Four in five new heroin users started out misusing prescription painkillers. A 2015 analysis by the Centers for Disease Control and Prevention found people who are addicted to painkillers are 40 times more likely to be addicted to heroin.
The epidemic actually began more than three decades ago. In 1980, crack and cocaine addiction contributed to the thousands of overdose deaths, whereas now people die from pain relievers and synthetic opioids such as fentanyl.
In 1990, I began studying its relationship to HIV and the experiences of people with multiple addictions. My research team and I have recruited research participants from emergency rooms, methadone programs, jails, prisons, alternative to incarceration projects, and HIV and primary care clinics. We have examined barriers to accessing care for drug addiction and HIV, and some of the lessons we have learned apply to the broader population.
Two faces of the opioid addiction
Years ago, I interviewed Jennifer, a former nurse, who was prescribed antidepressants to cope with childhood sexual abuse trauma. When this didn’t help, she stole narcotics from her clinic and was fired. With no access to pain pills, Jennifer began using heroin and cocaine. She reported facing stigma from health care providers due to her addiction, and she lacked access to counseling for depression. Jennifer’s case is not unique; many women face a lack of access to services addressing trauma and gender-based violence.
AP Photo/David Goldman
More recently, our research team interviewed John, who started using narcotics prescribed for back pain. His need for increasingly higher dosages exceeded the number of pills his physician would prescribe, so he turned to friends and then began heroin and injection drug use.
Although incarcerated numerous times for accidents while driving impaired, he said he was never asked about addiction or referred to drug treatment by his primary care office. Since John detoxed “cold turkey” in prison, he often overdosed after his release, reuniting with his “running buddies.” Recently, one of John’s buddies saved his life by using a free naloxone kit from a health department stall at a street fair. John was lucky: Thousands of opioid users cannot access naloxone.
Not addressing the core causes
Though overprescribing opioids may have contributed to the current epidemic, many addiction experts believe that the root causes remain poverty, incarceration, drug and health policies, stigma toward people who use drugs, and a lack of access to drug treatment.
Yet much of what has been done to end the opioid epidemic has focused mainly on [reducing the amount of prescription painkillers] and improving drug monitoring programs to identify newly filled prescriptions, which are not the real solutions to the growing opioid epidemic. In my view, there has been no clear policy action or plan to address the major root causes of the problem and improve access to drug treatment. President Donald Trump‘s plan to address the opioid epidemic emphasizes punishment, reduction of supply, and law enforcement strategies with no potential to produce important change in the crisis.
Here are my six recommendations to address the opioid epidemic.
- Increase Medicaid coverage for drug treatment in all states
The number of states providing benefits for addiction treatment grew with the creation of Affordable Care Act in 2010 and the expansion of Medicaid benefits – but only for states that opted to expand. Now, 32 states and the District of Columbia have adopted Medicaid expansion, which provides medical coverage including addiction treatment for most low-income adults.