America’s Drug-Death Crisis Began With Chronic-Pain Prescribing
Economists William Evans and Ethan Lieber argue that America’s drug-death crisis began with a domestic medical failure: a late-1990s shift toward prescribing opioids for chronic pain, reinforced by pharmaceutical promotion and regulatory acceptance. In Steven Davis’s interview, they trace how counties with more underlying pain were hit hardest, how OxyContin made the shift more dangerous, and why the crisis later moved from prescription drugs into heroin and fentanyl. Their account leaves little comfort for current policy: correcting prescribing practices may address the original channel, but most deaths now come from illicit fentanyl markets that are far harder to control.
Hoover Institution·Jun 3, 2026·15 min read
