The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis?

Publication date: Feb 17, 2020

While there has been extensive attention to the ‘demand side’ – or use and adverse consequences, including mortality – of the ‘opioid crisis’ presently unfolding across North America, few considerations have focused on the supply side. This paper examines the supply side dynamics of this unprecedented public health phenomenon. We provide evidence for several interrelated supply-side elements that have contributed to the present public health crisis. We observe that initially, persistently high levels of prescription opioid availability and use exposed large proportions of the North American population to opioids, resulting in correspondingly high levels of medical and non-medical use (e.g., involving diversion). While various intervention measures to control prescription opioid availability and use have been implemented in recent years, leading to eventual reductions in opioid dispensing levels, these occurred late in the crisis’s evolution. Moreover, these supply reductions have not been met by corresponding reductions in opioid use or demand levels. These growing discrepancies between opioid demand and prescription-based sources have left major gaps in opioid supplies. In response to such supply gaps, highly potent and toxic illicit opioid products have rapidly proliferated across North America, and become a core driver of the dramatic spikes in opioid overdose fatality levels in recent years. These supply-related interrelations are corroborated by a corresponding increase in illicit opioid-related fatalities, which arose just as medical opioid supplies began to decrease in many jurisdictions. Improved analyses and understanding of the supply-side dynamics of the opioid crisis are urgently needed in order to inform future intervention and policy development. Meanwhile, the high mortality toll related to illicit, highly toxic opioid exposure requires sustained solutions, including supply-oriented measures (e.g., safer opioid distribution for at-risk users) towards improved public health protection.

Open Access PDF

Fischer, B., Pang, M., and Jones, W. The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis? 04647. 2020 Subst Abuse Treat Prev Policy (15):1.

Concepts Keywords
Epidemic Heroin
Evolution Morphinans
Mortality Drug overdose
North America Sackler family
Opioid Analgesics
Opioid Overdose RTT
Opioids Morphine
Psychoactive drugs


Type Source Name
drug DRUGBANK Methionine
disease MESH development
disease MESH Substance Abuse
drug DRUGBANK Stavudine
disease MESH risk factors
drug DRUGBANK Fentanyl
drug DRUGBANK Diamorphine
drug DRUGBANK Cocaine
disease MESH death
disease MESH shock
drug DRUGBANK Oxycodone
drug DRUGBANK Hydromorphone
drug DRUGBANK Hydrocodone
drug DRUGBANK Esomeprazole
disease MESH opioid dependence
disease MESH diagnoses
drug DRUGBANK Morphine
drug DRUGBANK Trestolone
drug DRUGBANK Opium
disease MESH Hepatitis
drug DRUGBANK Coenzyme M
drug DRUGBANK Naloxone
disease MESH emergency
drug DRUGBANK Hexadecanal
drug DRUGBANK Indoleacetic acid
drug DRUGBANK Ethanol
drug DRUGBANK Carboxyamidotriazole
disease MESH chronic pain
drug DRUGBANK Methadone
disease MESH virus infections
disease MESH Infectious Diseases
drug DRUGBANK Roxithromycin
disease MESH drug users
disease MESH marriage
disease MESH divorce
disease MESH Pathology
drug DRUGBANK Nonoxynol-9
drug DRUGBANK Iron
drug DRUGBANK Buprenorphine


Original Article

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