1st Edition

The Opioid Epidemic in the United States Missed Opportunities and Policy Failures

By Kant B. Patel, Mark E. Rushefsky Copyright 2022
    376 Pages 3 B/W Illustrations
    by Routledge

    376 Pages 3 B/W Illustrations
    by Routledge

    The current opioid epidemic in the United States began in the mid-1990s with the introduction of a new drug, OxyContin, viewed as a safer and more effective opiate for chronic pain management. By 2017, the opioid epidemic had become a full-blown crisis as over two million Americans had become dependent on and abused prescription pain pills and street drugs.

    This book examines the origins, development, and rise of the opioid epidemic in the United States from the perspective of the public policy process. The authors, political scientists Kant Patel and Mark Rushefsky, discuss institutional features of the American political system that impact the making of public policy, arguing that the fragmentation of that system hinders the ability to coherently address policy problems, taking the opioid epidemic as an example. The book begins with a brief historical examination of the history of the problem of opioid addiction and crises in the United States and public policy responses to past crises, but the main focus is on the current national public health emergency. The book analyzes the following:

    • The origins of the current crisis
    • Indicators and warning signs pointing to the emergence of a significant public problem
    • Factors that contributed to the opioid crisis
    • Why the crisis emerged in the United States and not in other Western countries
    • The nature and scope of the opioid crisis, including socioeconomic and demographic characteristics and the human, social, and economic costs
    • Presidential administrations’ public response, and nonresponse, to the opioid crisis
    • Parallels between the role played by opioid manufacturers and tobacco/cigarette manufacturers in creating the problem of addiction, resulting in high mortality rates, and the public policy response to both

    This book explores the national policy response to the opioid crisis, as well as state and local government responses and separation of powers, including how the three branches of government deal with the opioid problem. The authors conclude with a discussion of how accurate problem definition, problem diagnosis, and appropriate and timely responses could have produced a more appropriate and robust policy response—policy process tools that will be essential in fighting both the current crisis and the next one. The Opioid Epidemic in the United States is essential reading for policy analysis courses in political science, health, and social work programs, as well as for United States policymakers at the local, state, and national levels.

    1. The Policy Process and Policy Cycles 2. The First Opiate Crisis: 1860s to 1920s 3. The Second Opioid Crisis: 1960s to 2000 4. The Third Opioid Crisis: 2000–Present 5. State Governments and the Current Opioid Crisis 6. A Perfect Storm: Big Pharma, FDA, DEA, and the Opioid Crisis 7. The Global Context of the Opioid Crisis: The Opioid Crisis From a World Perspective 8. Opioid Epidemics and Public Policy


    Kant Patel is Emeritus Professor of Political Science at Missouri State University, USA.

    Mark E. Rushefsky is Emeritus Professor of Political Science at Missouri State University, USA.

    "Anchored in a keen understanding of the policy process, Patel and Rushefsky provide an historical overview of government efforts in the United States to respond to three opioid epidemics. They devote particular attention to the current problems fueled by prescription pain killers. This book will be a valuable catalyst for learning in courses on public policy in general and health policy more specifically."

    Frank J. Thompson, Rutgers University, USA


    Book Reviews:

    “Many books address illicit drug use or misuse of prescription drugs and associated policies. This book is unique in the way it presents a historical context from the 1800s to present and then offers policy changes that have yet to fully address the problem. It ends with future policy recommendations. No other book currently available offers all of these aspects.”

    Excerpt from Carole A. Kenner, School of Nursing and Health Sciences, The College of New Jersey; Editorial Reviews, Doody’s Editorial Services. 2022.


    “This is a remarkably useful and comprehensive volume….The authors do an excellent job of explaining the policy failures that created the conditions for the 21st-century opioid epidemic, but an even better job of demonstrating the missteps that turned an epidemic of use into one of the most extraordinary policy catastrophes in United States history… Detailed and well-organized, with comprehensive lists of references drawn from a variety of disciplines, The Opioid Epidemic in the United States is an essential starting point for students of this moment. Indeed, it could find a place in the graduate or advanced undergraduate classroom. At the same time, more engaged scholars will find the arguments advanced by Patel & Rushefsky to be thought-provoking and worthy of further consideration.”

    Excerpt from Joseph F. Spillane, University of Gainesville, Florida, Addiction, Vol. 117, no, 10, (July, 2022): 2756-2757.


    “Kant B. Patel and Mark E. Rushefsky provide a relatively comprehensive look at the development of the current crisis and the various efforts to combat it, with a keen eye towards the titular failures and oversights of government at all levels…. the book is thorough and appropriate for a variety of audiences…. Patel and Rushefsky have contributed an accessible and relatively thorough look at the evolution of and fight against the opioid epidemic…. the authors have performed a laudable service to the disciplines of public policy and public health with this book.”

    Excerpt from Jack D. Collins, Siena College, Loudonville, NY, Political Science Quarterly, vol. 138, no. 1 (Spring 2023): 105-106.


    The Opioid Epidemic in the United States: Missed Opportunities and Policy Failures is perhaps one of the most exhaustive scholarly endeavours on the policy aspects of dealing with the American opioid crisis. It is unmatched in its characterisation of the crisis, encompassing historical, political, institutional and legal viewpoints. Through their eight chapters, Kant and Rushefsky take us through the life cycle of this policy problem that has turned out to be ‘$1tn’ worth of a public health debacle… The book is written in a scientific style rather than a journalistic style. This essentially means that each assertion and inference in the volume is backed by an empirical fact.” 

    Excerpt from Roshni Das, Department of Public Affairs, University of Missouri- Kansas City, Kansas City, Missouri. Journal of International Law and Management, vol. 65, no. 4 (2023): 368-370.