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

Abstract

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. Context Drug 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. Methods In 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. Findings De‐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. Conclusions Without 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.

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

“…It should be noted that the reformulation is not entirely "abuse-proof," since it cannot eradicate oral misuse (i.e., taking more pills or higher doses than prescribed), and some users have even found ways to counteract the abuse-deterrent properties of the new version. 8 The FDA recently announced its intent to encourage the development of more opioid formulations with abuse-deterrent properties. 9 To date, the FDA has approved abuse-deterrent versions for several brand-name extended-release opioids (e.g., Targiniq, Embeda, Hysingla, MorphaBond, Xtampza, and Troxyca), though OxyContin remains the most important given its large market size.…”

“…OxyContin was the first drug targeted for monitoring by the DEA by its brand name, specifically (GAO 2003) 7. This reformulated version received an official "abuse-deterrent" designation from the FDA in April 2013 8. Highly sophisticated methods were shared on websites for how to counteract the abuse-deterrent properties of the drug involving baking, freezing, or soaking the pill in solvents(Goodnough and Zezima 2011, Becker andFiellin 2017).…”

Native populations and the opioid crisis: forging a path to recovery

“…Park et al ( 2020 ) outlines community as an underutilized area in which the crisis can be solved. The community sector encompasses the conditions in which people live, commute, and work.…”

“…Scholars and practitioners recognize the need for community-based approaches to address the opioid crisis. These could include drug checking programs and appointing PWUD (persons who use drugs) to leadership positions for designing anti-opioid strategy and policy may help (Park et al 2020 ). Leston et al ( 2019 ) suggest implementing prevention and help services into school curriculum.…”

“People Don’t Just Start Shooting Heroin on Their 18th Birthday”: A Qualitative Study of Community Stakeholders’ Perspectives on Adolescent Opioid Use and Opportunities for Intervention in Baltimore, Maryland

“…A strong evidence base suggests that social and structural factors (e.g., peer, familial, school, neighborhood, health and social service system characteristics, jurisdiction and state characteristics) are critical to preventing and responding to the opioid epidemic among adults (Dasgupta et al, 2017 ; Park et al, 2020 ), but the relevance of these factors to adolescent opioid use has been understudied. Additionally, among Black and Latinx adolescents in particular, this topic has gone largely unexplored; (Ford & Rigg, 2015 ) and this is an important knowledge gap to address given that this population has a high likelihood of experiencing adverse health and social outcomes associated with use.…”