Is “Big Pharma” responsible for the opioid crisis?

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Last month, the CDC announced a horrific milestone: More than 100,000 people in the United States have died of an overdose in the 12-month period ending April 2021. This is an increase of nearly 30% from the previous year and a glaring sign that the country’s efforts to tackle overdose deaths are failing.

To many Americans, the potential solutions to this ongoing crisis may seem confusing or controversial – debates over safe consumption sites and the war on drugs continue, despite clear evidence that interventions like the first can help. in the face of devastation while the second certainly increases it, especially for communities of color. However, the causes of the overdose crisis are often taken for granted. For many, opioids have developed a reputation as dangerous poisons that should be avoided at all costs, and the drug companies that make and market the pills and the prescribers who “push” them should be held accountable.

Blaming the pharmaceutical companies for the current crisis seems fair and satisfying – indeed, the companies have made billions of dollars in opioid sales, and their deceptive actions and practices should not be ignored. Additionally, demonizing opioids as “killer pills” that will be devastatingly addictive to anyone who takes them can provide a sense of security – many people seem to believe that avoiding opioid use disorder requires just refuse to take opioids.

Sadly, this narrow focus on the pills themselves and the people who made and prescribed them ignores the complex and actionable issues that are driving the overdose crisis – issues that remain unresolved, even as states attempt. to hold opioid manufacturers legally and financially accountable.

Despite what many think about opioids – that they can potentially turn anyone’s brain regardless of how they are taken – there are many factors that can put individuals at a higher risk of developing opioids. disorder related to the use of opioids or other substances. Untreated pain, both physical and emotional, is often the reason many people use prescribed and non-prescribed substances. In the United States, about 20% of adults suffer from chronic pain, and physical pain is one of the most common reasons people in the United States come for treatment.

The burden of emotional and psychological pain is even more staggering: One in four adults in the United States struggles with depression, anxiety, or some other mental health problem, and Surgeon General Vivek Murthy, MD, MBA, recently issued a warning that youth mental health is currently in crisis.

While the COVID-19 pandemic certainly exacerbated the situation, Murthy made it clear that it existed long before the pandemic. Three in five American adults report at least one adverse childhood experience (ACE), such as neglect, child abuse, divorce, or parental incarceration, and these types of childhood trauma are associated with substance use as they age adult.

Unsurprisingly, factors like poverty and housing insecurity – on the rise in the United States – contribute to the physical and emotional pain and health inequalities often associated with increased substance use. Additionally, despite what might be considered an untreated physical and emotional pain crisis, effective pain care and mental health treatment is incredibly difficult for many people to access, as is evidence-based treatment. evidence for people already struggling with drug addiction. Instead, we have often turned to law enforcement and criminalization approaches to address these issues.

All of this provides an incredibly fertile environment for an attack of substance use disorders, especially pain-targeting substances. Pharmaceutical companies have taken advantage of the situation, but they alone have not laid the groundwork.

Clear identification of the true causes of substance use disorders and overdose attacks is essential to address them. While efforts are directed towards opioid regulations and decreasing opioid prescribing, we have yet to implement policies – many of which are clearly evidence-based – that can alleviate some of the contributing factors. risk associated with developing substance use disorders and helping 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 face a high stress-related workload and receive incredibly low wages themselves. We must tackle the financial and housing precariousness experienced by millions of American adults and children. The trauma crisis in our society – arguably one of the real drivers of substance use disorders – will continue to cause and contribute to substance use disorders of all kinds, even if opioids were made more difficult to access.

On that note, our approach to supply-side issues has clearly failed to address the overdose crisis and in fact exacerbated it. Our street drug supply is increasingly contaminated with fentanyl and other potent analogues that put opioid and non-opioid drug users at serious risk. The crackdown on opioid prescribing and the illicit drug trade has contributed to contamination by prompting the manufacture and trafficking of increasingly potent substances.

Contamination with non-opioid drugs means that people with no previous experience of using opioids (hence no acquired tolerance to opioids) may unintentionally take opioids and overdose, and since they usually do not use opioids, they may be less familiar with the harm reduction techniques of opioids. like naloxone. Tackling the street drug supply through decriminalization and safe supply – though highly controversial – would likely save countless lives, as would increasing access to harm reduction services and opening up safe consumption spaces across the country.

Clearly what we need is a sprawling, multi-pronged response to a complex problem – a problem that has not been caused by access to opioids alone and cannot be resolved by punishing pharmaceutical companies and cracking down on prescribing. Over the past few years, we have seen an increase in the rates of disorders and deaths related to alcohol and stimulant use, indicating a much bigger problem than opioids. If we choose to focus on the substances themselves rather than the foundations that make our society vulnerable, the end of this overdose crisis will be nowhere in sight.

Shoshana Aronowitz, PhD, MSHP, FNP-BC, is an Assistant Professor in the Department of Family and Community Health in the School of Nursing at the University of Pennsylvania.

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