Last month, the CDC announced a terrifying milestone: More than 100,000 people in the United States died of overdose in the 12 months ending April 2021. This is a nearly 30% year-over-year increase and a blatant sign that the country’s efforts to fight death from overdose are failing.
For many Americans, the possible solutions to this ongoing crisis may feel confusing or controversial – the debates over safe places to use and the war on drugs continue despite clear evidence that interventions like the former can help fight the devastation while the latter it certainly reinforced. especially for color communities. However, the causes of the overdose crisis are often viewed as trite. For many, opioids have earned a reputation for dangerous poisons that should be avoided at all costs, and the pharmaceutical companies that made and marketed pills, and the prescribers for “advancing” them, should be held accountable.
Blaming drug companies for the current crisis feels fair and satisfying – in fact, opioid sales companies have made billions, and their actions and fraudulent practices should not be ignored. In addition, the demonization of opioids as “killer pills” that cause devastating addiction to anyone who takes them can make one feel safe – many people seem to believe that to avoid opioid use disorders, simply turning off opioids should be .
Unfortunately, this narrow focus on the pills themselves and the people who made and prescribed them ignores the complex and workable problems underlying the overdose crisis – issues that continue to go unnoticed even as states attempt to hold opioid manufacturers legally accountable and financially.
Regardless of what many believe about opioids – that they can potentially hijack the brain of anyone, regardless of how they are taken – there are numerous factors that can increase your risk of developing an opioid or other substance use disorder. Untreated physical and emotional pain is often the reason many people take prescription and nonprescription drugs. Approximately 20% of adults in the US have chronic pain, and physical pain is one of the most common reasons people seek medical care in the US.
Even more astounding is the burden of emotional and mental pain: one in four adults in the US is struggling with depression, anxiety, or some other mental health problem, and surgeon general Vivek Murthy, MD, MBA, recently issued a warning that the mental health of young people is a problem currently in crisis.
Although the COVID-19 pandemic certainly made things worse, Murthy clearly stated that it existed long before the pandemic. Three in five adults in the US report at least one Adverse Childhood Experience (ACE), such as neglect, abuse, divorce, or parental imprisonment, and these types of childhood trauma are associated with adult drug use.
Unsurprisingly, factors such as poverty and housing insecurity – which are on the rise in the US – contribute to the physical and emotional pain and health inequalities often associated with increased substance use. Furthermore, despite what could be viewed as untreated physical and emotional pain, despite a crisis, effective pain management and mental health care is incredibly difficult to access for many people, as is evidence-based treatment for people already struggling with addiction problems. Instead, we have often turned to law enforcement and criminalization to address these issues.
All of this results in an incredibly fertile environment for a crisis of substance use disorders, especially substances that target pain. The pharmaceutical companies have taken advantage of the situation, but they have not set the course on their own.
It is crucial to clearly identify the real causes of substance use disorder and overdose crises in order to actually address them. While efforts are directed towards opioid colonization and opioid prescription reductions, we still need to implement guidelines – many of them clearly evidence-based – that can alleviate some of the risk factors associated with developing substance use disorders and help people who are currently suffering .
To protect people from developing substance use disorders, we need to make sure everyone has access to quality mental health care – and to strengthen our mental health care system, we need to support mental health workers, many of whom are exposed to heavy workloads – induced stress and receive incredibly low wages themselves. We need to address the financial and housing precariousness that millions of adults and children face in the United States. The trauma crisis in our society – arguably one of the real causes of substance use disorders – will continue to cause and contribute to substance use disorders of all kinds, even if access to opioids is made difficult.
With that in mind, our approach to supply-side issues clearly failed to address the overdose crisis, and actually exacerbated it. Our street drug supply is increasingly contaminated with fentanyl and other potent analogs that place both opioid and non-opioid users at great risk. Tough action against opioid prescribing and illicit drug trafficking has contributed to the contamination by stimulating the manufacture and trade of increasingly potent substances.
Contamination from non-opioid drugs means that people with no prior experience with opioids (that is, no acquired tolerance to opioids) may inadvertently take opioids and overdoses such as naloxone. Tackling the street drug supply through decriminalization and safe supplies – though highly controversial – would likely save countless lives, as would access to harm reduction services and opening up safe consumption rooms nationwide.
It is clear that we need a broad, multi-pronged answer to a complex problem – one that was not caused by access to opioids alone and cannot be solved by punishing drug companies and cracking down on prescriptions. In recent years we have seen rising rates of disorders and deaths from alcohol and stimulant use, indicating a much bigger problem than with opioids. If we prefer to focus on the substances themselves rather than the fundamentals that make our society vulnerable, there will be nowhere in sight to this overdose crisis.
Shoshana Aronowitz, PhD, MSHP, FNP-BC, is an Assistant Professor in the Department of Family and Community Health at the University of Pennsylvania School of Nursing.