Substance abuse, especially opioids, has been driven by a variety of factors in the US today. The cause of the opioid crisis was attributed to the prescription of opioid analgesics by physicians and promoted by selfish pharmaceutical companies. However, economic and social upheavals, evolving approaches to the treatment of pain, and inadequate treatment of drug-related problems have been the factors driving opioids and substance abuse in the US today.
The first phase of the opioid crisis dates back to 1980 when they were used to treat acute pain. In the nineteen nineties, there was a rise in chronic pain prevalence due to musculoskeletal disorders of an aging population, increased survivorship after injury and cancer, and increasing complexity and frequency of surgery. Chronic pain became big business, and biopharmaceutical manufacturers sensed an opportunity. Some pharmaceutical marketing improperly minimized addiction potential and promoted off-label use of opioids. Moreover, a small proportion of unscrupulous physicians administered opioids without adequate regard for medical needs. These factors caused a steady rise in opioid analgesic consumption, increasing rates of overdose, and addiction (Dasgupta & Beletsky, 2018).
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The next phase in the opioids crisis began around 2010. There were concerns over the relationship between opioid analgesics and heroin abuse. Deaths due to heroin overdose tripled between 2010 and 2015. The deaths were due to an enlarged pool of vulnerable individuals. With rising dependency and tolerance, some people who used prescription opioids turned to a more potent and cheaper alternative. During this period, medical practitioners and policymakers widely reassessed the effectiveness and safety of outpatient use of opioids analgesics.
In 2013, the last phase of the opioids crisis began and continues today. There was the emergence of potent and compact products found in counterfeit pills and heroin. The efficient global chains of supply and intensification in interdiction efforts were responsible for this condition. As opposed to health care as the cause of addiction, those enlisting for drug treatment currently in the US are more likely than not, to report heroin as their first drug. The blame for the trend of opioid analgesics to heroin to synthetic opioid use lies with the abused drugs themselves and those who supply them.
The authors state that there are intuitive causal connections between poor health and the ongoing drug crisis. This connection means that although the increase in the availability of opioids may have promoted the rates of the opioid epidemic, structural factors play a significant role in the misuse of opioids and other substances (Dasgupta & Beletsky, 2018). The structural factors include lack of economic opportunities, poor working conditions, eroded social capital as well as hopelessness and despair in depressed communities. Overall, the statement entails that there is an interconnection between fatal drug overdoses, alcohol-related disease, and suicide.
There are several suggestions made by the authors to address the drug crisis. The authors champion for the rapid improvement of access to evidence-based treatment for opioid use disorder as a critical intervention. The authors also advise against the widespread social stigma of drug treatment and the unrealistic expectations for quick remedies. They assert that physicians should focus on suffering and compassion rather than pain. They further advocate for the engagement of opioids users in comprehensive care, especially at a time when access to the drugs may be fluctuating. The authors note that it is crucial to integrate clinical care with attempts to improve patients' structural environment (Dasgupta & Beletsky, 2018). The authors say that training health care providers in structural competency is critical in addressing structural factors. Such factors include racial disadvantage, economic opportunity, social cohesion, and life satisfaction which are fundamental to public health. The authors opine that the root causes of drug abuse must be faced and advocacy for social change done because the root causes are social and structural. The authors also add that the root causes are related to genetic, behavioral, and individual factors.
The authors of the article are Nabarun Dasgupta and Leo Beletsky. N. Dasgupta is an employee of the RADARS system as well as the Eshelman School of Pharmacy, University of North Carolina. Leo Beletsky is with the Bouve' College of Health Sciences, Northeastern University, Boston, and is also with the University of California, School of Medicine.
Reference
Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: no easy fix to its social and economic determinants. American journal of public health , 108 (2), 182-186.
