Societal Biases, Institutional Discrimination, and Trends in Opioid Use in the USA


History has demonstrated cyclical trends in opioid use in the USA, alternating between high rates of prescribing driven by compassion and marketing and restrictive prescribing driven by stigma and fear of precipitating addiction and other harms. Two under-recognized yet powerful forces driving these trends are societal biases against individuals who use and are addicted to drugs, as well as a recognized social determinant of health, institutional discrimination. In the context of these influential forces, which are often based on racist and classist ideologies, we examine the history of opioid use in the USA from the 1800s when the vast majority of those addicted to opioids were middle- to upper-class women to the present-day white-washed narrative of the opioid crisis. As the demographics of those affected by opioid use and addiction has started to shift from white communities to communities of color, we cannot allow the preliminary success observed in white communities to obscure rising mortality rates from opioids in black and Latinx communities. To do so, we highlight ways to prevent racist and classist ideologies from further shaping responses towards opioid use. It is important to acknowledge the long history that has influenced responses to opioid use in the USA and take active steps towards promoting a sense of compassion towards all individuals who use and those who are addicted to drugs.

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Dr. Fine receives funding support from an Institutional National Research Services Award (T32 2015D006913), the Ryiochi Sasakawa Fellowship Fund, and the Division of General Medicine at Massachusetts General Hospital.

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Study concept and design: Dr. Fine and Dr. Wakeman. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Dr. Fine. Critical revision of the manuscript for important intellectual content: All authors.

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Correspondence to Danielle R. Fine MD, MSc.

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The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Fine, D.R., Herzberg, D. & Wakeman, S.E. Societal Biases, Institutional Discrimination, and Trends in Opioid Use in the USA. J GEN INTERN MED (2020).

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