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Experts are warning that without urgent intervention, the U.S. will see more than 1.2 million fatal opioid-related overdoses during the next decade, and are calling for immediate action to curtail the epidemic in North America.

In a newly published report in , the Stanford-Lancet Commission on the North American Opioid Crisis -- including Stanford psychiatry professor Keith Humphreys, PhD, and a group of other clinicians, educators, public policymakers, and people who have lived with addiction and chronic pain -- identified unique "domains" of the epidemic and provided tailored recommendations for each one.

According , fatal opioid-related overdoses spiked last year, jumping from 56,064 in 2020 to 75,673 in 2021. The commission's model of the opioid crisis estimated that there will be 1,220,000 fatal opioid overdoses in the U.S. from 2020 to 2029, underlining the value of their evaluations of the current crisis and recommendations for the future.

Failure to Regulate

The dawn of the opioid crisis in the U.S. and Canada resulted from weak legislation and regulations, the commission members said, including the FDA's approval of OxyContin based on the manufacturer's fraudulent assertion that the drug was less addictive than other opioids, as well as the cozy relationships between drug companies, lawmakers, universities, and patient advocacy groups. Prescribers' limited access to harm surveillance or risk management resources further exacerbated an already deadly situation.

The commission recommended that limitations be put in place for manufacturers that wish to promote opioids, and that drug monitoring should be an essential government function. Along with the need to shield medical schools from the influence of pharmaceutical companies, bodies with the power to prescribe opioids should also be barred from industry influence, they added.

"Unrestrained profit-seeking and regulatory failure instigated the opioid crisis 25 years ago, and since then, little has been done to stop it," Humphreys said in a press release. "Pharma companies are all being sued, and they deserve to be sued, but we have to remember they exploited weaknesses in our health care regulatory system that are still there."

Understanding Opioids Better

Another point that members of the commission made is that the conversation around opioids lacks the necessary nuance. In some cases, these drugs can be detrimental, but for others, they may be beneficial. Instead of enacting policies that are either overly lax or highly restrictive, thereby perpetuating the polarization of opioid use, regulators should instead focus on the risks for addiction and require more robust clinical trials, the group said.

They recommended more vigorous opioid stewardship, such as prescription drug monitoring programs, adding prompts in electronic prescribing systems that promote safer prescribing practices, and expanding access to medication-assisted treatment.

Building Support Systems

To enhance access to and improve the quality of well-rounded care for those with opioid use disorder (OUD), members of the commission suggested that changes need to be made to the current healthcare system, especially in the U.S. It's crucial, they explained, that both public and private health insurance systems be reformed to address addiction treatment, "including cutting off funding for care that is likely to be harmful," they wrote.

Care systems should model addiction treatment plans on the established methods for managment of chronic diseases; however, in order to do this, the commission report stated that the longstanding disputes between experts in the field need to be abandoned -- or at least tabled -- before moving forward. Debates around which methods of recovery are better, and whether harm reduction is a superior objective, would have to be shelved, they said.

The Criminal Justice System

Despite arguments from many advocates that the prison system should not have a role in addiction response, prisons do have an inevitable part to play given the rates of incarcerated individuals who struggle with substance use disorder before, during, and after their sentences, the commission noted. Strategies should maximize the "good" of the prison system and minimize the damage it tends to inflict, they added.

In order to improve correctional facilities' ability to treat inmates, individually tailored addiction care is needed, the group explained. Correctional officials often worry that incarcerated individuals might abuse medications like methadone and buprenorphine, or that they might become part of the "black-market" trade inside of a jail or prison. But these potential risks can be quelled with proper supervision for oral medications or by offering injectable extended-release forms of medications for opioid use disorder (MOUD).

Improving transition services in and out of prisons is critically important for those who might be going into withdrawal, the group said. For previously incarcerated people with OUD who are re-entering society, the risk of a fatal overdose -- due to a loss of tolerance from lack of use -- is exceedingly high. Because of these risks, community monitoring programs and prison systems must prioritize improving their support networks to ease these moments of transition.

The commission also called for incarceration for illicit possession of opioids or drug-use equipment intended for personal use to end, including for pregnant women.

Prevention Is Key

The future of the opioid epidemic can't just be solved through modifications to our current systems; prevention efforts must remain a top priority as well, the commission emphasized.

Strategies can be adopted from other countries, such as making an effort to mass dispose of the billions of excess opioid pills in households across the U.S. In addition, horizontal prevention programs should be strengthened for young people struggling not just with addiction, but also with depression, anxiety, and other mental health issues. The bettering of these support systems, the group wrote, is especially important for children and adolescents from low socioeconomic backgrounds.

More Innovation Needed, and Warnings for the Future

In their report, members of the commission criticized the lack of biomedical research into pain relief drugs and MOUD. Policies should be put in place to correct for failures in patent law and market incentives, they said, thus prioritizing opportunities for opioid molecule redesign and the development of non-opioid medications.

Finally, U.S.-based pharmaceutical companies are still expanding their opioid prescribing practice worldwide, often using promotional tactics that have been domestically banned, the commission said. American regulators have a responsibility to put a stop to these companies' exportation of opioid promotion abroad. As an alternative, they suggested that the WHO and other donor nations come together to provide free generic morphine to hospitals and hospice facilities in lower-income countries.

Even if all of these recommendations are acted on, the opioid crisis won't be eliminated, the commission acknowledged. But taking these steps can save potentially millions of lives and lessen the global suffering caused by opioid dependency.

"It took more than a generation of mistakes to create the North American opioid crisis," the report concluded. "It may take a generation of wiser policies to resolve it."

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