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Here is a preview/summary of my talk today at the @NIH conference on 'Social Determinants of Opioid Use: Establishing a Research Agenda' https://apps1.seiservices.com/SocialDeterminants/Agenda.aspx
1. Our problem is bigger than #opioids. Its bigger than drugs altogether. An over focus on specific drugs risks that we’ll impose #policies that target specific substances rather than the #underlyingcauses of use.
2. We regularly hear that #addiction is a #braindisease. But its more than that. Addiction is a social disease.
The U.S. #addiction and #overdose crisis represents a perfect storm of underlying vulnerabilities combined with exposure to highly addictive and lethal substances. And both these factors were driven by breakdowns in our economic, social, and political systems.
3. We know a lot about individual risk factors for #addiction, & seem to understand that #addiction is an outcome of #lifecourse experiences. But places also have life courses, & contexts of many places have changed over the past 4 decades. Drug overdose rates vary across U.S.
The idea that context matters for addiction is not new. @sandrogalea wrote an article on contextual determinants of drug use risk 17 years ago. https://pubmed.ncbi.nlm.nih.gov/14713671/
Yet, most of our interventions target individual behaviors rather than broader social, economic, and political contexts.
Most efforts focus on increasing access to treatment & Narcan. To be sure, these efforts save lives, but they're tourniquets. They don’t prevent addiction. It is inefficient & inhumane to continue relying on tourniquets to solve our problem. We can't Narcan our way out of this!
I suspect that the main reason we default to individual-level #downstream interventions is because they are much easier to implement, and they can be accomplished more quickly than focusing #upstream.
But another big reason is because it’s difficult to do causal research on upstream drivers – especially the causes of the causes of the causes.
4. Yet, we can learn a lot from #descriptive research. So I’m asking that we do not lose the forest for the trees by always treating #causal research as the holy grail.
We can’t randomize 40 years of economic restructuring. And yet there is suggestive evidence that these long-term processes really matter when it comes to drug overdose trends.
By privileging #causal research, we are hamstringing ourselves from advocating for truly transformative #upstream solutions. END
