Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

Milbank Quarterly - Tập 98 Số 3 - Trang 700-746 - 2020
Ju Nyeong Park1, Saba Rouhani1, Leo Beletsky2, Louise Vincent3, Brendan Saloner1, Susan G. Sherman1
1Johns Hopkins Bloomberg School of Public health
2School of Law and Bouvé College of Health Sciences Northeastern University
3Urban Survivors Union

Tóm tắt

Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug‐related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. ContextDrug overdose is the leading cause of injury‐related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction.MethodsIn this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The “continuum of overdose risk” framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally.FindingsDe‐escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction.ConclusionsWithout recognizing the full drug‐use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.

Từ khóa


Tài liệu tham khảo

CDC WONDER.Overdose death rates.2018.https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed September 30 2018.

10.15585/mmwr.mm6911a4

Centers for Disease Control and Prevention.The three waves of opioid overdose deaths.2019.https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed December 19 2019.

10.1016/j.drugpo.2017.06.010

10.1097/MLR.0000000000000625

Council of Economic Advisers.The underestimated cost of the opioid crisis.2017.https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf. Accessed June 1 2020.

10.1513/AnnalsATS.201701-022OC

Stobbe M., 2017, Today's opioid crisis shares chilling similarities with past drug epidemics, Chicago Tribune, 28

10.1126/science.aau1184

10.2105/AJPH.2017.304187

Alexander M., 2012, The New Jim Crow: Mass Incarceration in the Age of colorblindness

10.1016/S0140-6736(16)00619-X

Beletsky L, 2019, America's favorite antidote: drug‐induced homicide in the age of the overdose crisis, Utah Law Rev

US Federal Bureau of Investigation, 2018, Persons Arrested: Arrests for 2018

10.1097/FTD.0000000000000465

10.1016/j.drugpo.2017.05.050

10.15585/mmwr.mm6817a3

Scholl L, 2019, Drug and opioid‐involved overdose deaths—United States, 2013–2017, Morbidity Mortality Weekly Rep, 67, 1419

US Drug Enforcement Administration.2018National Drug Threat Assessment. 2018.https://www.dea.gov/sites/default/files/2018-11/DIR-032-18%202018%20NDTA%20final%20low%20resolution.pdf. Accessed June 1 2020.

Johns Hopkins University.Coronavirus COVID‐19 global cases by the Center for Systems Science and Engineering (CSSE).https://coronavirus.jhu.edu/map.html. Accessed March 30 2020.

10.1080/02791072.2001.10400463

10.1016/j.drugalcdep.2006.10.014

Harm Reduction Coaliation.Principles of harm reduction.2019.https://harmreduction.org/about-us/principles-of-harm-reduction/. Accessed December 19 2019.

McMurranM.The Psychology of Addiction. Book 10.Abingdon UK:Taylor & Francis;1994. ISBN 10: 0748401873.

10.1056/NEJMra1511480

10.1146/annurev.clinpsy.121208.131438

10.1177/0033354918793627

10.1080/10826080802297302

10.1016/j.addbeh.2011.11.011

10.1111/j.1467-9280.2008.02196.x

10.1016/j.addbeh.2006.11.017

10.1371/journal.pone.0210877

10.1016/j.addbeh.2008.10.021

10.1016/S0140-6736(07)60369-9

10.1016/j.drugpo.2017.06.010

10.31887/DCNS.2017.19.3/tcicero

10.1146/annurev-publhealth-031914-122957

10.2105/AJPH.2015.302972

10.1056/NEJMsa1406143

10.1257/pol.20170082

10.1016/j.drugpo.2019.04.010

Centers for Disease Control and Prevention.Drug overdose deaths in the United States 1999–2017.2018.https://www.cdc.gov/nchs/data/databriefs/db329-h.pdf. Accessed June 1 2020.

Centers for Disease Control and Prevention.Rising numbers of deaths involving fentanyl and fentanyl analogs including carfentanil and increased usage and mixing with non‐opioids.2018.https://emergency.cdc.gov/han/han00413.asp. Accessed June 1 2020.

Centers for Disease Control and Prevention.Notes from the field: unintentional fentanyl overdoses among persons who thought they were snorting cocaine—Fresno California January 7 2019. 2019.https://www.cdc.gov/mmwr/volumes/68/wr/mm6831a2.htm. Accessed June 1 2020.

US Drug Enforcement Administration.Deadly contaminated cocaine widespread in Florida.2018.https://www.dea.gov/sites/default/files/2018-07/BUL-039-18.pdf. Accessed June 1 2020.

10.1186/s12954-015-0088-4

10.1111/acem.13034

10.1080/02791072.2017.1394508

10.1186/s12954-018-0240-z

US Drug Enforcement Administration.DEA releases 2016 drug threat assessment: fentanyl‐related overdose deaths rising at an alarming rate. 2016.https://www.dea.gov/press-releases/2016/12/06/dea-releases-2016-drug-threat-assessment-fentanyl-related-overdose-deaths. Accessed June 1 2020.

10.1080/00952990.2016.1186684

10.1186/s12954-016-0120-3

10.2105/AJPH.2003.02178

10.1001/jama.2016.0198

10.1016/j.drugpo.2016.03.003

10.1016/j.addbeh.2009.05.002

10.1007/s10964-017-0647-y

10.2105/AJPH.2003.02178

10.1353/eca.2017.0005

10.1016/j.drugpo.2011.05.014

10.1016/j.addbeh.2006.05.022

10.1016/j.addbeh.2017.03.024

10.1542/peds.2015-1364

10.1111/j.1360-0443.2012.04001.x

10.1080/10550887.2019.1609336

10.1111/add.13491

10.1016/j.jpeds.2015.04.071

10.1016/j.drugalcdep.2015.11.005

10.1056/NEJMra1508490

10.1111/j.1360-0443.2007.02015.x

Rouhani S PJ, 2020, Trends in opioid initiation in 3 U.S. cities, Drug Alcohol Rev

10.1186/s12954-019-0311-9

10.1016/j.addbeh.2017.05.030

Substance Abuse and Mental Health Services Administration, 2017, Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health

Evans CJ, 2016, Neurobiology of opioid dependence in creating addiction vulnerability, F1000Research, 5

10.1111/j.1360-0443.1994.tb00896.x

10.1046/j.1360-0443.1996.918118710.x

10.1016/j.socscimed.2003.08.006

10.1186/s13011-017-0137-y

10.1093/jurban/jtg022

10.1136/bmj.326.7396.959

10.1016/j.jpsychires.2015.01.002

10.1080/02791072.2005.10399817

10.1016/j.healthplace.2008.05.004

10.1093/aje/kwf222

10.1046/j.1360-0443.1999.9456755.x

10.1093/infdis/174.4.690

10.1053/ajem.2003.50006

10.1046/j.1360-0443.2002.00132.x

10.1159/000360697

10.1111/j.1360-0443.2010.03230.x

US Food and Drug Administration.Opioid use disorder: endpoints for demonstrating effectiveness of drugs for medication‐assisted treatment guidance for industry. 2018.https://www.fda.gov/regulatory-information/search-fda-guidance-documents/opioid-use-disorder-endpoints-demonstrating-effectiveness-drugs-medication-assisted-treatment. Accessed June 1 2020.

10.1016/j.addbeh.2017.09.026

10.1007/s11524-012-9720-8

Heimer R, 2018, Prevalent misconceptions about opioid use disorders in the united states produce failed policy and public health responses, Clin Infect Dis

10.3109/10826084.2015.1007669

Human Rights Watch.Philippines: Duterte's first year a human rights calamity. 2017.https://www.hrw.org/news/2017/06/28/philippines-dutertes-first-year-human-rights-calamity. Accessed August 20 2017.

Collins SE, 2013, Abstinence violation effect, Encyclopedia of Behavioral Medicine, 8

10.1038/nrn.2016.67

10.1037/0033-2909.129.1.52

10.1016/S0306-4603(98)00070-7

10.1016/0306-4603(91)90016-B

10.1176/ajp.142.11.1259

10.1176/appi.ajp.158.8.1184

10.1016/j.drugalcdep.2005.11.007

10.2105/AJPH.2015.302843

10.1016/j.drugalcdep.2018.06.004

10.36076/ppj/2019.19.215

10.1016/j.drugalcdep.2016.02.024

10.1080/09595230500286005

10.2105/AJPH.91.11.1842

10.1016/j.drugalcdep.2012.08.014

10.1016/j.drugalcdep.2010.11.003

10.1016/j.addbeh.2012.01.019

10.1016/j.drugalcdep.2009.09.005

10.1080/10826084.2018.1491051

10.1016/j.drugpo.2018.03.026

10.1016/j.drugalcdep.2006.07.009

10.1016/j.drugalcdep.2017.07.016

10.1016/j.socscimed.2007.03.033

10.1016/j.drugpo.2016.01.009

10.2105/AJPH.2018.304585

10.1016/j.drugalcdep.2018.11.024

10.1007/s11524-010-9525-6

10.1111/j.0887-378X.2004.00304.x

10.1016/j.drugalcdep.2016.11.033

10.2105/AJPH.2014.301966

10.1046/j.1360-0443.2003.00376.x

10.1016/j.drugalcdep.2010.11.029

10.3109/10826084.2015.1082594

10.1016/j.drugalcdep.2010.11.007

10.1016/j.drugalcdep.2010.07.008

10.1001/jama.2018.2844

10.1016/j.drugalcdep.2019.03.026

10.1007/s11524-019-00365-1

10.15585/mmwr.mm6734a2

10.1111/add.14508

10.1016/j.socscimed.2007.05.041

10.1073/pnas.1523465113

Hedegaard H, Urban‐rural differences in drug overdose death rates, by sex, age, and type of drugs involved, 2017, Natl Center Health Stat Data Brief, 2019, 1

10.7326/M17-1812

10.1016/j.jrurstud.2018.12.004

10.1016/j.amepre.2018.01.040

10.1016/j.drugalcdep.2015.03.002

10.1146/annurev.pu.14.050193.002213

10.3138/9781442657533

Wheeler E, 2015, Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014, Morbidity Mortality Weekly Rep, 64, 631

10.3109/10826084.2012.644177

10.1016/j.jsat.2016.01.003

US Department of Health and Human Services (HHS), 2016, Office of the Surgeon General. Facing addiction in America: the Surgeon General's report on alcohol, drugs, and health

10.1176/appi.ps.201600056

10.1016/j.ypmed.2019.03.018

10.1007/s11013-016-9496-5

National Academies of Sciences E, and Medicine, 2019, Medications for Opioid Use Disorder Save Lives

10.1016/j.drugpo.2019.10.001

Centers for Disease Control and Prevention, 2018, Evidence‐Based Strategies for Preventing Opioid Overdose: What's Working in the United States

10.1007/s11524-013-9814-y

10.1136/bmj.l5437

10.1016/j.drugalcdep.2014.10.012

10.2105/AJPH.2016.303523

10.1016/S0140-6736(10)62353-7

10.1080/09595230500167460

10.1371/journal.pmed.1002964

10.1111/j.1360-0443.2009.02837.x

10.1186/s12954-017-0153-2

10.1111/add.13195

10.1503/cmaj.080808

10.1016/j.amepre.2017.06.010

10.1186/s12954-017-0179-5

BarrattM KowalskiM MaierL RitterA.Global review of drug checking services operating in 2017 (Drug Policy Modelling Program Bulletin No. 24).Sydney Australia:National Drug and Alcohol Research Centre.ndarc_med-unsw_ed_au/resource/bulletin-no-24-global-review-drug-checking-services-operating-2017.2018. Accessed June 1 2020.

Palamar JJ, 2020, Drug checking to detect fentanyl and new psychoactive substances, Curr Opinion Psychiatry, 13

10.1016/j.drugpo.2020.102661

10.1016/j.drugpo.2019.03.003

10.1016/j.drugpo.2018.09.009

10.1016/j.drugpo.2018.08.007

Krawczyk N, 2020, Opioid agonist treatment and fatal overdose risk in a state‐wide US population receiving opioid use disorder services, Addiction, 24

10.2105/AJPH.2018.304590

National Institute on Drug Abuse.Medications to treat opioid use disorder.2018.https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder. Accessed June 1 2020.

10.1002/14651858.CD002207.pub4

10.1186/s13722-019-0149-1

Wakeman SE., 2018, Comparing medications to treat opioid use disorder, Harvard Health Blog

10.1146/annurev-publhealth-040617-013526

10.1097/MLR.0000000000000727

10.1377/hlthaff.2017.0890

10.1016/j.drugalcdep.2018.12.030

10.1001/jama.2014.2147

10.1176/appi.ps.201700076

10.1056/NEJMp1803982

10.1377/hlthaff.2014.1205

10.7326/M18-3457

10.1016/j.drugalcdep.2016.05.010

10.1002/pam.22112

Courtwright DT., 1992, Treating Drug Problems: Volume 2: Commissioned Papers on Historical, Institutional, and Economic Contexts of Drug Treatment

10.1093/qje/qjx043

10.4159/9780674969223

Center of Addiction and Substance Abuse, 2010, Behind Bars II: Substance Abuse and America's Prison Population

National Alliance on Mental Illness.Jailing people with mental illness.https://www.nami.org/learn-more/public-policy/jailing-people-with-mental-illness. Accessed December 20 2019.

10.1146/annurev-publhealth-031811-124614

10.1016/j.addbeh.2018.02.024

10.1001/jamapsychiatry.2017.4614

Brief on Behalf of the Massachusetts Medical Societyet al. as Amici Curiae Eldred v Massachusetts 101 N.E.3d 911 (No. SJC‐12279) (2017) available athttp://www.massmed.org/advocacy/eldred-amicus-brief-final/.

CramerM.Legislators seek to bar judges from sending drug users who relapse to jail Boston Globe (Mar. 17 2019) https://www.bostonglobe.com/metro/2019/03/17/legislators-seek-bar-judges-from-sending-drug-users-who-relapse-jail/qNWRWdvmYOL4ETfWBho0VM/story.html

U.S. Department of Justice National Institute of Corrections LEAD:Law Enforcement Assisted Diversion NIC(2015) https://nicic.gov/lead-law-enforcement-assisted-diversion

European Monitoring Centre for Drugs and Drug Addiction.Portugal Country Drug Report 2017.Luxemborg:Publications Office of the European Union;2017.

Greenwald G., 2009, Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies

10.7249/RR2693

10.1002/14651858.CD003410.pub3

10.1111/j.1360-0443.2011.03601.x

Blau PM, 2003, Formal Organizations: A Comparative Approach