October 9, 2023

The Opioid Epidemic Continues: Overdose Rates Rise Despite Decline in Prescription Pain Pill Use

Table of Contents

Table of Contents

Contributors & Editors

Julie Miller

Addiction & Mental Health Writer

Last Update on October 9, 2023

grief and loss signs and symptoms

Let us help you start your journey to recovery.

Get compassionate evidence- based and trauma focused substance abuse treatment in Arizona.



The Opioid Epidemic in the United States has resulted in over 750,000 deaths due to overdose from 1999 to 2020.

The proliferation of Fentanyl, an incredibly potent synthetic opioid, has significantly contributed to the recent sharp rise in overdose fatalities.

Minority communities and rural areas have borne the brunt of this epidemic.

Despite attempts to tackle this crisis, such as improved access to Naloxone and treatment, a considerable amount of work must be done to resolve this urgent public health emergency.

The Washington Post recently published an article detailing some troubling data.


The Opioid Crisis: From Prescription Plunge to Overdose Surge

Here are some key points from a recent article by The Washington Post.


Prescription Pills vs. Overdose Rates

The number of prescription opioid pain pills in the U.S. decreased by 45% from 2011 to 2019, but fatal overdoses reached record highs due to increased heroin and illegal fentanyl use.


Evolution of the Addiction Crisis

The widespread availability of pain pills fueled the initial wave of opioid addiction.

As law enforcement increased, public concerns grew, and changes in prescription practices for opioids were implemented, users turned to street drugs.


Insights from DEA Data

Prescriptions for hydrocodone and oxycodone peaked at 12.8 billion pills in 2011, then decreased to 7.1 billion in 2019.

In 2019, shipments of 80-milligram oxycodone pills decreased by 92% compared to a decade ago.


 Connection Between Prescription Rates and Overdose Deaths

Certain counties in West Virginia, Kentucky, and Ohio have experienced many fentanyl-related deaths, and it has been noted that these areas also had high prescription rates.

Furthermore, counties with the highest average doses between 2006 and 2013 had the highest death rates in the following six years.


Soaring Overdose Statistics

Over 100,000 people died from drug overdoses in 2021 for the first time in U.S. history.

The following year, in 2022, that number rose to 110,000, with two-thirds of those deaths attributed to synthetic opioids like fentanyl.


The Transition: From Pills to Street Drugs

Daniel Ciccarone, a researcher, emphasizes the transition from opioid pills to heroin and the resulting lethal fentanyl wave.

DEA records from 2015 to 2019 provide a detailed overview of prescription patterns.


Current State of the Opioid Crisis

The crisis of synthetic fentanyl, originating from China and Mexico, has caused unprecedented damage.

An investigation reveals that illegal fentanyl is now the leading cause of death among Americans aged 18 to 49.


An Exception: Buprenorphine

Prescription opioids decreased, but buprenorphine for addiction treatment increased, highlighting its importance in addressing the crisis.


Accountability and Litigation

Many cities and states are accusing different players in the pharmaceutical industry of contributing to the opioid crisis, even though there are clear signs of widespread addiction.

Shockingly, over 300,000 people have lost their lives due to prescription opioids since 2000.

Recent data reveals that many pain pills are still being shipped to the U.S., resulting in many fatalities.


Expert Opinions and Legal Repercussions

G. Caleb Alexander notes that while legal pain pill prescriptions have decreased, he is saddened by the ongoing loss of lives.

The use of legal data could potentially strengthen cases against companies that are suspected of ignoring warning signs.

Peter J. Mougey emphasizes the devastating and long-lasting effects of prescription opioids and the lack of responsibility shown by the defendants.



A Summary: National Decline in Prescription Pills

Reasons for Decline:

The reduction in prescription pills nationwide can be attributed to changes in regulations and society.

The DEA targeted major pill distributors in the late 2000s and early 2010s, while law enforcement went after pill mills and unscrupulous doctors.

The medical community also changed its stance on pain medication due to warnings about abuse, which went against previous messaging by pharmaceutical companies.

The DEA made it more difficult to prescribe certain medications with hydrocodone by reclassifying them in 2014.

The CDC issued guidelines in 2016 that limited daily opioid use, making doctors more cautious in their prescription practices. As of 2019, 39 states had implemented laws or regulations to restrict opioid prescriptions.


Data Source

The DEA’s ARCOS database tracked over 100 billion oxycodone and hydrocodone pills distributed by significant companies between 2006 and 2014.


Shifts in the Industry

The drug manufacturing industry experienced a shift in market dynamics between 2006 and 2014.

During this time, Mallinckrodt, Actavis, and Par Pharmaceutical held most of the market share.

However, by 2019, their combined share had decreased to 57%.

Despite facing legal troubles, Mallinckrodt’s SpecGx remained the top manufacturer of pain pills in 2019.

However, the company has since been under bankruptcy injunctions starting in 2020.

Purdue Pharma, which has been heavily criticized for its role in the opioid crisis due to its production of OxyContin, saw its market share increase almost fivefold by 2019.

In the face of numerous lawsuits, Purdue was forced to declare bankruptcy, and the Sackler family, who own the company, faced intense scrutiny.

KVK Tech, a newer player in the industry, became the third-largest manufacturer in 2019.

However, the company has also faced legal action and criminal charges.


Settlements & Financial Impacts

Several prominent corporations have resolved legal disputes through settlement payments.

Mallinckrodt initially agreed to pay $1.7 billion but later declared bankruptcy, reducing the amount they paid.

Endo Pharmaceuticals and Teva Pharmaceuticals reached settlements of $600 million and over $4 billion, respectively.

According to The Post’s analysis, prescription opioid use has declined for the eleventh consecutive year, consistent with other healthcare data.

Annual sales of prescription opioids in 2012 amounted to $8.5 billion, but by 2022, they had decreased to $3.8 billion.


Changing Medical Perspective

The decline in prescription opioid volume, particularly high-dose prescriptions, reflects a broader change in medical practice driven by accountability, new regulations, and societal attitudes.

The current direction is increasingly anti-opioid.



An Overview: Shift to Heroin and Fentanyl in the U.S. Opioid Crisis

The Transition From Prescription to Street Drugs

In the early 2010s, many users turned to heroin, which was cheaper and provided similar euphoric effects to illicit pain pills like hydrocodone and oxycodone.


Hamilton County’s Struggle

In 2011, Hamilton County in Ohio experienced a significant rise in the distribution of hydrocodone and oxycodone.

However, after the authorities took action to address overprescribing, the number of pills was reduced by 2019.

Unfortunately, drug dealers in the area started replacing the shortage with heroin mixed with potent substances such as fentanyl and carfentanil.

As a result, the community suffered from a surge in overdoses and fatalities, confirmed by Thomas W. Synan Jr., the local police chief.


Hope on the Horizon

Hamilton County saw a six-year low in fatal drug overdoses in 2022.1

This is due to public health interventions and increased access to naloxone, which could result in even lower numbers in 2023.


The Situation in Appalachia

Between 2006 and 2009, pill distribution in West Virginia, southwestern Virginia, and Kentucky was exceptionally high.

However, by 2019, there was a significant reduction in per capita pill distribution.

For instance, Mingo County’s pill distribution dropped to the national average after being astronomically high.

Cabell County also saw a significant decline, but its numbers remained above the national average.


Additional Contributing Factors

New Synthetic Opioids ‘Nitazenes’ Are Potentially More Potent Than Fentanyl

The introduction of Nitazenes into the illicit drug market exacerbates the already dire opioid crisis.2

As a class of synthetic opioids, Nitazenes, like Isotonitazene and Metonitazene, are known for their extreme potency, with some variants being multiple times more potent than Fentanyl.

Their presence amplifies the risk of unintentional overdoses, as even minuscule amounts can prove lethal.

Often, these drugs are mixed with other substances, making it difficult for users to gauge dosage and purity.

As a result, emergency responders and medical professionals face heightened challenges in treating overdoses, especially when encountering unfamiliar synthetic opioids.

The surge of Nitazenes further underscores the critical need for robust harm reduction measures and timely access to addiction treatment services.


The Addition of ‘Tranq’ Dope (Xylazine) into the Opioid Crisis

Xylazine, developed initially as a veterinary tranquilizer, has emerged as a concerning adulterant in the opioid crisis.

Though not an opioid, Xylazine has been increasingly mixed with opioids, particularly Fentanyl, in illicit drug supplies.

This combination increases the risk of respiratory depression, a primary cause of opioid-related overdose deaths.

Moreover, adding Xylazine, with its soothing properties, can intensify the depressant effects of opioids, heightening the risk of fatal overdoses.

In the event of an overdose, however, Naloxone (Narcan) cannot revive an individual since it is not an opioid.

Users often remain unaware of these factors, further escalating the danger.

Lastly, using Xylazine can result in sores and wounds, which will not heal.3

Severe infections, skin necrosis, and amputations may result from these wounds.

Incorporating Xylazine into the drug market exemplifies the unpredictable and ever-evolving nature of the opioid crisis, making public education even more paramount.


Collaborative Efforts to Mitigate Risks

The opioid crisis is complex and requires a collaborative effort from healthcare professionals, policymakers, and law enforcement.

Healthcare professionals are crucial in treating overdose cases, providing harm reduction services, and helping those with substance use disorders recover.

Their understanding of the changing nature of drug misuse and its effects is vital for developing effective policies and strategies.

Individuals in policymaking positions are crucial in shaping the narrative and developing practical plans.

By keeping up-to-date with the latest research and trends, they can efficiently allocate resources, enforce regulations to prevent the spread of harmful substances, and ensure that health and social services are equipped to address the crisis.

Law enforcement is responsible for combatting illegal drug operations while working with communities to guide individuals toward treatment instead of punitive measures.

The significance of public awareness and education cannot be overstated.

When people are well-informed, they can better comprehend the complexities of the opioid crisis, avoid stigmatizing those impacted, and make informed decisions prioritizing safety.

Grassroots movements, media promotions, and school educational programs effectively spread essential information and alert people to the increased risks of newer opioids such as Nitazenes.


Treatment Challenges and Potential Solutions

Improving access to addiction treatment services is crucial to ensure that individuals in need can receive prompt and efficient care.

This encompasses medical treatments, therapy, peer support groups, and community-based programs.

It is essential to address potential obstacles, such as financial limitations or geographical barriers, to expand care reach.

The recent emergence of more potent opioids, such as Nitazenes, has created more challenges for treatment.

These drugs are more potent than others, so the standard treatments that worked for other opioids may not be as effective.

Overdose reversal drugs, like Naloxone, may need to be given in larger doses or more often.

Furthermore, Naloxone is ineffective in cases of Xylazine overdose, as it is not an opioid.

The potency of these synthetic opioids varies widely, making the difference between therapeutic use and overdose very small.

As a result, it is vital to be extremely careful in treatment to avoid any mistakes.

Treatment interventions should be modified to include both pharmacological and psychosocial strategies that can address the unique challenges posed by these potent drugs.


Richie Armstrong: From Pills and Prison to Recovery

At 33, Richie Armstrong’s journey into opioid addiction began in his teenage years with prescribed low-dose painkillers after a fall from a ladder.*

His dependency escalated to procuring strong OxyContin illicitly in West Virginia.

Later, his addiction-driven theft landed him in prison, and upon release in 2013, he found that OxyContin had been replaced by pervasive heroin on the streets.

His life oscillated between incarceration and rehab until a near-fatal overdose in 2016.

A friend’s timely CPR and a life-saving naloxone shot from paramedics steered him toward sobriety.

Today, Armstrong contributes as an outreach coordinator at Kathy Ireland Recovery Centers and Wise Path Recovery Centers.

His survival is a stark contrast to the grim overdose statistics of Cabell County in 2017, which reported the country’s highest mortality rate due to heroin and fentanyl.

“I still have friends dying. I have been to more funerals for friends than I care to admit,” Armstrong reflects. “And it all started with the pills.”


The opioid epidemic has ravaged the U.S., causing over 750,000 fatalities from overdoses between 1999 and 2020.

Even with expanded treatment access and the availability of Naloxone, the battle against this catastrophe is far from over.

Individuals like Richie Armstrong show the possibility of recovery and transformation, emphasizing that hope and healing are attainable while the journey is challenging.

Remember, every story of recovery can inspire countless others to seek help.




Overdoses soared even as prescription pain pills plunged

[1] Overdose deaths drop to 6-year low in Hamilton County, expected to drop statewide in Ohio

[2] New Opioids Called Nitazenes May Be 20 Times Stronger Than Fentanyl

[3] Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA


Contributor: Julie Miller

Editor: Susana Spiegel 

Share this Article


Author & Reviewers

julie miller recovery writer and author
Julie is a recovery advocate, with over two years sober. She is a recovery speaker who believes people can change for the better. Her mission is to write factual, helpful information about addiction, treatment, and recovery. She believes that no one should be left in the dark about the process at any stage of their recovery.
lionel estrada lisac clinical director

Lionel is the Clinical Director of Cornerstone’s treatment facilities in Arizona. He has had over 4 years at Cornerstone. He is personally in recovery and passionate about helping others overcome substance abuse and mental health challenges, he is trained as an EMDR, adopting a trauma-informed approach to treat the underlying issues of conditions.

More From Our Resources

Identifying Depression: signs, symptoms, and help

Identifying Depression: signs, symptoms, and help

Depression is a common mental health condition that can profoundly impact the way we think, feel, and go about our…
DUI Insights: How Does The Point System Work With A DUI?

DUI Insights: How Does The Point System Work With A DUI?

How does the point system work with a DUI? Let us help you understand its impact on your driving record…
Unmasking Meth's Impact: How Does Meth Affect Cognition?

Unmasking Meth's Impact: How Does Meth Affect Cognition?

How Does Meth Affect Cognition? Take a deep dive with us and learn how Methamphetamine (Meth) impacts the brain and…
Cornerstone DUI Sponsors MADD Arizona and Joins Community Initiatives

Cornerstone DUI Sponsors MADD Arizona and Joins Community Initiatives

We are proud to announce that Cornerstone Healing Center has partnered with Mothers Against Drunk Driving (MADD) to sponsor their…