Opioid/heroin abuse has exceeded epidemic levels in America.

Drug overdoses are now the leading cause of death for individuals under the age of 50. And a huge resurgence in heroin use over the last decade seems the primary culprit. The question is, who or what is to blame for the skyrocketing problem? As with any large problem the answers vary and are often more nuanced than black and white. However, there is strong evidence suggesting that the rise in heroin use is directly tied to an increase in the abuse of prescription drugs. “As someone uses prescription drugs more and more regularly, the propensity to try other forms of opioids goes up,” said National Institute on Drug Abuse deputy director Dr. Wilson Compton. “In many ways they’re not two separate epidemics — it’s just one opiate epidemic.”

More than a third of American adults were prescribed opioids in 2015. Therefore it would seem that the leading culprit for the increasing heroin problem is powerful prescription medications. But the verdict is not that simple. Recognizing the danger of these powerful opioid-based prescription drugs, is the pharmaceutical industry the ultimate culprit? That seems to be the perspective of at least 20 state and local governments as they have pursued lawsuits against several pharmaceutical companies, arguing that these companies have engaged in deceptive marketing.

But the problem may be more guilt by association rather than an actual violations of law. Last year a federal judge threw out the city of Chicago’s claim because it “failed to identify the prescribers who were exposed to defendants’ [alleged] misrepresentations as the same prescribers who prescribed defendants’ drugs and thereby caused the City to incur costs.” As The Wall Street Journal describes it, “Plaintiffs contend that pharmaceutical companies fraudulently market opioids for chronic pain and that long-term use encourages dependency. Yet the Food and Drug Administration approves the labeling and warnings for prescription opioids. Lawyers and politicians are trying to substitute their medical judgement for that of regulators and physicians.”

Solutions to the rising drug epidemic will need to be more comprehensive as there is no “one” cause for the problem. Holding pharmaceutical companies liable for the abuse of their legal products, where such liability is associated with deceptive practices, is only part of the solution. Physicians need to be more cautious and responsible in issuing these prescriptions, because once the prescription expires, if an addiction has developed, the user will go to the street to satisfy that addition. Still, the vast majority of individuals who have been prescribed opioids pain killers do not abuse them or become heroin addicts.

(Edited.)