The Opioid Pandemic Leaves No Part of the Globe Unaffected
Posted: October 27th, 2022
A description of the social problem selected and any known causes or explanations of the problem.
The opioid pandemic leaves no part of the globe unaffected. It is also important to dismiss the illusion or misunderstanding that this is a relatively “new” problem. The use of opium dates back to Mesopotamia in 3,400 B.C. This, according to a presentation given by the History Channel on three different occasions, 2017, 2019, and 2021, entitled “Heroin, Morphine and Opiates” (History.com, 2021). Many other sources attest to this fact and dispel any notion that the use of opiates, from a historical perspective, is a recent phenomenon.
The watershed moment or “launching point,” in my opinion, was when a German scientist named Friedrich Serturner isolated the chemical bond in opium in 1803, creating a “Pandora’s Box” called/labeled morphine. Morphine would make its way into American history during the Civil War, being used as a powerful pain killer for wounded soldiers. What was documented then, ironically enough, was wounded soldiers becoming addicted to morphine and overdosing/dying. The introduction of morphine has now evolved, and grown exponentially, into the current pandemic of today, with the US being opiates' largest consumer. “The pandemic has worsened an existing drug overdose crisis that claimed the lives of over 81,000 people in the U.S. from May 2019-June 2020” (Penn LDI, 2021). These numbers, in my opinion, are much too low, but I will address this point later in the paper.
A description of the problem’s prevalence today
Since morphine’s discovery, it has been synthesized and chemically altered, primarily by large pharmaceutical companies, into other compounds, but all are derivatives of opium and chemically altered to create an even more powerful and addictive drug. The CDC reported, “since 2019 close to 850,000 deaths have come from opiate overdoses,” (CDC 2019). These deaths are caused, primarily, by heroin laced with fentanyl and prescription opiates like oxycontin, oxycodone, codeine, etc. This number of deaths is far too low, however, because of the stigma attached to OUD (many families “hide” the cause of death), while hundreds of thousands have been murdered through the violence that comes with the selling and distribution of these drugs.
Finally, the causes of the OUD pandemic we have been in are many. “Big pharma,” and drug cartels usually come to mind as the primary culprits driving this “bloodbath,” but this would be too simplistic and naïve of an understanding. The opioid epidemic is essentially a matter of “following the money,” and the players involved are many. The federal government (FDA, AMA, CDC), corrupt judicial systems, corrupt politicians, 80+% of rehabilitation centers and halfway houses, foreign suppliers (primarily China with fentanyl) and healthcare system, etc. all make trillions as long as the “addiction pipeline” remains full. Opiates, as well as other licit and illicit drugs, will always have a market in this country, the bigger question is why? Understanding the “why” is the only way to get to the “how,” in my opinion.
A description of the specific population impacted by this social problem.
“Rural areas are experiencing a disproportionate burden with OUD concerns” (Cashwell, Campbell & Cowser, 2021). There is a “big pharma” intentional agenda concerning rural communities. Many rural communities tend to be “blue-collar,” towns, meaning that the industries there (fishing, coal mining, farming, forestry, etc.) have a very high degree of injury/death, while the socio-economic and education levels achieved tend to be below the national average. Big pharma, as I have mentioned in previous posts, systematically targeted these populations in states that were known to have a large number of towns/cities with this statistical “blueprint.” Consequently, back in the late 1980s and early ’90s as big pharma companies like Purdue Pharma and later McKesson Pharma, led the highly organized, well-researched, “attack” on these populations with its development of oxycontin. In very short order, these towns were decimated with addiction, crime, and overdose issues. “A recent study conducted by the American Farm Bureau Federation indicated that just under half of rural Americans reported a direct impact from OUD and nearly three-quarters of farmers/farm workers indicate the same exposure” Cashwell, et al 2021). Add to these communities the impact of the Covid pandemic, and now you have the “perfect storm” for OUD, addiction increases, relapse, depression, and a whole gambit of other mental health issues.
Rural communities were targeted, as I have said, by “big pharma,” but this is only a part of the OUD saga. Heroin, a much more powerful/deadlier opiate, has been used in epidemic proportions with poor, underserved, inner-city populations since the early, the mid-1960s. The “delay” in any real press and resources offered were dormant because the ravaged communities, in the “eyes” of society, did not seem to matter in my opinion. Why, when the primarily inner city, poor, black populations were being “drown” in heroin (picking up momentum during and after the Vietnam War) did nothing/nobody of any real substance/standing help these populations? There was little press, no care/attention from politicians, etc. because of the inherent racism and classism by the primarily white power base. Tens of thousands were dying all over the country, either by overdose or violence and nothing was done. Why, even in the case of the primarily white, rural poor, did this get little attention. Until this scourge started killing middle-class and wealthier “White” American kids/adults, did the news explode with front-page stories on a daily basis. In fact, it was Covid that came along and “stole” the front pages from the opioid crisis, which paradoxically got even worse. Once again, the poor, marginalized, voiceless, populations are left “scratching their heads” wondering why it took almost 30 years for this OUD to get any attention. It is sickening, sad, unethical, and immoral, and yet the more things change the more they have sadly stayed the same on many fronts.
An explanation of the theories that support the problem and approaches scholars and policy analysts use to address the problem.
“Although many states have made significant gains, further improvements in reporting in reporting drug information are needed to better reflect the true burden of drug overdose mortality in the United States” (Warner & Holly, 2018). There are a wide variety of strategies and new policies that have gone into effect to help “slow” the overdose rate that OUD, if left untreated, inevitably brings.
Policies that combine health care coverage and increased SUD treatment access may reduce child abuse and neglect (CAN) by reducing parents’ drug use and use disorder. Exposure to parental drug use disorder is an ACE (adverse childhood experiences) and ACEs are preventable. Policies that focus on health care access and treatment options are important but may not be enough to comprehensively support children and families to have safe, stable, nurturing relationships and environments.
Rhode Island, one of the hardest-hit states, has passed many policies, that were both evidence-based, and self-created. “The Rhode Island Cascade of Care for OUD provides statewide data-sharing partners and policymakers with a starting point for understanding and assessing engagement in care” (Yedinak, Goedel, Paull, Lebeau, Krieger, Maxwell, Thompson, Buchanan, Codree, Boss, Rich, Marshall & Brandon, 2019). In a state where OUD accounts for over 10% of the SUD cases, Rhode Island has created evidence-based research/results that other states can emulate. Does it “take a village?” – YES! Collaborative efforts by local and state policies makers that have proven effective in treating OUD should be the primary resource with regards to federal policy, in my opinion, while still allowing the state to edit/adjust as needed, to better serve their specific populations. If local and state-level efforts are “handcuffed” by federal policy/mandates, we end up back in the contradictory/self-defeating world faced by Tessa and Luisa as an example.
The answer is certainly not to “throw in the towel,” but in my experience (national and international lectures on addiction prevention, speaking on Capitol Hill concerning OUD in the workplace, etc.), I have found that the solutions start on the mezzo and macro levels. Families, groups, and communities need to take “fight” (social justice) against the people in power, but you have to know who the real “enemy” is before anything can be accomplished.
There is strong bipartisan support for addressing the opioid epidemic, and for providing for providing effective treatment for people with OUD. Recent laws, including the Comprehensive Addiction and Recovery Act of 2016 and the Twenty-First Century Cures Act, authorize funding for local treatment efforts.
I offer this citation because I want to be clear that I am not throwing a “blanket of guilt and corruption” on every politician, pharmaceutical company, etc., that would be unfair and inaccurate. There are many good people in high positions of corporate, and political power that have been affected by the opioid crisis, no one is immune. What I am saying, as an example, is not to take political rhetoric, promises by unvetted rehabilitation centers, and big pharma propaganda at face value. Again, all the more reason for the work of macro practice in the social work profession.
OUD needs macro, mezzo, and micro practice to “lock arms” in dealing with a problem that is so complex and multifaceted. These “reactive” policies are necessary to help stem the tide of this pandemic, however, there needs to be more research on the “why,” in my opinion. Why is the United States the largest consumer, by an incredibly wide margin, in licit and illicit SUD? Why are healthy, strong coping strategies/behaviors being “eroded” away in the minds of our culture/society? What are the variables, drivers, issues that have this culture/society so determined to keep itself “sick,” disconnected, and incapable/not wanting to live life on life’s terms? This question, for me, is more complicated than the OUD issue itself and these are the questions that need to be pursued.
References:
Cashwell, S., Campbell, M., & Cowser., (2021). Stone soup: social work community engagement in rural America’s opioid crisis. Social work in mental health, 19:2, 81-87,
DOI: 10.1080/15332985.2021.18795965
Centers for Disease Control and Prevention, (2017). Annual surveillance report of drug-related
risks and outcomes, United States, MMWR Surveill Summ 2017.
https://www.cdc.gov/drugoverdose/data.
Clemans-Cope, L., Wishner, J. B., Allen, E.H., Lallemand, N., Epstein, M., Spillman, B.C.,
(2017). Experiences of three states implementing the Medicaid health home model to address
opioid use disorder – Case studies in Maryland, Rhode Island, and Vermont. Journal of
substance abuse treatment, ELSEVIER: Washington, D.C.
https://doi.org/10/1016/j.jsat2017.10.001
History., (2021). Heroin, morphine, and opiates. A&E Television Networks, history.com
Penn LDI, (2021). Ending the opioid overdose crisis. Center for addiction medicine and
policy, Leonard Davis Institute of Health and Economics.
https://ldi.upenn.edu/wp-content/uploads/archive/pdf/LDI-PolicyBrief-Ending-the- Opioid-and-
Overdose-Crisis.pdf
Tang, S., Matjasko, J., Hharper, C.R., Rostad, W.L., Ports, K.A., Strahan, A.E., Florence, C.
(2021). Impact of Medicaid expansion and methadone coverage as a medication for opioid use
Disorder on foster care entries during the opioid crisis. Children and youth services review,
Vol. 130 106249. Science Direct
https://doi.org/10.1016/j.childyouth.2021.106249
Warner, M., Hedegaard, H., (2018). Identifying opioid overdose deaths using vital statistics data.
American journal of public health, 108(12):1587-1589. (3p)
DOI:10.2105/AJPH.2018.304781
Yedinak, J.L., Goedel, W.C., Paull, K. Lebeau, R., Krieger, M.S., Maxwell, M.S., Thompson, C.,
Buchanan, A.L., Codree, T., Boss, R. Rich, J.D., Marshall, J., Brandon, D.L. (2019). Defining a
recovery-oriented cascade of care for opioid use disorder: A community-driven, statewide cross-
sectional assessment. PLoS Medicine, 16(11):1-16. (16p)
DOI: 10.1371/journal.pmed.1002693