The American opioid epidemic killed nearly 400,000 people from 1999 to 2017, according to the Centers for Disease Control and Prevention. What caused America’s deadliest drug crisis and what can be done to solve it? Experts from The University of Southern California offer their insights.

How is prescription opioid abuse leading to heroin use?

“Some illicit drugs are geographically specific but opioids are almost everywhere, regardless of where you live. This is also the first time we’ve really had a drug use epidemic that has started through the health care system.

“Many users transitioned to heroin which is more potent and less expensive. Meanwhile, we reacted to the crisis by cutting in half the number of opioid prescriptions. We now know people are moving from opioids to heroin to injection. We missed the opportunity to change that progression, so we need to move more aggressively to reduce opioid abuse and to implement safer venues to consume drugs. The end result will benefit public health.”

Ricky Bluthenthal is the associate dean for social justice and a professor in the Department of Preventive Medicine at the Keck School of Medicine of USC.

How do opioids fit into America’s larger addiction crisis?

“Opioids are part of a larger addiction crisis. You’ve got new forms of commercialized cannabis, a youth nicotine vaping epidemic and a whole generation addicted to their smartphones.

“For some, opioids can produce pain relief without much euphoria. For others, opioids produce powerful euphoria and a sense of calm that can be difficult to cultivate naturally. Coming up with a new medication that’s going to treat pain without getting people addicted — that’s the holy grail.”

Adam Leventhal is a professor of preventive medicine and psychology, and director of the USC Health, Emotion and Addiction Lab.

Where are people getting prescription opioids?

“To curb the opioid epidemic, we need better evidence to understand how and where people are obtaining opioids. For example, one hypothesis has been that the emergency room is a recurrent site of care and that patients could be going from ER to ER to obtain multiple prescriptions to support their addiction. But our research has shown that emergency rooms account for a very small share of all prescribed opioids.

“By understanding how people receive and use opioids we can develop tailored policies that reduce improper opioid use while minimizing negative health outcomes.”

Sarah Axeen is an assistant professor of research at the USC Schaeffer Center for Health Policy & Economics and at the Keck School of Medicine of USC in the Department of Emergency Medicine.

How has ‘survivorship bias’ contributed to overdose deaths?

“Opioid deaths can easily go unnoticed by clinicians. Clinic visits involve patients who are alive and who are either treated with a new opioid prescription or who are returning for a refill. This ‘survivorship bias’ can lead physicians to believe that the opioid crisis is not impacting their own practice, because they deal day-to-day with living patients.

“Doctors need to know what’s happened to their patients, and that someone is paying attention, so they can help avoid deaths while they seek to alleviate pain.”

Jason Doctor is an associate professor and chair of the Department of Health Policy and Management at the USC Price School of Public Policy.

Is litigation the key to holding drug companies responsible?

“Every country faces problems related to products that cause harm from either latent defects or corporate misconduct or both, whether it’s opioids, cigarettes, lead paint, asbestos or even Facebook. In the United States, we tend to rely more on litigation to address these problems — a trend that should continue given the rancor on Capitol Hill.

“While litigation has its strengths in revealing corporate secrets and holding powerful interests accountable, its focus on assigning individual fault can distract from the broader problem of what we should do about the inevitable risks of consumer products to the public well-being.”

Jeb Barnes is a professor of political science at the USC Dornsife College of Letters, Arts and Sciences. 3

Source: Courtesy of University of Southern California