In 2024, overdose remained the leading cause of death for Americans between the ages of 18 and 44, claiming the lives of more than 80,000 people across the country. Each of these deaths represents a family’s heartbreak—a child, parent, sibling, or spouse lost to a crisis that, at its heart, is both treatable and deeply complicated. The opioid epidemic, long fueled by a mix of corporate greed, government red tape, and social inequality, continues to exact a devastating toll, even as new medications and policies offer glimmers of hope. But for many, especially mothers and marginalized communities, the system remains deeply flawed and often punishing.
According to reporting by The New York Times Magazine, the story of buprenorphine—a medication now widely used to help people break free of opioid addiction—offers a window into the tangled web of profit motives and policy failures that have shaped America’s response to substance use disorder. Patented in 1965 and originally used to treat severe pain, buprenorphine was discovered by researchers to reduce opioid cravings. Yet when it came time to bring the drug to market as a treatment for addiction, the company that controlled it, Reckitt, hesitated. The reason? Money. Because the patent was old, buprenorphine would have been available as a cheap generic, offering little incentive for Reckitt to invest in the expensive process of FDA approval for addiction treatment.
So, how did buprenorphine become available as Suboxone? As The New York Times Magazine details, Reckitt partnered with the National Institute on Drug Abuse (NIDA), which paid for the clinical research necessary to prove the drug’s safety and effectiveness. While the federal government shouldered the research costs, Reckitt simultaneously sought a special orphan-drug status from the Food and Drug Administration (FDA). This status, typically reserved for rare diseases, would block generic competition for seven years. Reckitt argued that doctors would be unable to prescribe buprenorphine outside of highly regulated methadone clinics, limiting the potential patient pool. The FDA was skeptical, but eventually granted the request.
Meanwhile, Reckitt worked behind the scenes to change U.S. laws, making it easier for doctors to prescribe buprenorphine from their offices—a move that would vastly expand the market for the drug. The law, signed by President Bill Clinton in 2000, allowed doctors to prescribe buprenorphine after completing a training workshop, but capped the number of patients at 30. When the FDA approved Suboxone in 2002, it entered a landscape shaped as much by profit as by public health.
Sales of Suboxone were initially slow, hampered by stigma and the extra effort required of doctors. But with a massive sales push and a 2006 change in the law raising the patient cap to 100, things began to change. Reckitt later introduced a new film strip version of Suboxone, claiming it was safer than tablets—a claim the FDA doubted. Nevertheless, the film was approved, tablets were pulled from the market, and generic competition was delayed once again. By 2013, Reckitt was making $1.5 billion a year from Suboxone sales.
But these corporate maneuvers came at a cost. As the opioid crisis deepened, barriers to treatment remained high, especially for those already marginalized by poverty, lack of insurance, or racial discrimination. According to Mother Jones and The Marshall Project, these barriers are particularly acute for mothers. April Lee, a mother in Philadelphia, found herself spiraling deeper into addiction after a sexual assault. Unable to access treatment—partly because she couldn’t leave her children behind—she lost custody, was eventually arrested, and only began to recover after entering a recovery home post-incarceration.
Lee’s experience is far from unique. Decades of research have shown that addiction treatment programs allowing women to bring their children achieve better outcomes. Yet, as of 2023, fewer than 5 percent of treatment facilities nationwide provide child care, and fewer than 3 percent allow patients to bring their children with them. For mothers, especially those with limited means, this lack of support is often a dead end. "It’s a dead end. There are no facilities out there to help them," said Eloisa Lopez, a former member of Arizona’s maternal mortality committee, in an interview with Mother Jones.
Punitive policies only compound the problem. Pregnant women are routinely turned away from treatment, forced onto lengthy wait lists, and disproportionately impacted if they are Black. Many mothers who seek help risk having their children removed and placed into foster care, or even facing prosecution for drug use during pregnancy—including use of prescribed addiction treatment medications. Sometimes, children are taken away based on false positives from drug tests triggered by poppy seed bagels or medications. Once incarcerated, women have far less access to addiction treatment than men, and upon release, they face a staggering risk: one study found that recently released incarcerated people were 40 times more likely to die from opioid overdose than the general population.
The consequences ripple outward. Policies that punish drug use during pregnancy have been linked to higher overdose rates and more infants born with withdrawal symptoms. Another study found that infants taken from their mothers were less likely to smile, reach, roll over, or sit up compared to those who remained with their mothers. "We didn’t have, ‘Oh my God, let’s put them in treatment,’” Lee told Mother Jones. “It was, ‘Arrest them, separate them.’"
Despite these grim realities, there have been some signs of progress. The latest statistics show that drug-related deaths in 2024 dropped by 30,000 compared to the previous year, returning to pre-pandemic levels. Experts attribute this decline to policies like the widespread adoption of Narcan, an overdose-reversing medication that is now carried by first responders and available over the counter, as well as increased access to medication-assisted treatment using Suboxone and methadone. Yet even these gains are fragile. Federal cuts to Medicaid and addiction treatment programs, especially those expanded during the pandemic, threaten to reverse recent progress—particularly for mothers and people of color.
The roots of the crisis run deep. America’s approach to substance use disorder has long been shaped by moralism and criminalization, with drug laws disproportionately targeting Black communities. As The New York Times Magazine notes, the government has at times introduced the very drugs it then criminalized, and the for-profit health system often puts private gain above public good. For many experts and advocates, the solution lies not in more punishment, but in a public health approach that prioritizes compassion, comprehensive care, and access for all—especially mothers and families most at risk.
As the nation grapples with the ongoing fallout of the opioid epidemic, the stories of people like April Lee serve as a stark reminder: the crisis is not just about drugs, but about who gets help, who gets punished, and whose lives are valued. Until those questions are answered with justice and empathy, the fight against overdose will remain unfinished business.
