Marc LaRochelleWilliam Hazel Jr., MD, of GMU agrees that a large part of the problem started with attempts to treat pain more aggressively, and the addiction cycle usually does not start with a needle, but instead with a pill, he says.

“You can now of course order it on the dark web, and you didn’t have the dark web before. In essence, you can get fentanyl delivered to your house from China. It really is a confluence of things going on,” Hazel says.

As negative as the data are, it is the real-life anecdotes of what the law enforcement, judicial system, and the provider community are dealing with that makes the crisis even direr.

“I know of a case in New Jersey, where a drug dealer was arrested, and he was spiking every 15th bag of opioids to the point that it was lethal. And that was a selling point. People using it don’t want to die, but that quest for the high is insatiable and all-consuming,” he says.

“Another case had a brother of a woman die from an overdose, and the sister wanted the same drug not because she wanted to die but she wanted the ‘good’ stuff.”

The issue of people needing opioids more than those addicted to other drugs is what Marc LaRochelle, MD, assistant professor of medicine, Boston University School of Medicine, says is due to the “sticky” factor.

“Opioids are particularly sticky, by that I mean when people are using them they can very quickly become dependent on them. Going about stopping to use them is challenging, and so that level of physical dependence is more than we see with other drugs and hard to stop,” he says.

LaRochelle says opioids have a direct effect on suppressing the central nervous system, which can lead to overdose and death much more rapidly than for other drugs.