Written by Randy Yan and Edited by Ariel Min
More than 218,000 people in the United States have died from overdoses related to prescription opioids between 1999 and 2017 [1]. Opioids, a class of drugs that includes legally prescribed opioids and illegal opioids, contribute to thousands of deaths each year in America due to overdose and misuse. Each year, millions of people require medications in order to treat chronic and acute pain; as a result, prescription opioids such as hydrocodone and oxycodone are naturally prescribed to patients [2]. By doing so, physicians introduce opioids to those who may be vulnerable to the possibility of addiction and reliance on the substance in the future.
Pharmaceutical companies have contributed to potentially the worst drug crisis in American history by oversaturating the market with drugs and failing to implement proper controls against misuse and diversion [3]. In recent years, there has also been a surge of illegally manufactured fentanyl — an opioid that is not only 50 to 100 times more potent than morphine, but also one that produces heroin-like effects. Fentanyl is one of the biggest contributors to the recent increases in synthetic opioid deaths. From 2016 to 2017, overdose deaths involving synthetic opioids increased by almost 47% [4]. Although opioids themselves, whether legally or illegally obtained, are directly responsible for the deaths attributed to opioid overdose, the structural and societal significance indirectly causing overdoses are the main issues at stake.
Structural disadvantage contributes to addiction, which is the main cause of the opioid epidemic and the primary factor leading to overdose [5]. Income inequality, social disparities, and other structural inequities such as poverty, lack of opportunity, and substandard living and working conditions, all factor into the increasing number of individuals who misused opioids in recent years [6]. Individuals from communities of low socioeconomic status are typically more inclined to work in the manufacturing industry or in other service jobs with elevated hazards; these occupations come with a greater risk of developing and sustaining many work-related injuries that give rise to chronic pain [7]. As a result, there is an increase in opioid prescriptions and use in these communities.
In the same vein, according to a recent study investigating the association between mortality due to drug overdose and social capital within the U.S., counties with the lowest levels of social capital had the highest levels of overdose rates [8]. These results can be seen throughout the United States in the poorest areas characterized and plagued by structural deficits. The poorest communities are also the most likely to lack substance abuse service organizations that provide care and treatment to help prevent substance abuse. However, the opioid epidemic is not merely situated in these poorer areas; they are also prevalent in areas of higher socioeconomic status. Approximately 41% of drug overdose deaths occur in urban counties, 26% in the suburbs, 18% in small metropolitan areas, and 15% in rural communities [9]. Structural advantages in the healthcare system and in development, such as better access to medical centers and pharmacies, may have been the leading factor for the increase in widespread prescription opioids to communities of all types.
As the number of opioid overdoses in America continues to rise, healthcare providers should understand the structural challenges and inhibitors that contribute to the overarching opioid epidemic. They should be mindful to minimize the amount and dosage of opioids prescribed to patients. The government can also expand on opioid misuse prevention by enacting laws and regulations to ensure that physicians are not overprescribing opioids and that individuals are not abusing the drug [10]. Moving forward, public health and healthcare officials should aim to address the structural inequities of society in order to understand how to treat patients with chronic pain without overprescribing opioids to alleviate the issue. On a more ethical note, we should also consider treating pain with another substance that does not inflict as much additional pain in the community.
References:
- “Prescription Opioid Data.” Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/data/prescribing.html
- “Opioids.” National Institute on Drug Abuse. https://www.drugabuse.gov/drugs-abuse/opioids
- Haffajee, R.L., Mello, M.M. (2017) Drug Companies’ Liability for the Opioid Epidemic. New England Journal of Medicine, 377: 2301-2305.
- “Fentanyl.” Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/opioids/fentanyl.html
- Pendyal, A. (2018). Root Causes of the Opioid Crisis. Mayo Clinic Proceedings, 93: 1329–1330.
- Srivastava, A.B., Gold, M.S. (2018). Root Causes of the Opioid Crisis. Mayo Clinic Proceedings, 93: 1329–1330.
- Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. American Journal of Public Health, 108: 182–186.
- Zoorob, M.J., Salemi, J.L. (2017). Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States. Drug and Alcohol Dependence, 173: 1-9.
- Kneebone, E., Allard, S.W. “A nation in overdose peril: Pinpointing the most impacted communities and the local gaps in care.” The Brookings Institution. 25 September 2017. https://www.brookings.edu/research/pinpointing-opioid-in-most-impacted-communities/
- Schieber, L.Z., Guy, G.P., Seth, P., et al. (2019). Trends and Patterns of Geographic Variation in Opioid Prescribing Practices by State, United States, 2006-2017. Journal of American Medical Association, 2: 1-15.