The opioid addiction crisis: How it started, who's involved and what else you need to know

Opioids: In the last 20 years, they've spread through every corner of the country.

Every town — almost every person — has been impacted by these drugs in one way or another. Still, confusion and misconceptions continue to exist.

Here's a breakdown of some important questions about the opioid crisis.

How did the opioid crisis start?

Prior to the ‘90s, painkillers were sparingly prescribed by doctors. However, when a new opioid called OxyContin hit the market in 1996, manufacturer Purdue Pharma worked to sway doctors' opinions on opioids by funding studies to show their drug's safety and giving doctors kickbacks for prescribing it, lawsuits show.

Even when reports of abuse and addiction began to pour in, manufacturers in the ever-growing opioid market pressed on. Access to painkillers — even without a prescription — became widespread, leading to the start of many people's addictions.

Who are the major players?

Lawsuits have divided the key players behind the opioid crisis into three categories: manufacturers, distributors and pharmacies.

Manufacturers are the creators and marketers of the opioids, such as Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson. They're accused of — and, in some cases, charged with — downplaying addictiveness and influencing doctors to prescribe more painkillers.

Distributors like AmerisourceBergen and McKesson and pharmacies like CVS and Walgreens have been found to have either shipped or fulfilled suspicious prescriptions and large amounts of painkillers without reporting it to the Drug Enforcement Administration.

What does the opioid epidemic look like today?

With doctors now prescribing fewer opioids, many people whose addictions started with painkillers have turned to cheaper, more widely available alternatives like heroin and fentanyl, a synthetic opioid that's about 50 times stronger than heroin.

Drugs are increasingly being laced with fentanyl, often unbeknownst to users, which has led to a sharp rise in overdoses.

A new, deadly drug called xylazine, which is officially used as an animal tranquilizer, has also begun showing up in heroin and fentanyl.

How many people have been impacted?

Over a million Americans have died of drug overdoses in the past 20 years, according to the Centers for Disease Control and Prevention. This number doesn't include the countless loved ones that have been left behind, nor those in active addiction or recovery.

Some states have been hit harder than others by the epidemic. West Virginia consistently has the highest overdose rate, followed by states in the surrounding region, such as Kentucky, Delaware and Ohio.

What is addiction?

Drug addiction — also called substance use disorder — is a disease that affects people both physically and psychologically.

Often, addiction occurs with other mental health issues that — like other mental illnesses — can be influenced by genetics and other outside factors. What may start as a fun recreational activity or prescribed pain relief can quickly become a coping mechanism for stressors in life.

Regular use of drugs, whether prescribed or illegal, also rewires the parts of the brain that affect decision-making and rewards. This means that it may become physically impossible to feel pleasure or a sense of satisfaction outside of drug use. The dependence also impacts other organs, and suddenly stopping using drugs can cause withdrawal symptoms like fevers, nausea, pain and even death.

What is being done to solve it?

Government officials nationwide have taken opioid manufacturers, distributors and pharmacies to court over their roles in the opioid epidemic, with most major lawsuits starting in 2017. Settlements have sent companies like Endo Pharmaceuticals into bankruptcy, and the millions in funds have been diverted to organizations providing treatment and resources to those impacted by the epidemic.

Community organizations have also stepped up, directing people to treatment and, if they aren't ready to stop using, giving them the tools to stay safe, like clean needles and the overdose-reversing drug Narcan.

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This article originally appeared on Delaware News Journal: Delaware opioid addiction crisis: What you need to know