Opioid addiction and overdose deaths are up, but what is the core problem? Is it just an opioid epidemic? Or something else?

For some people, the answer still seems to be it’s a question of morals or willpower. For others, it is like a disease, like diabetes, maybe exacerbated by behavior but not a moral failing.

Andrew Kolodny, co-director of opioid policy research at the Brandeis University Heller School for Social Policy and Management, told the Philadelphia Inquirer that it is a problem of addiction, not opioids, citing the three main groups of opioid addicts:

  1. Surviving urban heroin addicts of color, who started on heroin from 1970 to 1990. Now in their 50s through 70s, fentanyl is killing them.
  2. Rural and suburban whites, in their 20s through 40s, who began using prescription opioids — medically then recreationally — then switched to heroin. Fentanyl-laced heroin is killing them, too.
  3. Prescription pill users in their mid-40s through 80s, who never used more than they were prescribed or switched to heroin or fentanyl, but who became addicted to doctor-prescribed opioids for chronic pain. When they die of heart disease or infection, opioids may be a contributing factor, but it goes unreported.

Kolodny says the third group is the largest group, but “is largely invisible and their deaths vastly undercounted.” Also, because many became addicts while using the drugs as they were told, it’s not a drug abuse problem but an addiction problem.

Pharmaceutical companies either underestimated or disregarded the risks of addiction posed by these new opioids. Now, Kolodny says, “When you are prescribing opioids, you are essentially giving them heroin.”

Kolodny says we can stop some future addictions with more careful prescribing, and this is being done, but to take care of the existing addicts, we need to “a new treatment system,” and the billions it will take to build it. Until we do, “Until effective outpatient treatment is easier to access than pain pills, heroin, and fentanyl,” Kolodny says, “overdose deaths will remain at record-high levels.”

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