A major contributor was also Purdue Pharma and the Sackler family, who got rich off getting people started on prescription opioids.

> A major contributor was also Purdue Pharma and the Sackler family,

Their 1980s and 1990s actions led to the pill mill event. The feds sharply reversed it before "opioid crisis" became a trending term.

Over the last 15+ years, Fentanyl has been the (primary) physical driver. The list of social drivers is fairly unchanged.

me: https://news.ycombinator.com/item?id=41578349#41579772

> Their 1980s and 1990s actions led to the pill mill event.

Oxycontin was approved by the FDA in 1995.

The FDA dinged them for misleading marketing claims in 2003.

https://www.fda.gov/drugs/food-and-drug-administration-overd...

https://en.wikipedia.org/wiki/Opioid_epidemic

> Between 1991 and 2011, painkiller prescriptions in the U.S. tripled from 76 million to 219 million per year, and as of 2016 more than 289 million prescriptions were written for opioid drugs per year.

I don't doubt that fentanyl kills a lot of people today, but a lot of those currently addicted got started on pills legally prescribed to them.

Pill mills notoriously maxed out count and dosage (per script) ratios. A single Rx could be for a jar of the highest dosage.¹ This was common.

Scripts written outside of pill mills were orders of magnitude lower in dosage and quantity. Lumping these very different numbers together paints a simplistic view of a complex issue.

> Between 1991 and 2011 painkiller prescriptions in the U.S. tripled

Years that include the rise/fall of pill mills.

> as of 2016 more than 289 million prescriptions

289M is a single broad number representing complex and distinct things. To determine opioid use trend, some of the things we need to know are count per Rx, dosage, med type and treatment type.

Institution (eg:ALF,hospice,VA) trends are distinct from public-facing doctors but we don't even look at them. We just lump their Rx #s into the pot.

An important number we don't have: Denial counts for reasonable need. Single-figure opioid views don't leave us room to consider it.

Chronic pain patients (who responsibly used pain relief for years) started getting shut out before 2016. That trend ratcheted one way. Their choice was losing what productivity they had or seeking illegal+risky options.¹

But as ever, the public and news orgs are much more interested in billionaires than vulnerable people in need.

   ¹These are things I personally witnessed.