Finding Hope in Combating the American Opioid Epidemic

The opioid epidemic has been called “not just an elephant [but] a herd of elephants, which touches on race, economics, health, politics, crime and stigma” (Hoffman, 2022, p. 15). This complex epidemic in the United States is not new, but overdose deaths are rising. According to Macy (2022), there were 108,000 overdose deaths during 2021. Volkow noted in a 2014 presentation to Congress that this country was the biggest consumer of prescriptions for opioids in the world. As the American public became aware of the potential for inadvertent addiction to these drugs (zealously marketed to doctors by pharmaceutical companies), these prescriptions became harder to obtain. Therefore, many dependent individuals turned to heroin and fentanyl, obtained from dealers not doctors, with a disastrous increase in overdose deaths. Then came COVID-19, which isolated vulnerable individuals, keeping them from their families, treatment, and support groups such as Narcotics Anonymous.

I live in a part of America (Appalachia) that has been truly ravaged by the opioid epidemic, as depicted in Macy’s (2018) book, Dopesick: Dealers, Doctors and the Drug Company. I have doctoral students who have done their dissertations on various aspects of the epidemic. For example, Lingerfelt (2022) investigated acute drug withdrawal of pregnant women incarcerated in rural county jails, and Todt (2020) elicited Appalachian nurses’ stories of caring for patients with infective endocarditis that resulted from their use of intravenous drugs. And among my personal social circle, I know parents who lost a child due to fentanyl overdose and friends who are raising the children of their family members who lost custody because of substance use disorder. The epidemic is all around me.

Despite the enormity of this problem, I do find some reasons for hope. I share them with you:

• Several recent books have detailed the corporate malfeasance that enabled the American opioid epidemic, and the subsequent litigation that is resulting in at least some payments to the plaintiffs (Hampton, 2021; Keefe, 2021) For example, in West Virginia a lawsuit against the three largest opioid distributors was settled for $400 million recently (Hoffman, 2022).

• There is increasing acceptance of the Harm Reduction approach to individuals with substance use disorders (National Harm Reduction Coalition, 2021). This holistic approach involves treating people with compassion rather than judgment. Clients are provided social services along with substance use treatment, often medication-assisted treatment. For opioid use disorder, methadone, buprenorphine, and naltrexone are all efficacious.

• Researchers are teasing out which medication-assistant treatment is most effective for which patients. As with most everything, “one size does not fit all” (Kahn et al., 2022). For example, Kahn et al. (2022) studied 35 opioid overdose survivors who were rescued with naloxone and currently receiving care in a harm reduction clinic. Using a social ecological model, the researchers illuminated individual-level, interpersonal-level, community-level, and society-level factors critical to retention in treatment. Particularly interesting were the study participants’ experiences with the different medications for opioid use disorder (MOUD). Some preferred methadone, although the requirement of daily dispensing at a certified clinic was burdensome; others preferred buprenorphine because it could be obtained with a provider prescription, although it did not always prevent craving. The study findings emphasize the need for individually tailored MOUD.

• Macy’s (2022) book provides an inspiring look at community volunteers who are helping individuals with opioid use disorder. These “Appalachian street warriors,” as described by Hoffman (2022, p. 15), “bring clean needles, pizza, condoms, fresh socks and hepatitis C testing kits to ‘trap houses’ (where illegal drugs are used), drive to parking lot encampments and visit holding cells rank with the stench of vomit-filled buckets, where the newly arrested writhe in opioid withdrawal.”

Of course, there is so much more to be done to combat the opioid epidemic. In a 2019 survey, Mauro et al. (2022) found that only 27.8% of people who needed MOUD received it. More substance use treatment programs and MOUD prescribers are needed (Kahn et al., 2022). It is encouraging that more than 80,000 nurses have registered for a training course required for prescribing buprenorphine for opioid use disorder (American Psychiatric Nurses Association, 2022). Macy (2022) advocates for a cabinet level national drug czar, and for directing the funds from opioid litigation to the community organizations that are doing the outreach and intervention in streets and jails.

In this editorial, I have focused solely on the American opioid epidemic, although the journal certainly welcomes and publishes submissions from researchers and clinicians across the globe (e.g., Melin et al., 2017). I invite your contributions to resolution of the ongoing crisis of opioid addiction and tragic deaths from overdose.