A historic opioid trial highlights what we know about the deadly drugs

There are no real winners in the opioid epidemic. But on August 26, a judge in Oklahoma handed a small victory to the state, which had sued opioid-maker Johnson & Johnson for its role in the morass.

In the first such ruling to hold a pharmaceutical company responsible for the opioid crisis, the judge found that the company had falsely and dangerously marketed the powerful drugs, a deception that led to addiction and death for too many people, the New York Times and other news outlets reported. To help offset the cost of the epidemic to the state, the company has to pay $572 million to the state of Oklahoma.

The rise of opioids undoubtedly has helped people ease severe pain. But for many people, the drugs fueled a dangerous addiction. Public health officials have been scrambling to tally the destruction, particularly as the death toll has risen in recent years. Scientists have been scrambling, too, trying to mitigate the harm and search for drug alternatives that can ease pain without opioids’ ill effects.

Here’s what we know about the extent of the opioid epidemic, and where we stand on efforts to slow it.

Opioids can affect the very young and very old and everyone in between.

In the United States, more than 130 people die every day after an opioid overdose, the Centers for Disease Control and Prevention estimates. In 2015, an estimated 91.8 million U.S. adults — or 1 in 3 people — used prescription opioids (SN: 8/1/17). Nearly 5 percent of all the adults in the country misused prescription opioids that year. Opioid use is also on the rise among pregnant women (SN: 8/9/18), raising complex concerns for the health of both mothers and babies (SN: 12/12/18).

Young adults and teens are bearing an extra-large burden. Among Americans aged 25 to 34, opioids were implicated in 1 in 5 deaths in 2016 (SN: 6/1/18). In 15- to 24-year-olds, 12 percent of deaths came from opioid overdoses that year.

Even children are not safe. Studies have noted an uptick in emergency room visits for children accidentally exposed to opioids or methadone, which is used to treat opioid addiction, with potentially catastrophic effects (SN: 3/14/18).

But there is a silver lining found in a 2018 survey on adolescents’ drug use: Beginning in 2014, rates of prescription opioid misuse began to fall among high school seniors, a downward trend that’s held through 2018.

Opioids can be highly addictive, problematic and deadly.

People may become addicted to opioids after a short-term prescription for a minor problem, scientists have found (SN: 5/19/17). After an ankle sprain — a mild injury that doesn’t usually require powerful painkillers — people who were sent home with prescriptions for more opioids were more likely to refill those prescriptions than people who received fewer opioids initially, a cycle that highlights how more exposure to the drugs can lead to more use.

What’s more, some experiments suggest that opioids, instead of easing nerve pain, could actually prolong it. After a nerve injury, rats treated with morphine had pain that lasted twice as long as pain in rats treated with a placebo (SN: 5/30/16).

Opioids kill people by quickly shutting down breathing, in part by hitting brain areas that oversee this vital task. Without air, the person essentially suffocates (SN: 3/31/18). Fentanyl, a particularly powerful opioid, may stop breathing in some people by freezing the chest muscles that allow air to flow in and out, some research suggests (SN: 8/19/16).

But there are reasons for hope.

Scientists are making headway in reducing the risks of deadly overdoses. Technological solutions, such as an app that tracks breathing and calls 911 if an overdose seems likely, offer hope (SN: 1/9/19). So does a better opioid antidote, including one spiked with tiny nanoparticles that eventually might combat powerful opioids such as fentanyl (SN: 3/31/19).

And there are efforts to move away from using opioids altogether. The search for better, safer painkillers is on, with some promising leads (SN: 5/30/17).

For now, the recent ruling in Oklahoma may signal a societal reckoning. A wave of an estimated 2,000  opioid lawsuits are sweeping the country, brought by states, cities and local governments.