In the Fight Against Opioids, Mistakes Were Made

In the early days of the opioid crisis, public officials had reasons to blame it on all the pills. News stories featured people who, to the shock of their neighbors and loved ones, had died suddenly of drug overdoses. In an emergency, authorities do what they can with the tools at hand. In tightening controls on doctors who prescribe pain relievers, state and federal agencies were focusing on the aspect of the problem most subject to regulatory intervention.

To some degree, the strategy worked. According to the Centers for Disease Control, overdose deaths declined by around 5 percent in 2018—a dip attributable almost exclusively to fewer deaths from oxycodone, hydrocodone, and other prescription opioids. (Fentanyl deaths are still climbing.) Now that the fever of the opioid crisis may be breaking, Americans can revisit some of the stories we have told ourselves about the role of prescription medication in the crisis.

Did policymakers and public health experts correctly assess who was at risk of becoming addicted to opioid medications? Were their views on the addictive potential of such drugs realistic? Did they anticipate the consequences of policies devised to constrain doctors from over-prescribing? In retrospect, policymakers seriously misjudged the answers to these questions, overestimating the risk that these drugs posed to the average patient while simultaneously doing too little to urge clinicians to identify those most vulnerable to addiction The best time to correct course is now—while the opioid problem still commands public