The opioid crisis claims more than 91 Americans per day from overdoses; more than die of car crashes, gun violence or murders. Although the rate of opioid addiction has risen recently at an alarming rate, there is a misimpression that legitimate opioid use for pain invariably places patients on a fast track to addiction, with many turning to illicit prescriptions and, in many cases, heroin. In reality, only a small portion (1 in 100,000) of those who become dependent on legitimately prescribed opiates become addicted to opioids, such as heroin. So what factors explain the opioid crisis and where should we devote our precious resources?
Two NIH institutes, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, have been extensively funding studies on addiction for many decades. Both have produced abundant knowledge on the problem with critical implications for where we should focus our attention to get the greatest return on our dollars
{mosads}In short order, individuals who become addicted to opioids are often those whose life-course trajectory points toward hard-core substance abuse due to early mental and behavioral health problems, exposure to adversity (e.g., poverty, child maltreatment, lack of social supports), unemployment, family distress, lack of job skills and opportunities, and other detrimental conditions. The underlying factors are the problem, not the drug, and they are all addressable. Translating this knowledge to policymakers is critical to identify funding targets worthy of our support.
The opioid crisis requires national leadership to provide cross-cutting support from multiple agencies, organizations, and state and local governments to develop comprehensive solutions. We offer the following policy recommendations for leading the national fight against the opioid crisis.
Disinvest in incarceration
Criminal justice solutions are 750 percent more costly than other options; a corpus of evidence demonstrates that incarcerating large numbers of drug users is ineffective. Advancements in substance abuse treatment practices offer new, promising alternatives for better-informed and infinitely more effective and cost-efficient policies.
Invest in prevention
The risk factors for addiction can be comprehensively and effectively addressed in systematic, high-quality and wide-scale implementation of evidence-based individual, family, school and community-level preventive interventions and policies. Well-established programs, designed to prevent negative behavioral outcomes, work to reduce exposure to the detrimental conditions and their harmful consequences that lead to addiction in the first place. We recommend scaling these interventions to public health-level policies, which will increase capacity to prevent the development of addiction.
Invest in medical and social research
Additional research is needed to advance our ability to thwart opioid and other substance addiction. We recommend funding studies into programmatic methods to utilize current and emerging knowledge on addiction to quell the opioid crisis and other substance abuse issues nationally.
Assist with collaborative data sharing
Addiction is an inter-state issue, requiring coordination by the federal government to ensure both federal and state agencies are connected and data can be shared across jurisdictions. In addition, public-private partnerships can encourage data sharing between researchers, private healthcare, emergency, criminal justice and laboratory services. We recommend developing a data clearinghouse to assist in deploying federal resources in the most afflicted areas, reducing physician and pharmacy shopping across state borders for opioid procurement, and developing metrics for examining current and emerging drug trends with greater accuracy and immediacy. This effort can assist local, state and federal law enforcement agencies with tracking trafficking across and within jurisdictions.
Address the stigma of opioid addiction
Opioid addiction affects a wide array of individuals, from high school athletes to blue-collar rural workers, yet stereotypes about those afflicted with addiction still exist. Stigma can lead to a lag in seeking addiction assistance and support from friends and family. Those with addiction deserve assistance, and we recommend developing national campaigns to help the public understand the causes and scope of communities and individuals affected by this malady.
The opioid crisis will not be solved by an individual agency or a single state. Instead, we need a comprehensive science-driven approach that combines the efforts of local, state and federal agencies, organizations and industry. We implore the federal government to take swift action to expeditiously coordinate the implementation of these solutions.
Diana H. Fishbein, PhD, director of the National Prevention Science Coalition to Improve Lives (NPSC) is a professor in the department of human development and family studies at Pennsylvania State University and Glenn Sterner, PhD (a member of NPSC) works in the justice center for research and the department of sociology and criminology at Pennsylvania State University. The views expressed by contributors are their own and not the views of The Hill.
The views expressed by contributors are their own and not the views of The Hill.