Abstract
The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis such as interpersonal relationships and the conditions of the community and society that people live in. Despite efforts to tackle the issue, the rates of opioid misuse and non-fatal and fatal overdose remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realised. In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualise the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal and societal levels. Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment.
Highlights
The alarming rise in opioid misuse over the past two and a half decades has resulted in a public health crisis, characterised most prominently by a dramatic increase in drug overdose deaths
The growing opioid misuse issue was recognised as a national public health
We present a social-ecological framework as an important step to conceptualise the complexity of the opioid epidemic
Summary
The alarming rise in opioid misuse over the past two and a half decades has resulted in a public health crisis, characterised most prominently by a dramatic increase in drug overdose deaths. In 2017, approximately 12 million Americans misused opioids [1] and more than 47, 000 people died of opioid overdose [2]. This overdose fatality rate reflects an increase of 345% between 2001 and 2016 [3], with steep annual increases in overdose fatalities since 2015. Interventions that only target a single aspect of the issue, such as restricting opioid supply, will not be sufficient to ameliorate the opioid epidemic. This is further complicated by the rapidly evolving nature of the epidemic. The widespread availability of fentanyl and fentanyl analogues beginning around 2013 has resulted in a steep escalation of overdose death rates, even as other public health indicators (e.g. prescription opioid misuse) have begun to improve
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