Quora on 10/8/2018
What factors fueled the growing opioid crisis that exists in the US right now? originally appeared on Quora: the place to gain and share knowledge, empowering people to learn from others and better understand the world.
Rapacious overselling of painkillers, pushed under the false notion that pain was largely being under-treated, seeded the current opioid and heroin/fentanyl crisis. And doctors, many of them duped by pharmaceutical reps carting around swag and lies that opioid drugs weren’t addictive, helped get us into this crisis by rampant overprescribing. I believe doctors should lead the way in getting us out of this crisis. Too many doctors are unwilling to treat addicted patients, even though they played a role in getting them addicted to opioids. When France expanded its medication-assisted treatment capacity tenfold in the late 1980s, that country’s overdose death rate declined rapidly.
MAT needs to be as accessible to people as street drugs are. The horse is already out of the barn: We have 2.6 million people with opioid use disorder, and physicians helped create many of them. Just because they’re no longer overprescribing opioids doesn’t let them off the hook. They need to do no harm by not abandoning their addicted patients and helping them access treatment.
This is a much harder fix, but especially in inner cities and in rural areas where job losses have been extreme, we need massive retraining and higher-education programs to give young people hope that they, too, can one day have a pathway for meaningful work with a living wage. Studies show that drug use improves when people move to neighborhoods with less economic disadvantage, but people from families with multigenerational trauma who should move are often the least likely to have the social capital and/or money to move.
As addiction specialist Dr. Anna Lembke told me: “It’s important to note, it’s really not just the unemployed and the poor who are vulnerable today; it’s really everybody, especially underchallenged youths or youths who aren’t engaged in school or other meaningful activities.” People whose grandparents or parents were drug- or alcohol-addicted have dramatically increased odds of becoming addicted themselves, so those children should be identified and targeted to receive evidence-based prevention treatment in schools. None of these things are a cheap and easy fix, but we can’t afford not to implement them.
Felony records severely limit people’s ability to obtain employment, sending many people back to dealing drugs in order to eat and/or pay their bills and court fines and child-support arrears. Ronnie Jones’s story in “Dopesick” is a great example of that. Lacking opportunity for work, he simply went back to what he knew — dealing drugs. I’m not excusing him for that — he broke the law multiple times and helped seede addiction in his community — but it would have been so much cheaper for society if the government would have spent a little time and money helping Jones find work upon re-entry than spending hundreds of thousands investigating, prosecuting and re-incarcerating him for 23 years.