The first wave of the opioid crisis began primarily in the USA with the usage of opioids in medical context, specifically pain medication prescriptions. They were advertised as life changing pain medication and prescribed at alarming rates because of the profit they made for big pharmaceutical companies. Soon their highly addictive qualities became known to the public and a change in restrictions on how they could be both prescribed and sold were seen world wide. Because of this, even to this day, prescribed painkillers are a lot more difficult to access, especially in higher doses. In a study by UNSW, collected data showed that one in five Australians that suffer from chronic pain reported having troubles with accessing doctors and medication. This is true in many countries, such as Africa and India.

After the removal of easily accessible prescription opioids, the market shifted and these people that had already been hooked on the drug moved on to the growing illegal heroin market. Because of this high demand, it became easier and easier to profit off illegally distributed opioids in countries such as Australia and the USA. These drugs were often imported. Although Mexico and Columbia have been historically known for this, the majority of the world's heroin comes from Afghanistan. There are also issues with usage of heroine in these same producing countries, with opioids being the drug class most often detected in the biological samples (5·6%) in Afghanistan.

The third wave of the opioid crisis is known as the most deadly. Every country in our world is struggling with opioid addiction, but the introduction of synthetic opioids, namely fentanyl, has led to a rising issue of fatal overdose in those countries that have reached this phase. With opioids, given that they affect the body's ability to breath, there have always been cases of fatal overdose. But in recent years, misleading descriptions of what is exactly in illegally bought opioids has led to even more in countries such as the USA, Canada, and Australia. Criminalisation and bans on specific drugs have always been linked to unsafe use. Without any regulations on the distribution and making of illegal drugs, it's extremely likely for drugs such as heroin to be cut with other things. This is often done with fentanyl, given it is 100 times more potent than morphine. Over 150 people die every day from accidental synthetic opioid overdoses.

Because this has been an ongoing issue since the 1970's, there is lots of research into effective solutions specifically in the USA given it has been hit the hardest so far by this growing epidemic. Even though these damage control methods have been proven to save lives, only 10% of people in need actually have access to effective help for opioid dependency. There are multiple reasons for this lack of implementation.

First of all, there's a lack of international funding. Even though the United Nations have already recognised this as a global issue, many countries just don't have access to these services yet in the way more developed countries do. In places such as Africa that are primarily battling tramadol addiction, it is also one of the few opioids available in medical environments. Removing the drug entirely will just worsen issues in other areas. But even in places such as the USA or Australia that have the economy to fund these prevention strategies, the money is simply not being used.

This connects to another issue; the way we view addiction. Addiction has been mostly perceived as a self imposed issue, as something that we shouldn’t waste our governments money on. This is, of course, not true at all. Recent research has led us to the truth, that addiction is an illness that should be treated with the sympathy and respect that we do for other diseases. Awareness on this needs to be spread, so the general public of all countries can be educated on the truth to addiction. This will lead to more public support on preventative methods.

Now what are these solutions? There are two separate sides of this issue that need addressing; first, fatal overdoses, and second, the addiction itself. There are a few immediate action plans that have already begun to save lives from overdoses. Beginning with safe usage sites and drug testing, and later on the use of naloxone to jumpstart bodies in the midst of a dangerous opioid overdose. Not to mention the potential rehab services have to free a person from their addiction as efficiently as possible.

Naloxone is a drug that is not yet widely distributed, though there is a large demand for it. The drug can rapidly reverse the immediate effects of an opioid overdose by essentially ripping the drugs off of and blocking the opioid receptors they attach to in the brain. This allows the brain to function better, specifically the lungs and heart. Wider and cheaper distribution of this can save lives. The people most likely to see a fatal overdose are those that use opioids themselves, the loved ones of people that do, and emergency paramedics. These specific people need to be instructed on how to first identify an opioid overdose, how to administer naloxone, and they need to be provided with it. There are some programs in place that allow those at risk of seeing an overdose to have free, take home naloxone without need for a prescription. However they are not widely spread programs, and there is little to no active talk of them. Because of this, few people in need actually know about and access them. Aside from these programs, which must be mentioned only exist in countries that are already in the third wave, prescriptions are needed to buy naloxone. This inaccessibility is extremely irresponsible, especially as other countries across the world are beginning the entire third phase of the opioid dependency crisis.

Although this risk prevention strategy is mostly helpful to those countries in the third phase, safe usage sites are a strategy that could be implemented worldwide. There is a common misconception that they encourage drug use. This is just not true. Drug use is going to happen, be it licit or illicit, no matter what. This has been learnt time and time again, a good example being the Prohibition in the United States from 1920 to 1933. So, harm reduction methods are used to make this inevitable drug use safer and in the process lower rates of overdose, injury, and disease.

Safe usage sites provide clean needles, places to safely dispose of them after use, as well as supervision that secures immediate help if anything were to happen. Clean needles are an alternative to the common practice of reusing either your own or others needles, an extremely fast way to spread diseases or cause infection.

Not all safe usage sites provide drug free drug testing, but it is a standard that should be met. It’s not uncommon for opioids to be mixed with other substances to add bulk, a scheme invented by dealers to increase profit. These extra additions are never labelled, and because of that there is no way for a person to know what exactly is in the drug they’re taking. They won’t ask for help from a lab that would charge them, and especially not one that would report their usage or take the drug away. Instead, free testing provides an opportunity people will actually take to help ensure their safety. Even if they are to take the drug no matter what they discover is in it, at least they are aware of what is being put in their body.

This is especially needed currently as more and more synthetic opioids are being created and released into the drug market. Carfentanil, for example, is a tranquiliser used on large animals that is 10,000 times more potent than morphine, or 100 times more potent than the deadly fentanyl. These drugs must be identified before they are taken to avoid even more accidental deaths by synthetic opioid overdose. A final solution to this problem of rising global opioid addiction rates are effective rehabilitation programs. According to the National Institute on Drug Abuse, 85% of rehab patients relapse within a year after treatment. There are multiple types of substance abuse disorder therapies, including inpatient programs for those going through the detoxification process. This is the time after regular drug use where one suddenly stops, and their body is readjusting to a change in chemical normal. It involved intense withdrawal symptoms and is one of the main reasons opioids specifically are so hard to quit.

Signing up for one of these programs, although it ensures support through your detox journey, means risking termination at a job for many people, because of the long absence. Detox needs to be treated the same way as any other medical recovery term, with an ensured return after a leave of absence. Addiction treatment is also wildly expensive. This is the main reason why people are unable to receive treatment, even if they’re willing.



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