Research News Brief: Researchers Propose New Framework to Address the Opioid Epidemic’s Social Roots, Decrease Drug-Related Deaths

New study uses a social determinants of health approach to evaluate the opioid epidemic, offering a six-strategy framework to curb long-term drug-related deaths in the U.S.

A new paper co-authored by researchers in the Johns Hopkins Bloomberg School of Public Health’s Department of Health, Behavior & Society uses a social determinants of health lens to examine the U.S. opioid epidemic, presenting a new approach to lower drug-related deaths.

The paper, published online on August 19 in Milbank Quarterly, proposes a six-strategy framework to decrease drug-related mortality by recognizing and responding to the epidemic’s social roots. For their analysis, the researchers reviewed more than 200 articles of published opioid research. They then developed a new “continuum of risk” (COR) framework, identifying five stages of drug use that are critical targets for a comprehensive response to the overdose epidemic: drug initiation, active drug use, addiction, nonfatal overdose, and fatal overdose.

In the U.S., drug overdose is the top cause of injury-related deaths. Over 67,000 overdose deaths occurred in 2018 alone, nearly 70% of them tied to opioid use. The Center for Disease Control projects that the number of overdoses in 2019 will exceed 71,000.

In their new publication, the research team, which includes Ju Park, PhD, and Susan Sherman, PhD, of the Department of Health, Behavior & Society, stresses that the social determinants of health, which the WHO defines as “the conditions in which people are born, grow, work, live, and age” have been underused in efforts to manage the opioid epidemic.

“We need to see those battling substance use disorders or who use drugs recreationally as people with complex lives,” says Park, the paper’s first author. “To be effective, we need to rethink drug policy, invite a diverse coalition of people who use drugs to the decision-making table, and incorporate evidence-based harm reduction services and medication-assisted treatment and into our plans.”

Social determinants of health, including trauma, employment status, housing insecurity, and structural racism, can catalyze and exacerbate the homes associated with unsafe drug use. Still, the researchers highlight that U.S. efforts to mitigate the opioid crisis have been characterized by “stigmatization and criminalization of drug use and abstinence-centric ideology and racism” and have failed to comprehensively address the epidemic.

An effective, long-term strategy to reduce U.S. drug-related deaths, the researchers assert, must adopt a harm-reduction approach to the epidemic that recognizes its social roots.

They then offer six-strategies to open doors and de-escalate progression along the continuum of risk: building meaningful partnerships with people who use drugs, prevention, harm reduction, treatment, recovery, and reversing criminalization of people who use drugs.

With the onset of the COVID-19 pandemic, which has further highlighted the country’s health disparities, the researchers state that expanding research around social determinants of health and drug use is even more urgent.

Brendan Saloner, PhD, associate professor in the Bloomberg School’s Department of Health Policy and Management, is also a co-author, along with Saba Rouhani, DrPH, a postdoctoral fellow in the Department of Mental Health.

“Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework” was written by Ju Nyeong Park, PhD, Saba Rouhani, DrPH, Leo Beletsky, JD, MPH, Louise Vincent, MPH, and Susan G. Sherman, PhD. 

Media contact: Lauren Padilla at lpadill3@jhu.edu.