Integrating tactics on opioids

Many parts of the world are in the middle of an opioid addiction crisis. It is an equal opportunity destroyer, affecting rich and poor, urban and rural people alike. The current epidemic differs from the long-standing heroin addiction problem in its broader demographic and in that it has resulted from inappropriate marketing and overprescription of pain medicines and the intrusion of powerful and lethal synthetic opioids. The magnitude of the crisis is also unprecedented: In the United States alone, more than 2 million people are estimated to have “opioid use disorder,” and 47,000 people died of an opioid overdose in 2017. Traditional strategies for dealing with addiction have had limited success. They have primarily used parallel tactics of “supply control” (limiting availability) and “demand control” (trying to prevent or reduce use), which might be considered as criminal justice and public health approaches. But this side-by-side approach may be counterproductive. Last week, the U.S. National Academies of Sciences, Engineering, and Medicine released a report* on the state of medication-based treatments for opioid addiction. What is clear is that in addition to the need for more research, the nature of the epidemic requires new approaches that integrate public health, regulatory, and criminal justice strategies.