Even though it is said that the opioid crisis started in the 1990s, overdose mortality rates started increasing in 1979. This was the result of American economic policies in the 1970s that placed capitalistic gain above human well-being. 

In a new study published by Frontiers in Public Health, the opioid crisis is reimagined as a product of socio-structural factors beyond individual control. The study changes the typical addiction narrative that centers on victim-blaming. Instead, it holds the economic structures accountable for the creation of vulnerable communities that became susceptible to unethical pharmaceutical practices. 

Existing initiatives are addressing opioid addiction, such as the HEALing Communities Study, but “these programs themselves do not address the social roots of the crisis” (Friedman et al, 2020). In order to reduce the total toll on society, the conversation about the opioid crisis must shift the blame from victims to the socio-structural factors rooted in the 1970s. 

The 1970s saw a “one-sided class war” due to the neo-liberal focus on economic prosperity at the cost of individual health and safety. 

By weakening unions, cutting budgets for social services, and reducing regulations in industries, America saw the victory of companies over individual workers. America also saw a growth in economic inequality, economic recession, and a growing Rustbelt region. In short, the change in economic regulations created vulnerable communities.

The ideological focus on ‘individual responsibility’ and ‘individual guilt for failure’ also sets up a climate of hostility and blame towards victims of addiction. This remains a prevailing issue that misconstrues opioid addiction as a choice, instead of a structural problem. It serves to do nothing but create harmful myths and stigmas about communities suffering from the opioid epidemic. 

Through sociological qualitative community studies done on Woonsocket, Rhode Island and Weymouth, Massachusetts, the team found that the primary factor for opioid misuse is the change in economic circumstances (Friedman et al, 2020). Both of these communities show that when the decline of union employment resulted in people losing access to safe, long-term, full-time jobs, they had to turn to more dangerous occupations with higher injury rates and fewer benefits. Workers were easily wounded and frequently prescribed opioids without alternative methods. These findings correlate with previous research about how jobs with musculoskeletal injuries as an occupational hazard have higher rates for opioid poisoning. 

Along with the economic factors that weakened these communities, the irresponsible and unethical actions of pharmaceutical companies exacerbated the vulnerable situation. 

Despite the sharp increase in opioid-related fatalities since the 1990s, in 1996, the FDA also approved OxyContin, which Purdue Pharma marketed as a non-addictive and effective drug in treating chronic pain. 

Not only that, but in 1996, the American Academy of Pain Medicine and the American Pain Society released a statement on “The Use of Opioids for the Treatment of Chronic Pain” that also endorsed the widespread use of opioids. Instead of addressing the growing problem, they announced that opioids should be the first treatment for patients with non-cancerous chronic pain.

The successful adverts and declarations yielded prosperity for the pharmaceutical industry: opioid sales quadrupled between 2000 to 2010. 

Not only were the companies unethically advocating for and selling opioids, there were also nefarious ‘pill mills’. These are unregulated pain management clinics, hubs for selling opioids, that are still in existence. They have a strong role in opioid-related deaths, for “in Florida, where such clinics proliferated, oxycodone-related overdose deaths increased 265% from 2003 to 2009” (Friedman et al, 2020).

It is not only wrong but also dangerous to view the opioid crisis as an individual responsibility. The trajectory of addiction is expanding beyond just the scope of opioid addiction. 

Indeed, the first phase of the epidemic started in the 1990s with the rise in use and abuse of prescription opioids, but the late 2000s saw heroin use and related overdoses increase. Since prescription opioids and heroin have similar pharmacological properties, they are similarly addictive. In fact, heroin users often start with using prescription opioids, and individuals who have a history of prescription opioid misuse are more likely to start using heroin. 

The third phase followed in 2014 with the introduction of fentanyl and synthetic drugs into the market, seeing more overdose deaths because these chemicals are much stronger than the previous two, and often mixed with other drugs. Now is the fourth phase of polysubstance abuse. There are increasing cases of overdoses with a mix of opioids, methamphetamines, and cocaine. 

In the meantime, communities must coordinate between treatment, harm reduction, and community organizations to make naloxone (used to block opioids from affecting the central nervous system during an overdose) more accessible. 

This is especially crucial now with COVID-19 creating more social and economic disruptions, resulting in increased community despair and occupation pain. Ontario, Canada has already seen a 25% increase in opioid overdoses from March to June during 2020. It is more important than ever to recognize that the opioid crisis is not due to individual choices, rather a result of socio-structural factors that started in the 1970s. 

Even though the opioid crisis remains a huge social problem, there are actions that can be taken to help mitigate the problem. The researchers suggest, based on their experience as harm reductionists, to set up community organizations that can help correct misconceptions about opioid addiction. However, local movements are not sufficient; the crisis must be reevaluated as a product of socio-structural causes, systematic failures, and a problem that exists beyond the individual level. It needs to start with rethinking our priorities: we must put human lives above economic gains.