The opioid industry: A snake eating its own tail

Sociologist Zygmunt Bauman (1993) once described modern times as a snake eating its own tail. This metaphor perfectly encapsulates the opioid industry: a cycle where medical advancements, though invaluable, simultaneously generate immense societal harm.

Opioids, initially developed as life-saving painkillers, have morphed into substances fueling one of the most devastating public health crises of our time. The North American opioid epidemic stands as a grim testament to this pattern—a tragic interplay between medical innovations, profit-driven pharmaceutical companies, and addiction. Compounding the issue, America’s punitive and prohibitionist drug policies have failed to enact systemic change or promote widespread harm reduction measures.

Although the ongoing American opioid crisis is unprecedented in scale, its warning signs are global. The situation in Europe has been different, with a general decline attributed to an aging of people who use opioids and fewer young people starting opioid use. However, this trend may be shifting, as seen in the Nordic countries, where opioid use among young people appears to be on the rise. Recent studies (Nygaard-Christensen et al., 2024) from Denmark and Sweden highlight active opioid use among young people, while Finland reports one of the highest proportions of drug overdose deaths among youth in Europe. The relatively low cost of opioids, combined with easy access through social media platforms and the dark web, further exacerbates the issue.

From medicine to crisis: A brief history of opioids

Opioids have been used for centuries to alleviate pain, tracing back to ancient Egypt and Greece. Morphine, discovered in the 19th century, was a medical breakthrough, providing effective pain relief. Yet, its addictive properties quickly surfaced, marking the beginning of a dangerous relationship between medicine and dependence.

In 1898, the German pharmaceutical company Bayer introduced heroin as a “non-addictive” alternative to morphine. History proved otherwise. Similarly, at the end of the 1990s, buprenorphine entered the market with claims of being a safe substitution treatment for opioid addiction, but it too was soon widely misused. In Finland, buprenorphine has been by far the most commonly used street opioid for 25 years and is responsible—when combined with benzodiazepines and alcohol—for the majority of drug poisonings.

Many new opioids have followed the same trajectory: introduced as a safer and more effective medical innovation, only to be exploited for its intoxicating effects and ultimately contributing to addiction.

The North American opioid crisis: Medicine turned disaster

The North American opioid crisis began in the late 1990s with the launch of OxyContin, a long-acting opioid painkiller developed by Purdue Pharma. Marketed aggressively as a safe, low-risk treatment for chronic pain, OxyContin rapidly gained widespread popularity among physicians and patients. Purdue spent millions promoting the drug, influencing medical practices across the United States. Doctors prescribed opioids in unprecedented quantities, unaware of the addictive disaster unfolding.

By the 2010s, the consequences were clear: millions of Americans were dependent on prescription opioids. When stricter regulations curbed access to legal opioids, many users turned to illicit alternatives like heroin, marking the second wave of the crisis. Soon after, synthetic opioids such as fentanyl entered the scene. Fentanyl, 100 times more potent than morphine, caused overdose deaths to skyrocket. By 2021, the U.S. recorded over 80,000 opioid-related deaths—surpassing annual traffic fatalities and the combined number of soldiers lost in the Vietnam, Iraq, and Afghanistan wars.

The opioid crisis is not just a story of addiction, but a failure of systems driven by profit. Purdue Pharma, along with other pharmaceutical giants, prioritized sales over safety. Misleading claims about the addictiveness of OxyContin and aggressive marketing campaigns normalized opioid prescriptions, despite mounting evidence of harm. A single, non-peer-reviewed article from 1980 claiming opioids carried a “low risk” of addiction was widely cited, fueling the epidemic.

This crisis also exposes broader structural issues. The U.S. healthcare system lacked adequate safeguards to monitor opioid prescriptions, while addiction treatment remained inaccessible for many. Meanwhile, drug policy focused on criminalizing users rather than addressing the root causes of opioid use and related harms.

The rising threat of Nitazenes

Today, a new opioid threat looms: nitazenes. These potent synthetic opioids, originally developed in the mid-20th century, have recently emerged on the illicit drug market. Reports from the UK and Ireland highlight a growing crisis, with nitazenes linked to an increasing number of overdose deaths. The potency of nitazenes, which can even exceed fentanyl, makes them exceptionally dangerous, especially when users are unaware they are consuming them.

These incidents underline the urgent need for comprehensive reviews of nitazenes and coordinated actions to reduce harm in large communities. Enhanced harm reduction strategies, including drug testing, education, and access to naloxone, are critical to addressing this emerging crisis. However, while the faces of the crisis may change, the underlying dynamics remain the same.

Why the cycle persists – and how to break it

The opioid crisis illustrates a recurring pattern within modern medicine: new pharmaceutical innovations, hailed as solutions, often bring unforeseen consequences. Each new opioid—heroin, methadone, OxyContin, fentanyl, nitazenes—promised more effective relief but also delivered harm. This cycle is perpetuated by a pharmaceutical industry that has prioritized profit and a society increasingly reliant on chemical solutions for pain, both physical and emotional. As scholar Nikolas Rose has put it (2003), we live in a “psychopharmacological society,” where altering mental states through substances is both normalized and exploited.

If the opioid crisis has taught us anything, it is that we cannot rely solely on medical and technological solutions to fix problems created by the same systems. Addressing the opioid epidemic requires a multi-faceted approach. Pharmaceutical companies must be held accountable for deceptive practices that endanger public health, facing significant consequences for their actions. Availability of and access to addiction treatment must be expanded, ensuring that effective treatments, including opioid agonist therapies and harm reduction measures, are available to everyone who needs them (see Viskari & Tammi 2021; Abel-Ollo et al. 2022).

Punitive drug policies need a complete overhaul. Policies should emphasize harm reduction, prevention, and support for individuals battling addiction, rather than focusing on punishment. At the same time, regulating prescription practices with stronger oversight can help prevent new cases of opioid dependence, addressing the problem at its roots.

Finally, global preparedness is essential. Countries outside of North America must proactively address opioid risks, learning from the U.S. epidemic to avoid repeating the same mistakes. Through coordinated efforts, the international community can tackle these crises before they escalate.

Will the snake continue to eat its tail?

The opioid crisis is far from over. As fentanyl continues to spread across drug markets and nitazenes emerge as a new threat, opioid poisonings are on the rise. While Europe may not yet face a crisis comparable to North America, recent Nordic data indicate that opioids are becoming increasingly popular among younger people, and the volatility of drug markets poses a significant risk of localized epidemics.

Without systemic change, the cycle of medical innovation, punitive prohibition, and unintended harm will persist. The snake will keep eating its tail.

The article is written by Tuukka Tammi, PhD, Lead Expert at the Finnish Institute for Health and Welfare (THL) and Docent at the Universities of Helsinki and Tampere.

References: 

• Abel-Ollo, K.; Andree, R.; Colman, C.; Kivimets, K.; Kools, J.-P.; Kurbatov, A.; Moazen, B.; Oja, M.; Pattyn, R.; Pérez Gayo, R.; Rigoni, R.; Smit Rigter, L.; Strada, L.; Stöver, H.; Tammi, T.; van der Gouwe, D.; Viskari, I. (2022): Toolkit on key responses to synthetic opioids. SO-PREP 06 / 2022.
• Bauman, Z. (1993). Postmodern Ethics. Oxford: Blackwell.
• Nygaard-Christensen; M., Thylstrup, B. & Houborg, E. (2024). New study on young people’s use of non-prescribed opioids in Denmark. PopNAD.
• Rose N. (2003). Neurochemical selves. Society, 41(1), 46-59.
• Viskari, I. & Tammi, T. (2021). Report on good practices of synthetic opioid preparedness, and needs and challenges in EU Member States. SO-PREP 2021.