The opioid epidemic is one of the most devastating public health crises in the United States, claiming the lives of nearly 50,000 people in 2019 alone. While many factors contribute to this complex problem, three stand out as particularly harmful: the greed and lack of empathy of the pharmaceutical industry, the neglect and criminalization of people experiencing homelessness, and the restrictive and punitive government policies on opioid prescribing.
The Role of the Pharmaceutical Industry
The opioid epidemic has its roots in the aggressive marketing and promotion of prescription opioids by the pharmaceutical industry in the 1990s and 2000s. Companies like Purdue Pharma, the maker of OxyContin, misled doctors and patients about the safety and effectiveness of their products, downplaying the risks of addiction and overdose. They also incentivized prescribers to prescribe more opioids, often for conditions that did not warrant such powerful painkillers. As a result, opioid prescriptions skyrocketed, creating a large supply of legal opioids that were diverted or misused by millions of Americans. Many of these people became dependent on opioids and suffered from withdrawal symptoms when they tried to stop or reduce their use. Some of them turned to illicit opioids, such as heroin or fentanyl, which are cheaper and more potent, but also more dangerous and unpredictable. The pharmaceutical industry profited from the sales of opioids, while ignoring or denying the harms they caused to individuals and communities.
The Plight of People Experiencing Homelessness
People experiencing homelessness are among the most vulnerable and marginalized groups in society. They face multiple challenges, such as poverty, unemployment, mental illness, trauma, and stigma. They also have limited access to health care, social services, and safe housing. Many of them use drugs, including opioids, as a way to cope with their difficult circumstances, or to self-medicate their physical or emotional pain. However, instead of receiving compassion and support, they often encounter hostility and discrimination from the public and the authorities. They are frequently subjected to involuntary displacement, such as encampment sweeps, bans, move-along orders, and cleanups, that force them to relocate away from essential services and support networks. These practices not only violate their human rights, but also worsen their health outcomes. A recent study published in the Journal of the American Medical Association (JAMA) showed that involuntary displacement of people experiencing homelessness who inject drugs could lead to substantial increases in overdose deaths, hospitalizations, and life-threatening infections, as well as hinder access to medications for opioid use disorder1.
The Impact of Government Regulation
In response to the opioid epidemic, federal and state governments have enacted various policies to restrict opioid prescribing and prevent opioid misuse. These include prescription drug monitoring programs (PDMPs), which track opioid prescriptions and flag potential doctor shopping or overprescribing; opioid production quotas, which limit the amount of opioids that can be manufactured and distributed; and opioid prescribing guidelines, which recommend lower doses and shorter durations of opioid therapy for pain management. While these policies may have good intentions, they also have unintended consequences. They may reduce the availability of opioids for legitimate medical purposes, such as treating acute or chronic pain, and create barriers for patients who need them. They may also induce fear and stigma among prescribers and patients, leading to underprescribing or abrupt discontinuation of opioids, which can cause severe pain, distress, and withdrawal. Some patients may resort to obtaining opioids from alternative sources, such as the street or the internet, where they have no control over the quality or potency of the drugs they consume. These factors may increase the risk of overdose and death among opioid users.
A Better Way Forward
The opioid epidemic is a multifaceted and dynamic problem that requires a comprehensive and compassionate approach. Rather than blaming and punishing opioid users, prescribers, or manufacturers, we need to address the underlying causes and consequences of opioid misuse, such as pain, addiction, mental health, homelessness, and social injustice. We need to promote evidence-based and patient-centered pain care, which includes a range of nonopioid and opioid therapies, as well as harm reduction and addiction treatment services. We need to support people experiencing homelessness, by providing them with safe and affordable housing, health care, and social support, rather than displacing and criminalizing them. We need to reform government policies on opioid prescribing, by balancing the goals of reducing opioid misuse and ensuring access to opioids for legitimate medical needs, and by involving patients and prescribers in the decision-making process. We need to end the war on drugs, which has failed to curb drug supply or demand, and instead adopt a public health and human rights perspective on drug policy. By doing so, we can hope to reduce the harms of opioids, while improving the lives of people who use them.