on the black market, from a pill mill or from another unlicensed individual, prescription opioids weren’t cheap. It might cost $15 or $20 for one OxyContin pill, if bought illegally. 

[00:11:51] And the same types of people that were illegally selling these prescription pills, the drug dealers essentially, they would often have something else for sale that was much more powerful and much cheaper: heroin, and later its even more powerful cousin, fentanyl.

[00:12:12] The cycle of addiction that doctors started to see would be someone first prescribed an opioid to treat pain, which would lead to abuse of the drug - either using it more frequently or in larger quantities than prescribed by the doctor - and often lead to the abuse of more serious, illegal and really dangerous opioids such as heroin and fentanyl.

[00:12:40] To give you some numbers on this, data from the National Institute on Drug Abuse suggests that in America anywhere between 20-30% of patients who are prescribed opioids misuse them, and around 10% of people who use opioids develop some sort of addiction.

[00:13:03] Of those people who misuse opioids, around 5% of them move on to heroin and fentanyl. So, for every 100 people who are prescribed opioids by their doctor, 1 is likely to develop a heroin or fentanyl addiction.

[00:13:21] Put the other way, of heroin users in the United States, 80% of them first abused prescription opioids - 4 out of 5 heroin users in the country got started with drugs prescribed by a doctor.

[00:13:38] And to state the obvious, to say what we all know, becoming a heroin addict isn’t generally a sensible life choice. 

[00:13:47] For most addicts, it is an all-consuming disease, and your entire life becomes based on feeding your expensive drug addiction. For many people it is a disease that leads to homelessness, increased criminal activity, and overdose and death.

[00:14:07] What’s more, the boom in use of fentanyl, which is a synthetic opioid even more powerful and dangerous than heroin, has made the life of an American opioid addict even more precarious, even more scary and dangerous.

[00:14:25] Fentanyl, like heroin and morphine, is nothing new. 

[00:14:29] It was first made in 1960 and used as a pain killer. But it is even stronger than heroin - about 50 times stronger to be precise - and cheaper.

[00:14:41] So, as more and more Americans looked for cheaper alternatives to the opioids their doctors were prescribing them, there was a boom in the production of fentanyl for sale on the street.

[00:14:55] Because it is so powerful and cheap to produce, it can be smuggled into the United States more easily than any other drug.

[00:15:04] One kilogramme of fentanyl can be bought from suppliers in East Asia for around $3,000, and relatively easily brought into the United States, either simply posted in the normal post or sent first to Mexico and then smuggled across the border. 

[00:15:23] This one kilo, because it is so incredibly powerful, can be cut up and mixed with other substances and can lead to up to $1.5 million in profits for the drug dealers.

[00:15:37] And of course, for the drug users, the people who are either using fentanyl knowingly, or are using other drugs that have small amounts of fentanyl in them, this can be incredibly dangerous.

[00:15:51] Just 2mg, 0.002 grammes, is considered to be a lethal dose for the average person, so it is very easy for someone to unwittingly, unintentionally, take more than they think and die.

[00:16:10] Indeed, of the 100,000 people who died of a drug overdose in the United States in the last year, two thirds were linked to fentanyl.

[00:16:20] So, you might be thinking, who is actually responsible for this, and is this situation going to change any time soon?

[00:16:30] In terms of the responsibility question, there have been numerous lawsuits against the drug manufacturers and sales organisations for pushing their drugs on doctors, encouraging them to prescribe them while being aware that they were more addictive than they claimed.

[00:16:49] The main target in this is Purdue Pharma, the company behind OxyContin, and indeed the Sackler family, the people who own Purdue Pharma.

[00:17:01] There is no doubt that Purdue Pharma and the Sackler family grew fabulously wealthy on the back of OxyContin, with estimates of sales of the drug totalling $30 billion over the past 25 years or so.

[00:17:16] Evidence has come to light that has shown that senior executives were aware of the fact that it was addictive, and the company was fined $4.5 billion in exchange for the Sackler family receiving immunity from future prosecution. 

[00:17:34] Essentially, the Sacklers agreed to pay out this vast amount of money so that they wouldn’t have to pay out any more, or didn’t risk being thrown in prison. 

[00:17:46] This case is still ongoing, so we will have to see where it ends.

[00:17:52] US authorities have been clamping down onpill mills”, the doctors clinics and pharmacies that were giving out prescriptions to anyone, regardless of whether they were actually in pain or not. And dozens of doctors and pharmacy owners have been prosecuted and ended up in jail.

[00:18:11] But the reality is that the very drugs that started the opioid crisis - drugs such as OxyContin - are still prescribed in vast amounts every single day.

[00:18:23] In 2020 there were 142,816,781 opioid prescriptions, one for every 2.4 people, including children. 

[00:18:37] To put it another way, if you were to take five average Americans, two would have a prescription for opioids.

[00:18:47] In the interests of balance - this number has gone down. At its peak in 2012 there were 255,207,954 opioid prescriptions, almost exactly one opioid prescription for every single adult in the United States.

[00:19:09] So, doctors are prescribing fewer opioids than they were 10 years ago, but the number is still massive.

[00:19:17] What’s next, you might be thinking?

[00:19:19] “Fixing” the opioid crisis is clearly far more complicated than simply stopping prescribing opioids. 

[00:19:27] Opioids are incredibly effective at reducing pain, and pain is recognised as a global health problem that affects 20% of the adult population. There are hundreds of millions of people who use opioids, use prescription painkillers, safely and happily, and for whom these drugs allow them to live a normal and pain-free life when the alternative would be constant pain. 

[00:19:55] So there are few that are suggesting that preventing the use of opioids is the answer.

[00:20:01] Indeed, there are plenty of other countries, Germany for example, that prescribe opioids in similarly high levels to the United States, but where there has not been a corresponding epidemic of opioid misuse and addiction.

[00:20:18] There is also the problem of the ten million or so Americans who currently misuse opioids, and the million or so who are currently addicted to heroin and fentanyl. Again, clearly simply telling them to “stop” is not a solution, especially - for the ones addicted to heroin and fentanyl at least - they are already getting their drugs from illegal drug dealers. The fact that what they are doing is illegal is not a sufficient deterrent.

[00:20:48] In terms of making it harder to abuse these opioids, the makers of OxyContin have made the drug harder to misuse

[00:20:58] In 2010 they released a new form of the pill which meant that if it was crushed it would turn into a substance that was harder to snort or inject.

[00:21:10] The idea was good - the theory was that if it were harder to abuse, people would abuse it less. They would have to swallow it, and the slow-release system would mean that there wasn’t a near-instant high.

[00:21:25] Unfortunately, data suggests that this simply accelerated people’s switch to heroin and fentanyl. Almost immediately after this new “abuse-proof” pill was released, heroin overdoses jumped up

[00:21:41] So the theory goes that abusing this legal, prescription pill became such a hassle that people just switched over to the easy, illegal, cheaper and more powerful alternatives.

[00:21:55] Of course, there are plenty of theories about how to reduce the number of people who end up addicted to opioids, and there are really three key stages to this journey, three key areas that people talk about.

[00:22:10] Firstly, it starts with the manufacturers of prescription opioids, and ensuring that the drugs that they are bringing to market can be taken as safely as possible, and that these drugs are offered to doctors with correct, evidence-based guidance on their use.

[00:22:29] Secondly, that the doctors are prescribing the drugs to the people who really need them, not to people who want to abuse them.

[00:22:38] And thirdly, for people who do unfortunately end up abusing opioids, especially those who move to more powerful and dangerous “street” drugs, such as heroin and fentanyl, that there are support networks for them to both take drugs safely, without the risk of dying, and to overcome their addiction, to kick their habit, and to return to society and live a normal life again.

[00:23:07] There is increasing pressure on the government, especially from groups of people who have lost a loved one to the opioid crisis, to work on each of these three stages, three areas, but the Opioid Crisis is not just still in full swing, there are more and more people dying every single year. 

[00:23:27] Indeed, there were 35% more opioid-related deaths in 2021 than in 2020, and although the number of opioids prescribed is reducing, the number of people dying continues to increase every year.

[00:23:45] In some areas of the United States, the levels of opioid-related deaths have even meant that the average life expectancy has decreased, so for the first time in history people are dying younger than their parents.

[00:24:03] So, while there is no easy or simple solution in sight, and the American opioid industry remains a multi-billion dollar market, the grim reality is that hundreds of thousands, if not millions, of people will continue to die unnecessarily.

[00:24:21] And the terrible irony of it all is that for the majority of people who will die, the journey towards addiction and death will start with being handed a harmless-looking piece of paper by their doctor.

[00:24:38] OK then, that is it for today's episode on The Opioid Crisis. I know we normally like to finish on a positive note, but unfortunately when it comes to this particular subject, there isn’t a lot of good news to share.

[00:24:53] As always, I would love to know what you thought of this episode. 

[00:24:57] What do you see as some potential solutions to this crisis? 

[00:25:01] What are the policies towards drug use and drug addiction in your country? 

[00:25:05] What do you think works, and doesn’t work?

[00:25:09] I would love to know.

[00:25:11] You can head right into our community forum, which is at community.leonardoenglish.com and get chatting away to other curious minds.

[00:25:20] You've been listening to English Learning for Curious Minds, by Leonardo English.

[00:25:25] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.


[END OF EPISODE]