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Am J Public Health. 2018 Feb;108(2):182-186. doi: 10.2105/AJPH.2017.304187. Epub 2017 Dec 21.

Opioid Crisis: No Easy Fix to Its Social and Economic Determinants.

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Nabarun Dasgupta is with the Injury Prevention Research Center and the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Leo Beletsky is with the School of Law and the Bouvé College of Health Sciences, Northeastern University, Boston, MA and is also with the University of California, San Diego School of Medicine, La Jolla. Daniel Ciccarone is with the Department of Family and Community Medicine, University of California, San Francisco.


The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Overreliance on opioid medications is emblematic of a health care system that incentivizes quick, simplistic answers to complex physical and mental health needs. In an analogous way, simplistic measures to cut access to opioids offer illusory solutions to this multidimensional societal challenge. We trace the crisis' trajectory through the intertwined use of opioid analgesics, heroin, and fentanyl analogs, and we urge engaging the structural determinants lens to address this formidable public health emergency. A broad focus on suffering should guide both patient- and community-level interventions.

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