The Opioid Epidemic Has a Prevention Problem


By: Mallory Stufsky, Substance Abuse Navigator

A recent article in the American Journal of Public Health (2019, 109 (2): 2:15 – 2:17) noted that with overdose deaths consistently increasing, more than 115 a day, the opioid crisis, both prescription and illicit, is now being called "one of the most urgent public health challenges of our time."

State health agencies have implemented standing orders for naloxone, overdoses-reversing medication, to be widely available. With these standing orders, it is the hope that more people will recognize that "more lives are worth saving," reducing the stigma attached to opioid use and addiction. Prescription drug monitoring program have also been implemented, aimed to identify those that are "pill seeking" with attempts in reducing overdoses.

Dr. Fraser states, "We must continue to deploy more and better clinical options to treat addiction, support evidence-based recovery programs, and increase attention to opioid use disorder and addiction from a community perspective." A public concern is limited community-driven health practices compared to clinicians and the greater health system to treat addiction at large. What is being asked for is more knowledge and deeper understanding of effective interventions for the substance using population.

This article points out a strategic framework aimed at high-risk groups and individuals, separating prevention strategies into the following groups: selective, universal, and indicated interventions. Universal interventions have been identified as ways to universally implement evidence-based alternatives to treat pain, as well specifying limited indications for prescribing opioids. 

Universal Interventions also call for community-level interventions (i.e. supporting quality education, stable housing, employment, etc.) to improve overall community well-being with aims of preventing addiction. Selective Interventions are focused towards specific groups and communities who are at higher than average risk of developing an addiction. Selective Interventions has utilized research from ACE's (adverse childhood experiences) to portray the connection between childhood trauma and future drug use. Indication interventions are utilized to assist in screening and identifying those who are in early stages of addiction. Clinically, prescription drug monitoring programs "allow clinicians to monitor individual patient use, to identify those seeking opioids inappropriately, and to counsel and refer…to treatment and recovery programs when indicated."

In order to address addiction and opioid use disorder, Dr. Fraser calls for collaboration across the board, between mental health, substance use, public health, law enforcement, and other like-minded leaders within the community. Our society must begin to first see addiction from both a clinical and community perspective in order to implement best practices.

Photo by Haley Lawrence on Unsplash

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