Last month, the CDC announced a horrific milestone: more than 100,000 people in the U.S. died of an overdose during the 12 month period ending in April 2021. This is nearly a 30% increase from the prior year and a glaring sign that the country's efforts to address overdose death are failing.
For many Americans, the potential solutions to this ongoing crisis may feel confusing or controversial -- debates about and the continue, despite clear evidence that interventions like the former can help address the devastation while the latter certainly increases it, especially for communities of color. However, the causes of the overdose crisis are often considered cut and dried. For many, opioids have developed the reputation of dangerous poisons that should be avoided at all costs, and the pharmaceutical companies that manufactured and marketed pills and the prescribers who "pushed" them should be held accountable.
Placing the blame squarely on pharmaceutical companies for the current crisis feels righteous and satisfying -- indeed, companies have made off opioid sales, and their actions and deceitful practices should not be ignored. In addition, demonizing opioids as "killer pills" that will cause devastating addiction in anyone who takes them can provide a sense of security -- many people seem to believe that to avoid opioid use disorder, one should just refuse to take any opioids.
Unfortunately, this narrow focus on the pills themselves and the people who made and prescribed them ignores the complex and actionable issues at the root of the overdose crisis -- issues that continue to go unaddressed, even as states attempt to hold opioid manufacturers accountable legally and financially.
Despite what many believe about opioids -- that they can potentially hijack anyone's brain, regardless of how they are taken -- there are numerous factors that can place individuals at higher risk of developing an opioid or other substance use disorder. Untreated pain, both physical and emotional, is often the reason why many individuals use prescribed and non-prescribed substances. Around in the U.S. have chronic pain, and physical pain is one of the most common reasons that people in the U.S. present for healthcare.
Even more staggering is the burden of emotional and psychological pain: in the U.S. struggles with depression, anxiety, or another mental health issue, and Surgeon General Vivek Murthy, MD, MBA, recently released that youth mental health is currently in crisis.
Although the COVID-19 pandemic certainly exacerbated the situation, Murthy was clear in stating that it existed long before the pandemic. at least one adverse childhood experience (ACE), like neglect, abuse, divorce, or parental incarceration, and these types of are associated with substance use in adulthood.
Unsurprisingly, factors like and housing insecurity -- in the U.S. -- contribute to the physical and emotional pain and health inequities often associated with increased substance use. In addition, despite what could be considered a crisis of unaddressed physical and emotional pain, effective and are incredibly hard for many individuals to access, as is evidence-based treatment for people who already struggle with . Instead, we have often turned to law enforcement approaches and criminalization to address these issues.
All of this amounts to an incredibly fertile environment for a crisis of substance use disorders, especially of substances targeting pain. Pharmaceutical companies certainly took advantage of the situation, but they alone did not lay the groundwork.
Clearly identifying the true causes of the substance use disorder and overdose crises is vital to actually addressing them. While efforts are funneled towards opioid settlements and decreasing opioid prescribing, we have yet to implement policies -- many of them clearly evidence-based -- that can alleviate some of the risk factors associated with the development of substance use disorders and help people who are currently suffering.
To protect people from developing substance use disorders, we need to ensure that everyone has access to quality mental health care -- and to strengthen our mental health care system we need to , many of whom experience a high burden of work-related stress and receive incredibly low wages themselves. We must address the financial and housing-related experienced by millions of U.S. adults and children. The in our society -- arguably one of the true drivers of substance use disorder -- will continue to cause and contribute to substance use disorders of all kinds, even if opioids were made harder to access.
On that note, our approach to supply-side issues has clearly failed to address the overdose crisis and has actually exacerbated it. Our street drug supply has become increasingly and other powerful analogues that put both opioid and non-opioid drug users in grave danger. Crackdowns on opioid prescribing and the illicit drug trade have by incentivizing the manufacture and trafficking of increasingly potent substances.
Contamination of non-opioid drugs means that people with no previous experience using opioids (therefore no acquired tolerance to opioids) can unwittingly take opioids and overdose, and since they don't generally use opioids, they may be less familiar with opioid harm reduction techniques like naloxone. Addressing the street drug supply via decriminalization and -- although very controversial -- would likely save countless lives, as would increasing access to and allowing safe consumption spaces to open .
It's clear that what we need is a sprawling, multi-pronged response to a complex problem -- a problem that was not caused solely by access to opioids and cannot be solved by punishing pharmaceutical companies and cracking down on prescribing. Over the past several years, we've seen rising rates of and use disorders and deaths, which points to an issue much larger than opioids. If we choose to focus on the substances themselves rather than the groundwork that makes our society vulnerable, the end to this overdose crisis will remain nowhere in sight.
is an Assistant Professor in the Department of Family and Community Health at the University of Pennsylvania School of Nursing.