Skip to main content

Advertisement

SpringerLink
Log in

The Deepening Opioid Crisis in North America: Historical Context and Current Solutions

  • Opioids (D Fiellin and J Donroe, Section Editors)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to (1) detail the historical context behind the rise of opioid use disorder (OUD) and opioid-related harms in the United States (US) and Canada, (2) describe the epidemiology of OUD in these two countries, and (3) discuss current strategies being employed to address this public health emergency in North America.

Recent Findings

Opioid-related overdose has become a leading cause of unintentional injury related death in North America. Deaths have risen in parallel with opioid prescribing and the rising prevalence of unintentional exposure to highly potent synthetic opioids. At the same time, rates of injection drug use-related infections such as hepatitis C and endocarditis have also increased.

Summary

Both Canada and the US have implemented policy changes and interventions at the national and local levels in an attempt to stem rising opioid attributable morbidity and mortality. In many settings, the collective goal has been to increase access to treatment of OUD, expand harm reduction interventions (including improved access to naloxone), and develop and disseminate guidelines on the safe prescribing of opioids for non-cancer pain and the management of OUD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

  1. Ahmad FB, Rossen LM, Spencer MR, Warner M, Sutton P. Provisional drug overdose death counts: National Center for Health Statistics; 2018 [cited February 18, 2018]. Available from: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.

  2. Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: apparent opioid-related deaths in Canada (January 2016 to September 2017) Web-based report. Ottawa: Public Health Agency of Canada; 2018. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-march-2018.html. Accessed 29 March 2018

    Google Scholar 

  3. Centers for Disease Control and Prevention. Annual Surviellance Report of Drug-Related Risks and Outcomes- United States, 2017. Surveillance Special Report 1: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2017. Available from: https://www.cdc.gov/drugoverdose/pdf/pubs/2017cdc-drug-surveillance-report.pdf. Accessed 12 March 2018

  4. Berterame S, Erthal J, Thomas J, Fellner S, Vosse B, Clare P, et al. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet. 2016;387(10028):1644–56.

    Article  PubMed  Google Scholar 

  5. Fischer B, Argento E. Prescription opioid related misuse, harms, diversion and interventions in Canada: a review. Pain Physician. 2012;15(3 Suppl):ES191–203.

    PubMed  Google Scholar 

  6. • Murphy Y, Goldner EM, Fischer B. Prescription opioid use, harms and interventions in Canada: a review update of new developments and findings since 2010. Pain Physician. 2015;18(4):E605–14 This narrative review synthesized key information on prescription opioid dispensing, non medical use, related-harms, interventions and impacts in Canada between 2010 and 2015.

    PubMed  Google Scholar 

  7. Fischer B, Keates A, Buehringer G, Reimer J, Rehm J. Non-medical use of prescription opioids and prescription opioid-related harms: why so markedly higher in North America compared to the rest of the world? Addiction. 2014;109(2):177–81.

    Article  PubMed  Google Scholar 

  8. • Humphreys K. Avoiding globalisation of the prescription opioid epidemic. Lancet. 2017;390(10093):437–9 This offers a concise review of the role of the pharmaceutical industry on the rising rates of opioid addiction and overdose.

    Article  PubMed  Google Scholar 

  9. Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017;189(18):E659–E66.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Quinones S. Dreamland: the true tale of America’s opiate epidemic. New York: Bloomsbury Press; 2015. 374 p

    Google Scholar 

  11. Hadland SE, Krieger MS, Marshall BDL. Industry payments to physicians for opioid products, 2013-2015. Am J Public Health. 2017;107(9):1493–5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. United States of America v. The Purdue Frederick Company, Inc., et al. Hearing before the US District Court for the Western District of Virginia. 2007.

  13. OxyContin and OxyNEO national settement agreement 2018. Available from: https://www.wagners.co/current-class-actions/oxycontin/. Accessed 28 May 2018

  14. Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36(1):559–74.

    Article  PubMed  Google Scholar 

  15. Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986;25(2):171–86.

    Article  CAS  PubMed  Google Scholar 

  16. Weisberg DF, Becker WC, Fiellin DA, Stannard C. Prescription opioid misuse in the United States and the United Kingdom: cautionary lessons. Int J Drug Policy. 2014;25(6):1124–30.

    Article  PubMed  Google Scholar 

  17. A consensus statement from the American Academy of Pain Medicine and the American Pain Society. The use of opioids for the treatment of chronic pain. Clin J Pain. 1997;13(1):6–8.

  18. Ornstein C, Weber T. American pain Foundation shuts down as senators launch investigation of prescription narcotics: ProPublica; 2012. Available from: https://www.propublica.org/article/senate-panel-investigates-drug-company-ties-to-pain-groups.

  19. King NB, Fraser V, Boikos C, Richardson R, Harper S. Determinants of increased opioid-related mortality in the United States and Canada, 1990–2013: a systematic review. Am J Public Health. 2014;104(8):e32–42.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Guy GP Jr, Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital signs: changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697–704.

    Article  PubMed  PubMed Central  Google Scholar 

  21. U.S. Prescribing Rate Maps: Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html. Accessed on 24 June 2018

  22. Overdose Death Rates: National Institute on Drug Abuse. Available from: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed 24 June 2018

  23. Fischer B, Vojtila L, Rehm J. The ‘fentanyl epidemic’ in Canada—some cautionary observations focusing on opioid-related mortality. Prev Med. 2018;107:109–13.

    Article  PubMed  Google Scholar 

  24. National report: Apparent opioid-related deaths in Canada (released June 2018): Public Health Agency of Canada; 2018. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/national-report-apparent-opioid-related-deaths-released-june-2018.html. Accessed 20 June 2018.

  25. Canadian Institute for Health Information. Pan-Canadian trends in the prescribing of opioids, 2012 to 2016. Ottawa: CIHI; 2017.

    Google Scholar 

  26. International Narcotics Control Board. Narcotic drugs: estimated world requirements for 2018; statistics for 2016. New York: United Nations; 2017.

    Google Scholar 

  27. Fischer B, Jones W, Krahn M, Rehm J. Differences and over-time changes in levels of prescription opioid analgesic dispensing from retail pharmacies in Canada, 2005-2010. Pharmacoepidemiol Drug Saf. 2011;20(12):1269–77.

    Article  PubMed  Google Scholar 

  28. Gomes T, Mamdani MM, Paterson JM, Dhalla IA, Juurlink DN. Trends in high-dose opioid prescribing in Canada. Can Fam Physician. 2014;60(9):826–32.

    PubMed  PubMed Central  Google Scholar 

  29. Fischer B, Jones W, Rehm J. Trends and changes in prescription opioid analgesic dispensing in Canada 2005-2012: an update with a focus on recent interventions. BMC Health Serv Res. 2014;14:90.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Health Canada. Canadian tobacco, alcohol and drugs survey (CTADS): 2015 summary2017 March 14, 2018. Available from: https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2015-summary.html.

  31. Luce J, Strike C. A cross-Canada scan of methadone maintenance treatment policy developments. A report prepared for the Canadian executive council on addictions. 2011.

  32. • Eibl JK, Morin K, Leinonen E, Marsh DC. The state of opioid agonist therapy in Canada 20 years after Federal Oversight. Can J Psychiatr. 2017;62(7):444–50. This paper provides an update of the state of opioid agonist treatment programs across Canada in 2017.

    Article  Google Scholar 

  33. U.S. Department of Health and Human Services. About the U.S. Opioid Epidemic: U.S. Department of Health and Human Services. 2018. Available from: https://www.hhs.gov/opioids/about-the-epidemic/. Accessed 8 March 2018

  34. Baldwin N, Gray R, Goel A, Wood E, Buxton JA, Rieb LM. Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: an observational analysis. Drug Alcohol Depend. 2018;185:322–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Ho J, DeBeck K, Milloy MJ, Dong H, Wood E, Kerr T, et al. Increasing availability of illicit and prescription opioids among people who inject drugs in a Canadian setting, 2010-2014. Am J Drug Alcohol Abuse. 2018;44(3):368–77.

    Article  PubMed  Google Scholar 

  36. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatr. 2014;71(7):821–6.

    Article  Google Scholar 

  37. Henry J Kaiser Family Foundation:Opioid overdose death rates and all drug overdose death rates per 100,000 population (age-adjusted). Available from: https://www.kff.org/other/state-indicator/opioid-overdose-death-rates/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Opioid%20Overdose%20Death%20Rate%20(Age-Adjusted)%22,%22sort%22:%22desc%22%7D. Accessed 26 June 2018

  38. Gladstone EJ, Smolina K, Weymann D, Rutherford K, Morgan SG. Geographic variations in prescription opioid dispensations and deaths among women and men in British Columbia, Canada. Med Care. 2015;53(11):954–9.

    Article  PubMed  Google Scholar 

  39. Fischer B, Jones W, Rehm J. High correlations between levels of consumption and mortality related to strong prescription opioid analgesics in British Columbia and Ontario, 2005-2009. Pharmacoepidemiol Drug Saf. 2013;22(4):438–42.

    Article  PubMed  Google Scholar 

  40. • O'Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700 - 10 states, July-December 2016. MMWR Morb Mortal Wkly Rep. 2017;66(43):1197–202. This study highlights the rising contribution of fentanyl and fentanyl analogs to the drug overdose death rate in the United States.

    Article  PubMed  PubMed Central  Google Scholar 

  41. • Hayashi K, Milloy MJ, Lysyshyn M, DeBeck K, Nosova E, Wood E, et al. Substance use patterns associated with recent exposure to fentanyl among people who inject drugs in Vancouver, Canada: a cross-sectional urine toxicology screening study. Drug Alcohol Depend. 2018;183:1–6. This study documented high prevalence of exposure to fentanyl among people who inject drugs, with the majority of participants being unaware of this exposure.

    Article  CAS  PubMed  Google Scholar 

  42. Amlani A, McKee G, Khamis N, Raghukumar G, Tsang E, Buxton JA. Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, Canada. Harm Reduct J. 2015;12:54.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Carroll JJ, Marshall BDL, Rich JD, Green TC. Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: a mixed methods study. Int J Drug Policy. 2017;46:136–45.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Macmadu A, Carroll JJ, Hadland SE, Green TC, Marshall BD. Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically. Addict Behav. 2017;68:35–8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fleischauer AT, Ruhl L, Rhea S, Barnes E. Hospitalizations for endocarditis and associated health care costs among persons with diagnosed drug dependence - North Carolina, 2010-2015. MMWR Morb Mortal Wkly Rep. 2017;66(22):569–73.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Banerjee G, Edelman EJ, Barry DT, Becker WC, Cerda M, Crystal S, et al. Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study. Addiction. 2016;111(11):2021–31.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Liebling EJ, Green TC, Hadland SE, Marshall BDL. Injection drug use and overdose among young adults who use prescription opioids non-medically. Addict Behav. 2018;76:20–6.

    Article  PubMed  Google Scholar 

  48. Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175–81.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Wejnert C, Hess KL, Hall HI, Van Handel M, Hayes D, Fulton P Jr, et al. Vital signs: trends in HIV diagnoses, risk behaviors, and prevention among persons who inject drugs - United States. MMWR Morb Mortal Wkly Rep. 2016;65(47):1336–42.

    Article  PubMed  Google Scholar 

  50. Burnett JC, Broz D, Spiller MW, Wejnert C, Paz-Bailey G. HIV infection and HIV-associated behaviors among persons who inject drugs - 20 cities, United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(1):23–8.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Peters PJ, Pontones P, Hoover KW, Patel MR, Galang RR, Shields J, et al. HIV infection linked to injection use of oxymorphone in Indiana, 2014–2015. N Engl J Med. 2016;375(3):229–39.

    Article  CAS  PubMed  Google Scholar 

  52. Evans ME, Labuda SM, Hogan V, Agnew-Brune C, Armstrong J, Periasamy Karuppiah AB, et al. Notes from the field: HIV infection investigation in a rural area - West Virginia, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(8):257–8.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Ronan MV, Herzig SJ. Hospitalizations related to opioid abuse/dependence and associated serious infections increased sharply, 2002-12. Health Aff (Millwood). 2016;35(5):832–7.

    Article  Google Scholar 

  54. Canadian Institute for Health Information. Opioid-related harms in Canada. Ottawa: CIHI; 2017.

    Google Scholar 

  55. Collins FS, Koroshetz WJ, Volkow ND. Helping to end addiction over the long-term: the research plan for the nih heal initiative. JAMA. 2018;320:129–30.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Alford DP, Zisblatt L, Ng P, Hayes SM, Peloquin S, Hardesty I, et al. SCOPE of pain: an evaluation of an opioid risk evaluation and mitigation strategy continuing education program. Pain Med. 2016;17(1):52–63.

    PubMed  PubMed Central  Google Scholar 

  57. Becker WC, Fiellin DA. Federal plan for prescriber education on opioids misses opportunities. Ann Intern Med. 2012;157(3):205–6.

    Article  PubMed  Google Scholar 

  58. U.S. Department of Health and Human Services. Opioid abuse in the U.S. and the HHS actions to address opioid-drug related overdoses and death 2015. Available from: https://aspe.hhs.gov/basic-report/opioid-abuse-us-and-hhs-actions-address-opioid-drug-related-overdoses-and-deaths. Accessed 18 April 1018

  59. Comprehensive Addiction and Recovery Act of 2016. Available from: https://www.govtrack.us/congress/bills/114/s524/text. Accessed on une 23 2018

  60. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49.

    Article  PubMed  Google Scholar 

  61. •• Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Reports of the Surgeon General. Washington (DC); 2016. This comprehensive report summarizes the chronic disease model of addiction and reviews evidence based approaches to addiction mangement.

  62. Fischer B, Rehm J, Tyndall M. Effective Canadian policy to reduce harms from prescription opioids: learning from past failures. CMAJ. 2016;188(17–18):1240–4.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Gomes T, Mastorakos A, Paterson JM, Sketris I, Caetano P, Greaves S, et al. Changes in the dispensing of opioid medications in Canada following the introduction of a tamper-deterrent formulation of long-acting oxycodone: a time series analysis. CMAJ Open. 2017;5(4):E800–E7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Fischer B, Rehm J, Patra J, Cruz MF. Changes in illicit opioid use across Canada. CMAJ. 2006;175(11):1385.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Socias ME, Ahamad K. An urgent call to increase access to evidence-based opioid agonist therapy for prescription opioid use disorders. CMAJ. 2016;188(17–18):1208–9.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Health Canada. Government of Canada: actions on Opiods, 2016 and 2017. Ottawa: Health Canada; 2017.

    Google Scholar 

  67. •• Bruneau J, Ahamad K, Goyer ME, Poulin G, Selby P, Fischer B, et al. Management of opioid use disorders: a national clinical practice guideline. CMAJ. 2018;190(9):E247–E57 This is the first-ever Canadian evidence-based guideline for the management of opioid use disorder. The guideline supports a stepped and integrated care approach, where treatment intensity is continually adjusted to match individual patient needs over time.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Rutkow L, Vernick JS. Emergency legal authority and the opioid crisis. N Engl J Med. 2017;377(26):2512–4.

    Article  PubMed  Google Scholar 

  69. Haffajee RL, Jena AB, Weiner SG. Mandatory use of prescription drug monitoring programs. JAMA. 2015;313(9):891–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. •• Fink DS, Schleimer JP, Sarvet A, Grover KK, Delcher C, Castillo-Carniglia A, et al. Association between prescription drug monitoring programs and nonfatal and fatal drug overdoses: a systematic review. Ann Intern Med. 2018;168(11):783–90. This is one of the first studies to systematically evaluate the literature regarding the relationship between prescription drug monitoring programs and overdose rates in the United States.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Soelberg CD, Brown RE Jr, Du Vivier D, Meyer JE, Ramachandran BK. The US opioid crisis: current federal and state legal issues. Anesth Analg. 2017;125(5):1675–81.

    Article  PubMed  Google Scholar 

  72. Davis C, Carr D. State legal innovations to encourage naloxone dispensing. J Am Pharm Assoc (2003). 2017;57(2S):S180–S4.

    Article  Google Scholar 

  73. Des Jarlais DC. Harm reduction in the USA: the research perspective and an archive to David purchase. Harm Reduct J. 2017;14(1):51.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Bouvier BA, Elston B, Hadland SE, Green TC, Marshall BD. Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: a cross-sectional study. Harm Reduct J. 2017;14(1):13.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Kral AH, Wenger L, Carpenter L, Wood E, Kerr T, Bourgois P. Acceptability of a safer injection facility among injection drug users in San Francisco. Drug Alcohol Depend. 2010;110(1–2):160–3.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Lysyshyn M, Dohoo C, Forsting S, Kerr T, McNeil R. Evaluation of a fentanyl drug checking program for clients of a supervised injection site, Vancouver, Canada. Montreal: Harm Reduction International; 2017.

    Google Scholar 

  77. Guidance for Injectable Opioid Agonist Treatment for Opioid Use Disorder. Vancouve: BC Centre on Substance Use; 2017 [cited 2018 March 21]. Available from: http://www.bccsu.ca/wp-content/uploads/2017/10/BC-iOAT-Guidelines-10.2017.pdf.

  78. B.C. nurse practitioners can now prescribe drugs for opioid addiction. Vancouver Sun. 2018 (col. 2018).

  79. Tyndall M. An emergency response to the opioid overdose crisis in Canada: a regulated opioid distribution program. CMAJ. 2018;190(2):E35–E6.

    Article  PubMed  PubMed Central  Google Scholar 

  80. D'Onofrio G, Chawarski MC, O'Connor PG, Pantalon MV, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. J Gen Intern Med. 2017;32(6):660–6.

    Article  PubMed  PubMed Central  Google Scholar 

  81. D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Hering R, Lefebvre L, Stewart P, Selby P. Increasing addiction medicine capacity in Canada: the case for collaboration in education and research. Can J Addict. 2014;5(3):10–4.

    Article  Google Scholar 

  83. Holt SR, Segar N, Cavallo DA, Tetrault JM. The addiction recovery clinic: a novel, primary-care-based approach to teaching addiction medicine. Acad Med. 2017;92(5):680–3.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

M. Eugenia Socias is supported by a Michael Smith Foundation for Health Research (MSFHR)/St Paul’s Foundation Scholar Award.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, Suite 305, New Haven, CT, 06510, USA

    Joseph H. Donroe

  2. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada

    M. Eugenia Socias

  3. Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    M. Eugenia Socias

  4. Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA

    Brandon D. L. Marshall

Authors
  1. Joseph H. Donroe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Eugenia Socias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brandon D. L. Marshall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph H. Donroe.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Opioids

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Donroe, J.H., Socias, M.E. & Marshall, B.D.L. The Deepening Opioid Crisis in North America: Historical Context and Current Solutions. Curr Addict Rep 5, 454–463 (2018). https://doi.org/10.1007/s40429-018-0228-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-018-0228-5

Keywords

Search

Navigation