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

Abstract

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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References

  1. 1.

    Centers for Disease Control and Prevention. Opioid Data Analysis. 2017. https://www.cdc.gov/drugoverdose/data/analysis.html. Accessed May 30, 2019.

  2. 2.

    Courtwright DT. Dark Paradise: Opiate addiction in America before 1940. Cambridge, MA: Harvard University Press; 1982.

    Google Scholar 

  3. 3.

    Fernandez H, Libby TA. Heroin: Its history, pharmacology, and treatment. 2nd ed. Center City, MN: Hazelden; 2011.

    Google Scholar 

  4. 4.

    Gabriel JM. Restricting the sale of “deadly poisons”. Pharmacists, drug regulation, and narratives of suffering in the Gilded Age. Pharm Hist. 2011;53(1):29-45.

    PubMed  Google Scholar 

  5. 5.

    Herzberg D. White Market Drugs: Big Pharma and The Hidden History of Addiction in America. Chicago University Press; 2020.

  6. 6.

    Acker C. Creating the American junkie: addiction research in the classic era of narcotic control. Baltimore, MD: Johns Hopkins University Press; 2002.

    Google Scholar 

  7. 7.

    Herzberg D. Entitled to Addiction?: Pharmaceuticals, Race, and America’s First Drug War. Bull Hist Med. 2017;91(3):586-623.

    PubMed  PubMed Central  Google Scholar 

  8. 8.

    Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.

    PubMed  Google Scholar 

  9. 9.

    Courtwright DT. The Controlled Substances Act: how a “big tent” reform became a punitive drug law. Drug Alcohol Depend. 2004;76(1):9-15.

    PubMed  Google Scholar 

  10. 10.

    Hansen H, Netherland, J. Is the Prescription Opioid Epidemic a White Problem? Am J Public Health. 2016;106(12):2127-2129.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Palamar JJ, Davies S, Ompad DC, Cleland CM, Weitzman M. Powder Cocaine and Crack Use in the United States: An Examination of Risk for Arrest and Socioeconomic Disparities in Use. Drug Alcohol Depend. 2015;149:108-116.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    Netherland J, Hansen, H. White opioids: Pharmaceutical race and the war on drugs that wasn’t. Biosocieties. 2017;12(2):217-238.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Mauer M. The Crisis of the Young African American Male and the Criminal Justice System. Washington, D.C.: The Sentencing Project; 1999.

    Google Scholar 

  14. 14.

    Mauer M, Huling, T. Young Black Americans and the Criminal Justice System: Five Years Later. Washington, D.C.: The Sentencing Project; 1995.

    Google Scholar 

  15. 15.

    Lembke A. Drug Dealer, MD. Baltimore, MD: Johns Hopkins University Press; 2016.

  16. 16.

    Van Zee A. The promotion and marketing of oxycontin: commercial triumph, public health tragedy. Am J Public Health. 2009;99(2):221-227.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Government Accounting Organization. OxyContin abuse and diversion and efforts to address the problem: highlights of a government report. J Pain Palliat Care Pharmacother. 2004;18(3):109-113.

    Google Scholar 

  18. 18.

    Centers for Disease Control and Prevention. Prescribing Data. 2017. https://www.cdc.gov/drugoverdose/data/prescribing.html. Accessed May 30, 2019.

  19. 19.

    Anderson KO, Green CR, Payne R. Racial and ethnic disparities in pain: causes and consequences of unequal care. The journal of pain : official journal of the American Pain Society. 2009;10(12):1187-1204.

    Google Scholar 

  20. 20.

    Olsen Y, Daumit, Gail L., Ford, Daniel E. Opioid Prescriptions by U.S. Primary Care Physicians From 1992 to 2001. The Journal of Pain. 2006;7(4):225-235.

  21. 21.

    Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. Jama. 2008;299(1):70-78.

    CAS  PubMed  Google Scholar 

  22. 22.

    Friedman J, Kim D, Schneberk T, et al. Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California. JAMA Intern Med. 2019.

  23. 23.

    Gaither JR, Gordon K, Crystal S, Edelman EJ, Kerns RD, Justice AC, Fiellin DA, Becker WC. Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients. Drug Alcohol Depend. 2018;0(0).

  24. 24.

    Christie C, Baker C, Cooper R, Kennedy P, Madras B, Bondi P. The President’s commission on combating drug addiction and the opioid crisis. 2017. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf. Accessed August 29, 2018.

  25. 25.

    Lutz J. Opioid prescribing guidelines: A state-by-state overview. 2018. https://www.affirmhealth.com/blog/opioid-prescribing-guidelines-a-state-by-state-overview. Accessed August 29, 2018.

  26. 26.

    Hansen H, Siegel C, Wanderling J, DiRocco D. Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City. Drug and Alcohol Dependence. 2016;164:14-21.

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    Lagisetty PA, Ross R, Bohnert A, Clay M, Maust DT. Buprenorphine Treatment Divide by Race/Ethnicity and Payment. JAMA Psychiatry. 2019.

  28. 28.

    Wilson N KM, Seth P, Smith H IV, Davis NL. Drug and Opioid-Involved Overdose Deaths — United States, 2017–2018. MMWR Morb Mortal Wkly Rep. 2020;69:290-297.

    PubMed  Google Scholar 

  29. 29.

    Health in Justice Action Lab and Legal Science. Drug Induced Homicide Laws. http://www.pdaps.org/datasets/drug-induced-homicide-1529945480-1549313265-1559075032. Temple University Beasley School of Law. 2019. Accessed February 15, 2020

  30. 30.

    Health in Justice Action Lab. Drug Induced Homicide. https://www.healthinjustice.org/drug-induced-homicide. Northeastern University School of Law. 2018. Accessed February 15, 2020.

  31. 31.

    James K, Jordan A. The Opioid Crisis in Black Communities. J Law Med Ethics. 2018;46(2):404-421.

    PubMed  Google Scholar 

  32. 32.

    Tesema L, Marshall J, Hathaway R, et al. Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors. Subst Abus. 2018;39(4):434-440.

    PubMed  Google Scholar 

  33. 33.

    Haffajee RL, Bohnert ASB, Lagisetty PA. Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment. Am J Prev Med. 2018;54(6 Suppl 3):S230-S242.

    PubMed  PubMed Central  Google Scholar 

  34. 34.

    Finley EP, Garcia A, Rosen K, McGeary D, Pugh MJ, Potter JS. Evaluating the impact of prescription drug monitoring program implementation: a scoping review. BMC Health Serv Res. 2017;17(1):420.

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Bao Y, Pan Y, Taylor A, et al. Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians. Health Aff (Millwood). 2016;35(6):1045-1051.

    PubMed  PubMed Central  Google Scholar 

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Funding

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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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). https://doi.org/10.1007/s11606-020-05974-0

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